不同评分对终末期肝病患者肝移植预后的预测作用  

Prediction value of different scoring models in predicting the prognosis of patients with end-stage liver disease undergoing liver transplantation

作　　者：尤丽英 解琴 李立[2] You Liying;Xie Qin;Li Li(Department of Family Medicine,Affiliated Calmette Hospital,Kunming Medical University,First Municipal People's Hospital,Kunming 650051,China;Department of Hepato-Biliary-Pancreatic&Vascular Surgery,Affiliated Calmette Hospital,Kunming Medical University,First Municipal People's Hospital,Kunming 650051,China)

机构地区：[1]昆明医科大学附属甘美医院,昆明市第一人民医院全科医学科,昆明650051 [2]昆明市第一人民医院肝胆胰血管外科,昆明650051

出　　处：《中华器官移植杂志》2022年第10期585-591,共7页Chinese Journal of Organ Transplantation

基　　金：云南省器官移植开放中心项目(2020SYZ-Z-006)。

摘　　要：目的探讨Child-Turcotte-Pugh(CTP)评分、终末期肝病模型(Model for End-stage of Liver Disease,MELD)、MELD联合血清钠(MELD-Na)评分、白蛋白-胆红素(albumin-bilirubin,ALBI)评分及中性粒细胞-淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)等不同预后评估评分系统对于终末期肝病(end stage of liver disease,ESLD)肝移植受者术后短期及长期预后的预测价值。方法回顾性分析2015年8月至2017年2月在昆明医科大学附属甘美医院接受原位肝移植手术125例ESLD受者的术前基本资料及术后5年内的生存状况。利用ROC曲线来评估5种评估评分系统对术后短期(术后3个月)和长期预后(术后5年)的预测能力,根据约登指数确定截断值,并通过截断值绘制Kaplan-Meier生存曲线,截断值上、下的生存率的差异分析用Log-rank检验检验。结果125例受者肝移植术后5年存活率为69.6%(87/125),病死率为30.4%(38/125);术后3个月内病死率为12.8%(16/125)。CTP评分、MELD评分、MELD-Na评分、ALBI评分及NLR预测短期预后的ROC曲线下面积值分别为0.787、0.767、0.875、0.801、0.837,预测长期预后的ROC曲线下面积分别为0.744、0.744、0.817、0.778、0.815,De Long法检验显示MELD-Na评分预测短期预后的能力与其余4种模型比较差异有统计学意义(P<0.05),预测长期预后能力比较,差异均无统计学意义(P>0.05)。MELD、MELD-Na评分对应的肝移植术后3个月和5年的截断值分别为20.09比16.44和23.63比17.79,以此截断值区分的3个月和5年的生存率分别为90.9%比50.0%、86.5%比45.1%和99.3%比55.6%、93.9%比42.4%,各组间生存率比较,差异均有统计学意义(P均<0.05)。结论MELD-Na评分对肝移植短期预后的预测价值优于CTP、MELD评分、ALBI评分、NLR,但在长期预后预测方面并无明显优势;受者术前MELD/MELD-Na评分升高者,术后病死率上升。Objective To explore the values of CTP score,MELD score,MELD-Na score,ALBI score and neutrophil-lymphocyte ratio(NLR)in predicting the short/long-term prognoses of patients with end-stage liver disease(ESLD)after liver transplantation(LT).Methods From August 2015 to February 2017,basic preoperative profiles and survival status were retrospectively reviewed for 125 ESLD patients undergoing orthotopic LT.Receiver operating characteristic(ROC)curve was utilized for evaluating the capability of five scores for predicting short-term(3 months post-operation)and long-term(5 years post-operation)prognoses.Cut-off value was determined according to the Jordan index and Kaplan-Meier survival curve plotted.The difference in survival rate between upper and lower cut-off values was analyzed by Log-rank test.Results Five-year survival rate post-LT was 69.6%(87/125),case fatality rate 30.4%(38/125)and case fatality rate within 3 months post-operation 12.8%(16/125).The AUROC values of CTP score,MELD score,MELD-Na score,ALBI score and NLR for short-term prognosis were 0.787,0.767,0.875,0.801 and 0.837 and AUROC values for predicting long-term prognosis 0.744,0.744,0.817,0.778 and 0.815 respectively.De Long test indicated that the capabilities of MELD-Na score for predicting short-term prognosis varied significantly from that of another four models(P<0.05).No significant difference existed in capability of predicting long-term prognosis(P>0.05).The cut-off values of MELD and MELD-Na scores at Month 3/60 post-LT were 20.09 vs.16.44 and 23.63 vs.17.79.The survival rates of upper and lower groups distinguished by cut-off values were 90.9%vs.50.0%,86.5%vs.45.1%and 99.3%vs.55.6%,93.9%vs.42.4%respectively.The differences were statistically significant(P<0.05).Conclusions Predictive value of MELD-Na score for short-term prognosis of LT is superior to than that of CTP,MELD score,ALBI score or NLR.However,it offers no significant superiority in predicting long-term prognoses.With a rising preoperative MELD/MELD-Na score,postoperative mortal

关 键 词：肝移植 终末期肝病 评分模型 预后 

分 类 号：R575[医药卫生—消化系统]