Child-Pugh、MELD、MELD-Na和iMELD评分对乙型肝炎肝硬化患者3个月和1年生存率的评估价值  

Predictive Value of Child-Pugh,MELD,MELD-Na and iMELD Score in Assessing 3-Month and 1-Year Survival Rates in Patients With Hepatitis B Cirrhosis

作　　者：张志华 巩晓欢 韩永荣 蒋青风 

机构地区：[1]青海西宁富康医院消化内科,810028 [2]青海西宁富康医院功能科,810028

出　　处：《胃肠病学》2018年第1期24-28,共5页Chinese Journal of Gastroenterology

摘　　要：背景:肝硬化患者预后的评估系统主要包括Child-Pugh、终末期肝病评估模型(MELD)及其衍生评估系统等,为患者预后的评估提供了重要的指导价值,但其价值仍需更多的临床实践来证实。目的:探讨Child-Pugh、MELD、MELD-Na和i MELD评分对乙型肝炎肝硬化患者3个月和1年生存率的评估价值。方法:选取2012年1月—2016年12月西宁富康医院的乙型肝炎肝硬化患者236例,评估3个月和1年的生存率,计算各组Child-Pugh、MELD、MELD-Na和i MELD评分,以ROC曲线下面积(AUC)评估各评分预测乙型肝炎肝硬化患者3个月和1年生存率的准确性。结果:在236例乙型肝炎肝硬化患者中,随访3个月时死亡43例,随访1年时死亡71例,死亡原因为上消化道出血、肝性脑病、肝肾综合征、自发性腹膜炎和感染。3个月和1年生存组的Child-Pugh、MELD、MELD-Na和i MELD评分均显著低于相应死亡组(P<0.05或0.01)。Child-Pugh、MELD、MELD-Na和i MELD评分预测乙型肝炎肝硬化患者3个月预后的AUC分别为0.791、0.818、0.853和0.897,四组相比差异有统计学意义(P<0.05)。Child-Pugh、MELD、MELD-Na和i MELD评分预测乙型肝炎肝硬化患者1年预后的AUC分别为0.772、0.832、0.861和0.906,四组相比差异有统计学意义(P<0.05)。Child-Pugh、MELD、MELD-Na和i MELD评分判断乙型肝炎肝硬化患者3个月和1年预后的准确性分别为70.1%、79.8%、86.2%和89.3%。结论:Child-Pugh、MELD、MELD-Na和i MELD评分对乙型肝炎肝硬化患者3个月和1年生存率的评估准确性较高,值得临床推广应用。Background： The evaluation system for predicting prognosis in patients with liver cirrhosis includes Child-Pugh,model for end-stage liver disease（ MELD） and its derivative system,which provides important guiding value for evaluating the prognosis. However,its value still needs to be verified by further clinical studies. Aims： To investigate the predictive value of Child-Pugh,MELD,MELD-Na and i MELD score in assessing 3-month and 1-year survival rates in patients with hepatitis B cirrhosis. Methods： A total of 236 patients with hepatitis B cirrhosis from January 2012 to December 2016 at Fukang Hospital were enrolled. The 3-month and 1-year survival rates of patients with hepatitis B cirrhosis were determined,and Child-Pugh,MELD,MELD-Na and i MELD score were calculated. Area under ROC curve（ AUC） was used to evaluate the accuracy of Child-Pugh,MELD,MELD-Na and i MELD score for predicting 3-month and 1-year survival rates. Results： Of the 236 patients with hepatitis B cirrhosis,43 died within 3 months,and 71 died within 1 year.The causes of death were upper gastrointestinal bleeding,hepatic encephalopathy,hepatorenal syndrome,spontaneous peritonitis and infection. Child-Pugh,MELD,MELD-Na and i MELD score in 3-months and 1-year survival group were significantly decreased than those in death group（ P 0. 05 or 0. 01）. AUC of Child-Pugh,MELD,MELD-Na and i MELD score for predicting 3-month survival were 0. 791,0. 818,0. 853 and 0. 897,respectively,and the difference among the four groups was significant（ P 0. 05）. AUC of Child-Pugh,MELD,MELD-Na and i MELD score for predicting 1-year survival were 0. 772,0. 832,0. 861 and 0. 906,respectively,and the difference among the four groups was significant（ P 0. 05）. The accuracy of Child-Pugh,MELD,MELD-Na and i MELD score for predicting 3-month and 1-year survival were 70. 1%,79. 8%,86. 2% and 89. 3%,respectively. Conclusions： The accuracy of Child-Pugh,MELD,MELD-Na and i MELD score for assessing 3-month and 1-year survival rates of patients with hep

关 键 词：乙型肝炎 肝硬化 存活率 评分系统 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]