摘要
目的研究终末期肝病模型(MELD)与血清钠比值(MESO)预测失代偿期肝硬化患者短期预后的临床价值;比较MESO与MELD及Child-Turcotte-Pugh(CTP)评分系统的预后预测能力;MESO结合CTP在失代偿期肝硬化患者预后预测中的价值。方法选择2007年9月至2009年9月间入住本院消化科及感染科的179例符合入组标准的住院病例,根据设计的肝硬化患者MESO调查登记表登记相关临床资料。分别计算每例患者入院后的首次CTP、MELD及MESO的分值,应用受试者特征曲线(ROC)及曲线下面积(AUC)衡量各评分系统预测患者预后的能力,及CTP在同一等级内,MESO指数与患者预后的关系。结果以入院时间为起点,死亡或者研究终止时间为终点。3个月死亡组(3个月内死亡)的MESO指数及MELD分值明显高于3个月生存组(P<0.05);MESO对3个月预后的预测能力优于MELD和CTP,Youden指数分别为60.92%、37.31%、30.12%;AUC分别为0.88、0.86、0.78(P<0.05)。CTP等级相同时,MESO指数>1.6组死亡率明显高于MESO指数<1.6组(P<0.05)。结论 MESO对失代偿期肝硬化患者的短中期预后均具有较好的预测能力,且优于MELD及CTP评分。在CTP等级相同时,MESO联合CTP评分能够更好的预测肝硬化患者的预后。
Objective To evaluate the value of MESO scoring system in predicting the prognosis of patients with decompensated cirrhosis and to compare the predictable value of MESO,MELD and CTP and to investigate the prognostic value of the combination of MESO and CTP in decompensated cirrhosis.Methods Here we present a retrospective cohort study of 179 decompensated cirrhotic hospitalized patients in gastrointestinal department or infectious department from september 2007 to september 2009.CTP,MELD,MESO score of each patient was calculated by using the information collected at the time of admission to our hospital respectively and the capacity of three scoring systems was evaluated for predicting the prognosis of cirrhotic patients according to the receiver characteristic curve and the area under the curve.Meanwhile,the relationship between the outcome of patients and MESO index within a single CTP class was investigated.Results 37（20.67%）patients died within the first 3 months,MESO and MELD of 3-month death group are significantly higher than that of 3-month survival group（P0.05）.MESO for predicting the 3-month prognosis is more efficient than MELD and CTP.Youden index is 60.92%,37.31% and 30.12% respectively and AUC is 0.88,0.86,0.78（P0.05）respectively.Mortality in the group of MESO index more than 1.6 is higher than that in the group of MESO index less than 1.6（P0.05）within a single CTP class.Conclusion MESO is a useful predictor for short-and mediate-term prognosis in decompensated cirrhotic patients and it is better than MELD and CTP.Combination of MESO and CTP scoring system can predict the outcome of patients with cirrhosis more efficiently within a single class.
出处
《临床肝胆病杂志》
CAS
2011年第10期1044-1046,1054,共4页
Journal of Clinical Hepatology
