病毒性肝炎肝硬化失代偿期患者评分系统对短期预后的分析  

Assessment of score systems for short-term prognosis of patients with hepatitis virus-related decompensated cirrhosis

作　　者：吴吉圆 张冬琴[1] 刘菲菲[1] 焦方舟 王鲁文 龚作炯[1] 

机构地区：[1]武汉大学人民医院感染科,武汉430060

出　　处：《中国肝脏病杂志（电子版）》2017年第1期54-60,共7页Chinese Journal of Liver Diseases：Electronic Version

摘　　要：目的评估终末期肝病模型(MELD)评分、Child-Turcotte-Pugh(CTP)分级和终末期肝病模型钠(MELDNa)评分对肝硬化失代偿期患者出院后3个月病死率的预测价值。方法研究对象为2014年1月1日至2015年10月1日入住武汉大学人民医院的120例单纯病毒性肝炎肝硬化失代偿期患者。收集所有患者的临床资料,分别计算MELD评分、CTP评分和MELDNa评分,统计研究对象出院后3个月内病死率并评估上述评分系统预测肝硬化失代偿期患者短期预后的价值。结果 3个月病死与生存患者的MELD评分、CTP评分和MELDNa评分差异有统计学意义(z值分别为-6.532、-6.674、-6.399,P均<0.001),MELDNa评分模型预测效果最佳(AUROC=0.882,P<0.001)。结论 MELD评分、CTP评分和MELDNa评分都能准确评估病毒性肝炎肝硬化失代偿期患者的短期(3个月)预后,MELDNa评分模型能够改进预测效能,但仍需大规模临床研究予以证实。Objectives To assess the prediction value of MELD, Child-Turcotte-Pugh （CTP） and MELDNa on the mortality of patients with virus-related decompensated cirrhosis during 3 months after discharging from hospital. Methods Total of 120 patients with virus decompensated cirrhosis in Department of Infectious Diseases of Renmin Hospital of Wuhan University from January 12014 to October 12015 were involved in this study. The mortality during 3 months was obtained and scores of MELD, CTP and MELDNa were calculated, respectively. The predictive ability of these scoring systems on the early-term outcome in patients with decompensated cirrhosis were also assessed. Results MELD, CTP and MELDNa scores systems were significantly different between the non-survival and survival group （z = -6.532, -6.674, -6.399; P 〈0.001）. MELDNa was the most excellent predictor of 3 months mortality （AUROC = 0.882,P 〈 0.001）Conclusions MELD, MELDNa and Child-Turcotte-Pugh score systems were reliable predictors of shortterm outcome in patients with virus-related decompensated cirrhosis. Compared with MELD and CTP classification, MELDNa could improve predictive ability of early-term mortality. However, data still needs to be confirmed by large scale trials.

关 键 词：病毒性肝炎 肝硬化 短期预后 MELD评分 Child-Turcotte-Pugh分级 MELDNa评分 

分 类 号：R512.6[医药卫生—内科学] R575.2[医药卫生—临床医学]