摘要
目的比较终末期肝病模型(MELD)及其衍生模型iMELD、MELD-Na和MESO对乙型肝炎相关性慢加急性肝衰竭(HBV-ACLF)患者12周生存预后的评估价值。方法按照现行中国肝衰竭诊治指南的诊断标准纳入67例HBV-ACLF患者,收集患者诊断成立时的相关实验室检测指标,分别计算MELD、iMELD、MELD-Na和MESO模型评分,应用Med Calc 15.8软件分析比较受试者工作特征曲线(ROC),确定MELD及其衍生评分系统对ACLF患者12周死亡风险预测的最佳截断点和约登指数,以评价不同评分预测ACLF患者短期生存的效能。结果在治疗12周内,在67例HBV-ACLF患者中,死亡45例(67.2%);入组时,生存组MELD、iMELD、MELD-Na和MESO评分分别为(22.12±3.24)、(41.59±5.30)、(22.55±4.07)和(1.64±0.24),显著低于死亡组【分别为(30.47±9.01)、(51.88±11.09)、(32.35±11.58)和(2.28±0.70),P<0.01】;MELD、i MELD、MELD-Na和MESO模型预测患者12周生存的ROC曲线下面积分别为0.814、0.802、0.806和0.817,其最佳截断点分别为22.70、47.76、22.16和1.69,约登指数分别为0.5040、0.5535、0.4808和0.4818,提示四种模型的预测效能比较,均无显著性差异(P>0.05)。结论MELD、i MELD、MELD-Na和MESO四种评分系统对于HBV-ACLF患者12周生存情况均具有良好的预测能力,可根据实际情况,选择应用。
Objective To validate the prediction of short-term survival by four scoring systems based onmodels for end-stage liver disease（MELD）in patients with acute-on-chronic hepatitis B-induced liver failure（HBV -ACLF） . Methods 67 patients with HBV -ACLF were enrolled in this study between April 2015 andOctober 2017. The clinical parameters were collected for calculation of MELD, iMELD, MELD -Na and MESOscores, respectively. The predictive efficacy on forecasting survival of patients with HBV -ACLF by the fourscoring systems was analyzed by receiver operating characteristic curve（ROC）supported by MedCalc15.8 software.Results 45（67.2%）out of 67 patients with HBV-ACLF died within 12 weeks; the scores of MELD, iMELD,MELD-Na and MESO models at presentation in survival group were （22.12±3.24） , （41.59±5.30） , （22.55±4.07）and（1.64±0.24） , much lower than （30.47±9.01） , （51.88±11.09） , （32.35±11.58）and（2.28±0.70） , respectively, P〈0.01in the dead group; the area under the ROC curve（AUC）in forecasting the survival of patients with HBV-ACLF by the four models were 0.814, 0.802, 0.806 and 0.817 respectively, the cut -off -values were22.70, 47.76, 22.16 and 1.69, and the Jordan index were 0.5040, 0.5535, 0.4808 and 0.4818, respectively, suggestingno significant differences between them （P〉0.05） . Conclusion The four scoring systems base on MELD havegood predictive efficacy on forecasting 12 weeks’survival in patients with HBV-ACLF, which hints they might beapplied in clinical practice.
作者
李磊
胡辉
郑晓玮
江守伟
沈强
Li Lei;Hu Hui;Zheng Xiaowei(Department of Infectious Disease, Provincial Hospital, Hefei 230001, Anhui Province, China)
出处
《实用肝脏病杂志》
CAS
2018年第3期417-420,共4页
Journal of Practical Hepatology
基金
安徽省科技厅自然科学基金资助项目(编号:1208085QH147)
关键词
慢加急性肝衰竭
乙型肝炎
终末期肝病模型
预后
Acute-on-chronic liver failure
HepatitisB
Models for end-stage liver disease
Prognosis
