四种基于MELD的评分系统对慢加急性乙型肝炎肝衰竭患者短期生存的预测价值分析  

Prediction of short-term survival by four scoring systems based on MELD in patients with acute-on-chronic hepatitis B-induced liver failure

作　　者：李磊[1] 胡辉 郑晓玮 江守伟[1] 沈强[1] Li Lei;Hu Hui;Zheng Xiaowei(Department of Infectious Disease, Provincial Hospital, Hefei 230001, Anhui Province, China)

机构地区：[1]安徽省立医院感染病科,合肥市230001

出　　处：《实用肝脏病杂志》2018年第3期417-420,共4页Journal of Practical Hepatology

基　　金：安徽省科技厅自然科学基金资助项目(编号:1208085QH147)

摘　　要：目的比较终末期肝病模型(MELD)及其衍生模型iMELD、MELD-Na和MESO对乙型肝炎相关性慢加急性肝衰竭(HBV-ACLF)患者12周生存预后的评估价值。方法按照现行中国肝衰竭诊治指南的诊断标准纳入67例HBV-ACLF患者,收集患者诊断成立时的相关实验室检测指标,分别计算MELD、iMELD、MELD-Na和MESO模型评分,应用Med Calc 15.8软件分析比较受试者工作特征曲线(ROC),确定MELD及其衍生评分系统对ACLF患者12周死亡风险预测的最佳截断点和约登指数,以评价不同评分预测ACLF患者短期生存的效能。结果在治疗12周内,在67例HBV-ACLF患者中,死亡45例(67.2%);入组时,生存组MELD、iMELD、MELD-Na和MESO评分分别为(22.12±3.24)、(41.59±5.30)、(22.55±4.07)和(1.64±0.24),显著低于死亡组【分别为(30.47±9.01)、(51.88±11.09)、(32.35±11.58)和(2.28±0.70),P<0.01】;MELD、i MELD、MELD-Na和MESO模型预测患者12周生存的ROC曲线下面积分别为0.814、0.802、0.806和0.817,其最佳截断点分别为22.70、47.76、22.16和1.69,约登指数分别为0.5040、0.5535、0.4808和0.4818,提示四种模型的预测效能比较,均无显著性差异(P>0.05)。结论MELD、i MELD、MELD-Na和MESO四种评分系统对于HBV-ACLF患者12周生存情况均具有良好的预测能力,可根据实际情况,选择应用。Objective To validate the prediction of short-term survival by four scoring systems based onmodels for end-stage liver disease（MELD）in patients with acute-on-chronic hepatitis B-induced liver failure（HBV -ACLF） . Methods 67 patients with HBV -ACLF were enrolled in this study between April 2015 andOctober 2017. The clinical parameters were collected for calculation of MELD, iMELD, MELD -Na and MESOscores, respectively. The predictive efficacy on forecasting survival of patients with HBV -ACLF by the fourscoring systems was analyzed by receiver operating characteristic curve（ROC）supported by MedCalc15.8 software.Results 45（67.2%）out of 67 patients with HBV-ACLF died within 12 weeks; the scores of MELD, iMELD,MELD-Na and MESO models at presentation in survival group were （22.12±3.24） , （41.59±5.30） , （22.55±4.07）and（1.64±0.24） , much lower than （30.47±9.01） , （51.88±11.09） , （32.35±11.58）and（2.28±0.70） , respectively, P〈0.01in the dead group; the area under the ROC curve（AUC）in forecasting the survival of patients with HBV-ACLF by the four models were 0.814, 0.802, 0.806 and 0.817 respectively, the cut -off -values were22.70, 47.76, 22.16 and 1.69, and the Jordan index were 0.5040, 0.5535, 0.4808 and 0.4818, respectively, suggestingno significant differences between them （P〉0.05） . Conclusion The four scoring systems base on MELD havegood predictive efficacy on forecasting 12 weeks’survival in patients with HBV-ACLF, which hints they might beapplied in clinical practice.

关 键 词：慢加急性肝衰竭 乙型肝炎 终末期肝病模型 预后 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]