摘要
目的在中国人群中评价拉米夫定治疗失代偿乙型肝炎肝硬化早期(6个月)死亡率和相关预测因素,并对比终末期肝病模型(MELD)、Index指数(Index)和Child-Turcotte-Pugh肝功能分级(CTP)三种评判模型对早期死亡的预测效果。方法146例患者入选后服用拉米夫定,每日100mg。依随访6个月时的转归,分为生存组和死亡组,对比分析基线肝功能指标、电解质、血常规、HBVDNA定量、MELD评分、Index评分和CTP评分的差别,用Cox比例风险回归模型分析有价值的死亡预测因素。运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价有关临床指标及三种评判模型的预测能力。结果146例患者随访6月时共有21(14.4%)例死亡。死亡组与生存组比较,平均MELD分值分别为21.35±5.01和13.05±5.0,平均Index分值分别为7.61±3.28和4.85±2.57,平均CTP分值分别为12.19±1.66和9.61±2.05,两组比较差异均有显著统计学意义(P<0.001)。从AUC得出凝血酶原时间国际标准化比值(INR)、胆红素、MELD、Index和CTP评分有较强的预测能力,最适临界值为:INR1.78,胆红素108.1μmol/L,MELD17.1分,Index5.1分,CTP12分。Cox比例风险回归分析显示,INR>1.78,胆红素>108.1μmol/L,MELD>17.1,Index>5.1,CTP>12有高度死亡危险。三种评判模型相比较,MELD优于Index(P<0.05)。结论拉米夫定治疗失代偿期乙型肝炎肝硬化早期死亡率14.4%,INR、胆红素水平是较好的临床预测指标。MELD、Index和CTP三种评判模型对早期生存率有较好的预测能力,MELD好于Index指数。
Objective To determine mortality rates, identify prognostic indicators, and determine the usefulness of these 3 scoring systems, the MELD, the Index and Child-Turcotte-Pugh （CTP） in predicting short-term （6 month） survival in Chinese patients with chronic hepatitis B related decompensation who were treated with lamivudine. Methods A cohort of 146 patients with HBV-related cirrhosis were studied and followed up at least for 6 months. All cases were allocated into two groups, the survivors＇ and the deaths＇. The MELD, the Index and CTP scores and the clinical data were calculated respectively. The area under the receiver operating characteristic （ROC） curve （AUC） was used to compare MELD,Index and CTP score in predicting accuracy. The relationship of the clinical data and the patients＇ prognosis was analyzed. Results 21 （14.4%） patients died within 6 months. Higher international normalized ratio （INR） for prothrombin time, high bilirubin level were factors significantly associated with death. The AUC for predicting survival by the MELD, Index and CTP scores were 0. 881, 0. 821 and 0. 836, respectively. The MELD system is more useful than Index. Conclusion We found that with a 14.4% mortality rate, INR and bilirubin levels were good prognostic indicators in Chinese patients with HBV related decompensation treated with lamivudine therapy. The MELD, Index and CTP scoring systems were good predictors of 6 month survival in the patients in this study. The MELD system is more useful than Index.
出处
《肝脏》
2008年第4期281-283,共3页
Chinese Hepatology
