终末期肝病模型联合血清钠（MELD-Na）评分预测重型肝炎肝移植术后并发症等级的价值  

The value of MELD-Na score in predicting complication severity grades after orthotopic liver trans-plantation for severe hepatitis

作　　者：张其坤[1] 王孟龙[1] 卢实春[3] 武聚山[1] 郭庆良[1] 林栋栋[1] 张振[1] 张海涛[1] 刘晋宁[2] 王鑫[2] 王璐[2] 

机构地区：[1]首都医科大学附属北京佑安医院普外科,100069 [2]首都医科大学附属北京佑安医院外科ICU,100069 [3]中国人民解放军总医院肝胆外科

出　　处：《中华肝胆外科杂志》2017年第12期793-798,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨术前终末期肝病模型联合血清钠（MELD—Na）评分对重型肝炎肝移植术后并发症等级的预测价值。方法回顾性分析2004年8月至2014年9月159例重型肝炎肝移植患者资料。应用Accordion分级系统，对移植术后并发症进行分级，1级-轻度，2级一中度，3级至5级一重度，6级-死亡。通过受试者工作特征曲线（ROC）及曲线下面积（AUC）分析MELD-Na评分对肝移植术后重度并发症及死亡的预测价值。通过相关分析和多因素分析探讨MLED—Na评分与重型肝炎肝移植术后不同等级并发症的关系。结果重型肝炎肝移植术后各级并发症的发生率分别为：2级43例（27．0％，MELD—Na评分27．3±7．4），3级41例（25．8％，MELD—Na评分32．7±12．4），4级31例（19．5％，MELD—Na评分34．3±12．1），5级9例（5．7％，MELD—Na评分30．7±12．3），6级35例（22％，MELD-Na评分37．1-610．4），无1级并发症。MELD—Na预测肝移植术后重度并发症及死亡的AUC分别为0．631（P〈0．05；95％CI，0．533～0．728）、0．670（P〈0．05；95％CI，0．574～0．766）。Spearman相关分析显示，MELD—Na评分与肝移植术后并发症严重程度显著相关（相关系数0．297，P〈0．01）。多因素分析显示，MELD—Na评分≥25是肝移植术后重度并发症的危险因素（P〈0．05，OR：4．35），MELD-Na〉35是术后死亡的危险因素（P〈0．01，HR=4．72）。结论MELD—Na评分与Accordion并发症分级相关性较好，可以有效预测重型肝炎肝移植术后并发症等级。Objective To study the value of preoperative MiLD-Na score （Model for End-Stage Liver Disease-Sodium） in predicting complication severity grades after liver transplantation （LT） for severe hepatitis. Methods Patients who underwent LT for severe hepatitis between August 1,2004, and Septem- ber 1, 2014 were retrospectively studied. The Accordion severity grading system was used to classify the complication severity grades after LT. The grades were classified as grade 1 （mild）, grade 2 （moderate）, grade 3-5 （severe）, and grade 6 （death）. The area under the curve （AUC） was calculated by plotting the receiver operating characteristic curve （ROC） to evaluate the predictive accuracy of the MELD-Na score for the severe and mortality grades after LT. The correlation between the MELD-Na score with the complication severity grade after LT was studied by the Spearman correlation and by multivariate analysis. Results The incidences of postoperative complications for the 159 patients in this study were： grade 2 in 43 patients （27.0% , MELD-Na score 27.3 ±7.4） , grade 3 in 41 patients （25.8% , MELD-Na score 32.7 ± 12.4） , grade 4 in 31 patients （ 19.5% , MELD-Na score 34.3 ± 12.1）, grade 5 in 9 patients （5.7%, MELD-Na score 30.7 ± 12.3） , grade 6 in 35 patients （22% , MELD-Na score 37.1 ± 10.4）. There was no grade 1 patient. The AUC of the MELD-Na score for the severe and death groups were 0.631 （P 〈0.05 ; 95% C1, 0.533 ± 0. 728） and 0. 670 （P 〈 0.05 ; 95 % CI, O. 574 N 0. 766） respectively. The MELD-Na score was significantly correlated with the Accordion severity grade （ rho 0. 297, P 〈 0. 01 ） on Spearman correlationanalysis. Multivariate analysis showed that a MELD-Na score 〉 25 was a risk factor of postoperative severe grade complication （P 〈 0. 05, OR = 4.35）, a MELD-Na score 〉35 was a risk factor of postoperative mortali- ty （P 〈 0. 01, HR = 4.72）. Conclusion The MELD-Na score was significantly correlated with the Accordion seve

关 键 词：MELD-Na评分 重型肝炎 肝移植 Accordion分级系统 并发症 

分 类 号：R657.3[医药卫生—外科学]