摘要
目的:评估终末期肝病模型(model for end stage liver disease, MELD)对肝硬化患者短期和中期生存预测的价值. 方法:对199例肝硬化患者的生存率进行回顾性评估,随访1 a.计算每例患者入院当天的MELD评分与Child-Pugh评分,以受试者特征曲线(ROC)下的面积衡量各评分系统预测患者预后的能力,依据ROC曲线截断值绘制Kaplan-Meier 生存曲线,分析MELD评分与Child-Pugh评分的相关性. 结果:随访3 mo内有37例患者死亡,死亡组MELD与Child-Pugh评分(23.4±9.90,10.8±2.29)与生存组(14.3±4.66,8.68 ±2.21)比较有显著差异(P<0.001);随访第1 a 内有59例患者死亡,死亡组MELD与Child-Pugh评分(20.3 ±9.31,10.3±2.32)与生存组(14.0 ±5.11,8.43±2.23)比较有显著差异(P<0.001);MELD评分与Child-Pugh 评分对3mo预后评估的ROC曲线面积分别为0.826,0.745 (P<0.05),对1 a预后评估的ROC曲线下的面积分别为0.758,0.724(P>0.05);生存分析表明两评分系统在截断值均可有效地分辨3mo或1a内可能生存及死亡的患者(P<0.001); MELD评分与Child-Pugh评分呈显著相关(r=0.69,P<0.001). 结论:MELD评分Child-Pugh评分均可有效地预测肝硬化患者的短期和中期预后,MELD评分短期评估效率优于Child-Pugh分级,能更准确反应病情危急程度,值得临床应用.
AIM: To evaluate the short- and medium-term prognosis of liver cirrhotic patients by using the model for end-stage liver disease (MELD). METHODS: The data of 199 cirrhotic patients were analyzed with a cohort method retrospectively and the follow-up period was at least one year. Both MELD score and Child-Pugh score were computed for each patient according to the original formula on admission day. Area under of receiver operating characteristic curve (ROC) was used to compare the value of MELD score with Child-Pugh's for predicting the prognosis. Kaplan-Meier survival curves were made using the cut-offs identified by means of ROC. MELD values were correlated with Child-Pugh scores. RESULTS: Thirty-seven patients died in three months, MELD scores and Child-Pugh scores for non-survivors (23.4±9.90,10.8±2.29) were higher than those for survivors (14.3± 4.66, 8.68±2.21) significantly (P<0.001). Fifty-nine patients died within the first year, MELD scores and Child-Pugh scores for non-survivors (20.3±9.31,10.3±2.32) were higher than those for survivors (14.0±5.11, 8.43±2.23) significantly (P<0.001). Area under the ROC of MELD for 3 months (0.826) was significantly (P<0.05) different from that of Child-Pugh (0.745), but there was no difference in area under the ROC for 1 year (P>0.05) between MELD value (0.758) and Child-Pugh score (0.724). Survival curves showed both MELD and Child-Pugh scores was clearly dis- criminated between patients who survived and those who died in short term as well as in the medium term (P<0.001). MELD grading system showed significant correlation with Child-Pugh scores (r=0.69, P<0.001). CONCLUSION: MELD grading is an objective predictive system for both short- and medium-term survival. It is more efficient than Child-Pugh score for short-term prognosis and is worth using in clinical setting.
出处
《世界华人消化杂志》
CAS
2004年第5期1159-1162,共4页
World Chinese Journal of Digestology
