终末期肝病模型评分及MELD-Na评分评估肝衰竭肝移植短期预后的对比观察  

Comparative study of the model for end-stage liver disease and MELD-Na scores in evaluating the short-term prognosis of liver transplantation in patients with liver failure

作　　者：陈永泰 许蜂蜂 王明 刘建勇 蔡秋程 杨芳 陈永标 江艺 Chen Yongtai;Xu Fengfeng;Wang Ming

机构地区：[1]福建医科大学福总临床医学院(900医院),福州350025 [2]厦门大学附属东方医院(900医院),福州350025 [3]中国人民解放军联勤保障部队第九〇〇医院肝胆外科,福州350025

出　　处：《中华普通外科学文献（电子版）》2020年第3期195-199,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：福建省自然科学基金面上项目(2018J01351,2019J01533);军区医学重大专项课题(14ZX22)。

摘　　要：目的探讨终末期肝病模型(model for end-stage liver disease,MELD)评分与MELD-Na评分对肝衰竭患者行肝移植短期预后(3个月)的临床价值。方法收集从2012年1月至2019年12月在中国人民解放军联勤保障部队第九〇〇医院因肝衰竭行肝移植的86例患者的术前及术中临床资料。采用受试者工作特征(ROC)曲线评价MELD和MELD-Na评分对短期预后的鉴别能力并根据Youden指数确定最佳的cut-off值。结果 86例患者中早期死亡21例(24.4%)。术前MELD评分(P=0.001)和术中输血量(P<0.001)是肝衰竭行肝移植患者早期死亡的独立危险因素。MELD和MELD-Na评分预测肝移植术后早期死亡的ROC曲线下面积分别为0.696和0.686,差异无统计学意义(P=0.677)。MELD≥24.3组、MELD<24.3组的早期生存率分别为51.7%(15/29)和87.7%(50/57),MELD-Na≥25.7组、MELD<25.7组的早期生存率分别为54.9%(17/31)和87.3%(48/55),差异均有统计学意义(P<0.001),MELD评分与MELD-Na评分升高时,早期生存率降低。结论在预测肝衰竭行肝移植患者早期预后方面,MELD评分与MELD-Na评分预测能力无明显差异。MELD评分与术中输血量是患者早期死亡的独立危险因素。Objective To discuss clinical value of the model for end-stage liver disease (MELD) and MELD-Na scores for predicting the short-term prognosis of liver transplantation in patients with liver failure.Methods The preoperative and intraoperative clinical data of 86 liver failure patients who underwent liver transplantation in the 900 Hospital of the Joint Logistics Team from January 2012 to December 2019 were collected in this retrospective analysis.Multivariate analysis were used to determine the risk factors of early death (within 3 months) after liver transplantation.The distinguishing ability of MELD and MELD-Na scores for early prognosis was evaluated by the receiver operating characteristic (ROC) curve,and the Youden index was used to determine the best cut-off value.Results Of the 86 patients,there were 21 patients (24.4%) of early death in the short-term after liver transplantation.Preoperative MELD score (P=0.001) and intraoperative blood transfusion volume (P<0.001) were independent risk factors of liver transplantation in patients with liver failure.The AUC of MELD and MELD-Na scores for predicting the short-term prognosis were 0.696 and 0.686 respectively,with no statistical significancebetween two AUCs (P=0.677).The early survival rates of MELD≥24.3 group and MELD<24.3 group were 51.7% (15/29) and 87.7% (50/57),respectively (P<0.001).The early survival rates of MELD-Na≥25.7 groupand MELD-Na < 25.7 group were 54.9% (17/31) and 87.3% (48/55),respectively (both P<0.001).When the MELD score and MELD-Na score increased,the mortality rate increased.Conclusion In predicting the early prognosis of liver failure patients undergoing liver transplantation,there is no significant difference between the MELD score and the MELD-Na score in predicting ability.MELD score and intraoperative blood transfusion are independent risk factors for early death.

关 键 词：肝移植 肝衰竭 预后 终末期肝病模型 MELD-Na评分 

分 类 号：R657.3[医药卫生—外科学]