四种评分系统对失代偿期肝硬化患者短期预后的评价

摘要

目的 比较终末期肝病模型(MELD)评分系统、MELD-Na评分系统、MESO指数评分系统以及iMELD评分系统对失代偿期肝硬化患者短期(3个月)预后的预测价值.方法 选择2008年10月至2011年10月云南省第三人民医院消化内科的失代偿期肝硬化患者230例,分别计算每例患者人院时的MELD、MELD-Na、MESO及iMELD分值,采用Kaplan-Meier法比较生存率,运用受试者工作特征曲线(ROC)及曲线下面积(AUC)比较四种评分系统判断失代偿期肝硬化患者短期预后的价值.结果 230例失代偿期肝硬化患者,随访3个月内死亡68例,生存组MELD、MELD-Na、MESO及iMELD评分分别为22.34±4.36、24.26±5.45、1.62±0.23和37.59±6.97,死亡组MELD、MELD-Na、MESO及iMELD评分分别为27.76±5.28、30.11±6.19、2.05±0.18和46.65±7.01.死亡组与生存组的MELD、MELD-Na、MESO及iMELD评分比较,差异均有统计学意义(P=0.005,0.005,0.000,0.003).MELD、MELDNa、MESO及iMELD评分系统在判断230例失代偿期肝硬化患者3个月生存时间的ROC曲线下面积分别为0.852、0.856、0.857和0.847,95％可信区间分别为0.759～0.897、0.754～0,893、0.760～0.898、0.781～0.906,四种评分系统比较差异无统计学意义(P＞0.05).结论 MELD、MELD-Na、MESO及iMELD评分系统对失代偿期肝硬化患者短期预后均有一定的预测价值,但四种评分系统比较差异无统计学意义,较准确的预后判断仍需要结合临床实际.%Objective To compare the short-term predicting values for prognosis of patients with derompensated liver cirrhosis through the model for end-stage liver disease (MELD) scoring system, MELI>Na scoring system, MESO exponent scoring system and iMELD scoring system. Methods Two hundred and thirty hospitalized patients with de-compensated liver cirrhosis in gastroenterology department of the Third People's Hospital in Yunnan Province from October 2008 to October 2011 were enrolled in the study. MELD, MEI.D-Na, MESO and iMELD score of each patient were calculated at the time of admission to hospital respectively. Kaplan-Meier method was adopted to compare their survival rates. Receiver characteristic curve (ROC) and area under the curve (AUC) were used to compare the short-term prognostic values of patients with decompensated liver cirrhosis through the four different scoring systems. Results Sixty eight patients of two hundred and thirty patients died within the three months. MELD, MEI.D-Na, MESO and iMELD scores of the survival group were 22. 34 + 4. 36, 24. 26±5. 45, 1. 62 ±0. 23 and 37. 59 ±6. 97 respectively, and those of the death group were 27. 76±5. 28, 30. 11 ±6. 19, 2. 05 ±0. 18 and 46. 65±7. 01 respectively. The scores of MELD, MELD-Na, MESO and iMELD scoring system in the dead group were higher than those in the survival group. The comparison of the four scoring ystems between the two groups had statistical significance (P = 0. 005, 0. 005, 0. 000, 0. 003). The areas under ROC curves of MELD, MELD-Na, MESO and iMELD scoring systems were 0. 852, 0. 856, 0.857 and 0. 847 respectively and their 95 % confidence intervals were 0. 7590. 897, 0. 754-0. 893, 0. 760-0. 898 and 0. 781-0. 906. Conclusion MELD, MELD-Na, MESO and iMELD scoring systems all had prognostic values in patients with decompensated liver cirrhosis. However, there was no significantly statistical differences of prognosis values among the four sconing systems. More accurate determination of prognosis still needs combination with clinical practice and experience.