终末期肝病模型及ChildPugh分级对失代偿期肝硬化患者的预后分析

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1、终末期肝病模型及Child-Pugh分级对失代偿期肝硬化患者的预后分析作者：占国清，郑三菊，朱琳，王崇慧，李金科，张薇薇【摘要】　　目的探讨终末期肝病模型(MELD)及Child-Pugh评分对失代偿期肝硬化预后评估的应用价值。方法应用MELD评分公式及Child-Pugh分级对136例失代偿期肝硬化患者进行评分及分级，比较两种系统对肝硬化预后的评估。结果分别有19.85%和33.82%患者3个月和6个月内死亡，死亡组MELD和Child-Pugh评分均高于生存组(P<0.001);MELD评分在3个月预后评估的ROC曲线A

2、UC高于Child-Pugh评分(P<0.05);生存分析表明MELD与Child-Pugh评分均可有效地分辨6个月内可能生存及死亡的患者(P<0.005);MELD评分与Child评分显著相关(r=0.67，P<0.001)。结论MELD评分及Child-Pugh评分均可预测失代偿期肝硬化患者短期预后，MELD评分短期评估优于Child-Pugh分级。【关键词】失代偿期肝硬化MELD评分Child-Pugh分级预后　　Theanalysisofprognosisofpatientswithdecompensat

3、edlivercirrhosisusingthecriterionofthemodelforend-stageliverdiseaseandChild-PughgradingZHANGGuo-qing,ZHENGSan-ju,ZHULin,etal.DepartmentofHepatology,9PeopleHospitol,YunyangMedicalCollege,Shiyan442000,China　　Abstract:　　ObjectiveToinvestigatetheprognosisvalueoftheModelfo

4、rEnd-stageLiverDisease(MELD)andChild-Pughgradinginpatientswithdecompensatedlivercirrhosis.Methods136patientswithdecompensatedlivercirrhosisweregradedwithMELDformulaandwithChild-Pugh,andtheprognosisvaluewerecompared.Results19.85%and33.82%ofthediedwithinthreeandsixmonth

5、termrespectively,MELDandChild-Pughscorefordeathswerehigherthanthoseforsurvivorssignificantly(P<0.001).AreaundertheROCofMELDwashigherthanthatofChild-Pughforthreemonthterm(P<0.05).SurvivalanalysisshowedMELDandChild-Pughgradingcouldclearlydiscriminatebetweenpatient

6、swhosurvivedordiedinsixmonthterm(P<0.005).MELDvalueshadsignificantcorrelationwithChild-Pughscores(r=0.67,P<0.001).ConclusionBothMELDandChild-Pughscorescanaccuratelypredicttheshort-termprognosisofpatientswithdecompensatedlivercirrhosis,MELDgradingismoreefficientt

7、hanChild-Pughscoreforshort-termprognosis.　　Keywords:Decompensatedlivercirrhosis;Modelfor9End-stageLiverDiseasescoring;Child-Pughgrading;Prognosis　　目前Child-Pugh分级仍广泛应用评估肝硬化患者肝功能储备、手术风险及预后。近年来国内外表明终末期肝病模型(Modelforend-stageliverdisease,MELD)评分可有效评价各种中晚期肝脏疾病的严重程度，并将其作为终末期

8、肝病患者进行肝移植的器官分配标准[1～3]。本文应用MELD评分系统及Child-Pugh分级回顾性分析了136例失代偿期肝硬化患者的生存状况，以评估并比较它们预测失代偿期肝硬化患者短期预后价值。　　1　材料与方法　　1.1　病例选择　收集自200