失代偿期肝硬化短期预后评价

Prognostic evaluation for patients with decompensated hepatic cirrhosis

关键词:  肝硬化  预后  MELD评分  Child-Pugh分级

Key words:  liver cirrhosis  prognosis  model for end-stage liver disease(MELD score)  Child - Pugh classification

摘要:

［目的］ 比较MELD评分及Child-Pugh分级对失代偿期肝硬化患者短期预后的评估价值。［方法］统计188例失代偿期肝炎硬化患者的MELD评分及Child-Pugh评分。比较不同MELD 评分及不同Child-Pugh分级患者3个月的病死率及ROC曲线下面积。统计学方法：χ2检验、t 检验。［结果］① MELD评分均值，死亡组为25.57±8.55，生存组为19.09±6.33，两组差异有非常显著性意义（t=-2.190，P= 0.001）。② Child－Pugh分值均值，死亡组12.07±1.81，与生存组8.90±1.92比较差异有非常显著性意义（t=9.701，P= 0.000）。③ROC曲线下面积MELD为0.804，Child-Pugh为0.818，差异无统计学意义（P>0.05）。提示二者对预后估计的准确性无差异。④死亡组及生存组各项并发症的发病率差异有显著性意义（P=0.000~ 0.045）。［结论］MELD评分及Child－Pugh分级均可对失代偿期肝硬化患者短期预后作出有效判断。肝硬化严重并发症应在肝功评价体系中体现。

Abstract:

［Objective］To compare the value between MELD score and Child-Pugh classification in determining the short-term prognosis of patients with hepatic cirrhosis.［Methods］Retrospective data from 188 patients with liver cirrhosis were analyzed. Patients were divided into the survival group and the death group. MELD and Child-Pugh score were calculated. Prediction of mortality for three months were analyzed using the area under the receiver's operating characteristics (ROC) curve (AUC). Statistical method: t-test and Che-square test analysis.［Results］① The mean of MELD scores was 25.57±8.55 in the death group, and was 19.09±6.33 in survival group. There was significant difference between the two groups (t=-2.190, P=0.001). ② The mean score of Child-Pugh was 12.07±1.81 in the death group, and was 8.90±1.92 in the survival group. The difference between the two groups was significant (t= 9.701,P=0.000). ③ AUC of MELD and Child-Pugh was 0.804 and 0.818 respectively, the difference was not significant (P> 0.05). ④The incidence of complications between the death group and the survival group was significantly different (P= 0.000~0.045).［Conclusion］Both MELD score and Child-Pugh classification can predict the short term prognosis of patients with decompensated liver cirrhosis. Complications were important indicators for prognosis, and should be reflected in the evaluation system.