MELD、Child-Pugh、SOFA评分系统在血浆置换治疗慢加急性肝衰竭中的应用  

Comparison of MELD, ChildPugh classification, and SOFA for prediction of short-term prognosis in patients with acute-on-chronic liver failure treated with plasm exchange

作　　者：杨黎冰 仝静[1] 祖晓满 王春峰[1] Li-Bing Yang Jing Tong Xiao-Man Zu Chun- Feng Wang(Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, He＇nan Province, Chin)

机构地区：[1]郑州大学第一附属医院消化内二科,河南省郑州市450052

出　　处：《世界华人消化杂志》2017年第21期1963-1967,共5页World Chinese Journal of Digestology

基　　金：河南省基础与前沿技术研究计划基金资助项目;No.142300410036;河南省医学科技攻关计划基金资助项目;No.201402009~~

摘　　要：目的探讨终末期肝病模型(model for end-stage liver diease,MELD)、Child-Pugh分级、序贯器官衰竭估计(sequential organ failure estimation,SOFA)三种评分系统在血浆置换治疗慢加急性肝衰竭中的应用.方法选取郑州大学第一附属医院2015-01/2016-12慢加急性肝衰竭患者83例,其中血浆置换组39例,非血浆置换组44例,在入院24 h内进行MELD、Child-Pugh、SOFA评分,并随访12 wk.应用受试者工作特征曲线(receiver operator characteristic curve,ROC)下面积(area under the curve,AUC)判断三个评分模型的预测能力.结果在12 wk末,PE治疗组患者病死率为30.8%,非PE治疗组患者病死率为65.9%,差异具有统计学意义(χ~2=10.213,P=0.002).在PE治疗组,三种模型AUC分别为0.852、0.836、0.708,两两相比差异无统计学意义;三种模型预测正确率为62.5%、58.8%、50.0%,两两相比差异无统计学意义;在非PE治疗组,三种模型AUC分别为0.809、0.768、0.699,两两相比差异无统计学意义;三种模型预测正确率为85.7%、85.7%、84.2%,两两相比差异无统计学意义.结论三种评分系统在血浆置换治疗慢加急性肝衰竭中,对患者短期预后均有较好的预测价值.AIM To compare the performance of model for end-stage liver disease（MELD）, Child-Pugh classification, and sequential organ failure assessment（SOFA） in predicting short-term prognosis in patients with acute-on-chronic liver failure treated with plasm exchange.METHODS Eighty-three patients with acute-on-chronic liver failure treated from January 2015 to December 2016 at the First Affiliated Hospital of Zhengzhou University, including 39 treated with plasma replacement and 44 treated with non-plasma replacement, were included in this study. MELD, Child-Pugh classification, and SOFA were performed within 24 h of admission. The patients were followed for 12 wk. The areas under the receiver operating characteristic curves（AUC） of the three systems in predicting short-term prognosis were calculated to evaluate their predictive ability.RESULTS At the end of 12 wk, the mortality rate was 30.8%（12/39） in the plasma replacement group and 65.9%（29/44） in the non-plasmareplacement group, and there was a significant difference between the two groups（χ2 =10.213, P = 0.002）. In the PE group, the AUCs of MELD, Child-Pugh classification, and SOFA were 0.852, 0.836, and 0.708, respectively, and there was no significant difference between any two of the three groups; the accuracy rates were 62.5%, 58.8%, and 50.0%, respectively,and there was also no significant difference between them. In the non-PE group, the AUCs of MELD, Child-Pugh classification, and SOFA were 0.809, 0.768, and 0.699, respectively, and there was no significant difference between any two of the three groups; the accuracy rates were 85.7%, 85.7%, and 84.2%, respectively,and there was also no significant difference between them.CONCLUSION The three models have comparable performance in predicting short-term prognosis in patients with acute-on-chronic liver failure treated with plasm exchange.

关 键 词：血浆置换 肝衰竭 预测模型 

分 类 号：R575.3[医药卫生—消化系统]