CAJ | 학술논문

目的比较终末期肝病模型(MELD)评分、Child-Turcotte-Pugh(CTP)评分、Mayo评分、MESO指数和MELD-Na评分系统预测慢性重型肝炎患者预后的价值.方法回顾性分析温州医学院附属第一医院213例慢性重型肝炎患者的临床资料,计算其MELD、CTP、Mayo、MESO和MELD-Na评分,比较各评分系统在死亡组和生存组中的差异,通过受试者工作特征(ROC)曲线,曲线下面积(AUC)及截断值进行比较分析.计量资料的比较使用成组t检验,各评分系统之间AUC的比较使用MEDCLAC软件.结果死亡组的MELD、CTP、Mayo、MESO、MELD-Na评分分别是(30.6±9.5)、(11.3±1.5)、(10.4±1.3)、(2.3±0.8)和(39.0±11.8)分,均高于生存组的(21.1±6.8)、(10.6±1.6)、(9.0±1.5)、(1.6±0.5)和(22.6±8.2)分,差异有统计学意义(t=7.31,t=3.10,t=6.70,t=7.90,t=10.21,均P＜0.01);各评分系统的AUC分别为0.810、0.623、0.749、0.829和0.885;Youden指数分别为0.507、0.175、0.389、0.528和0.650.结论 CTP评分判断慢性重型肝炎的预后尚不理想;Mayo评分具有一定的预测能力;MELD、MESO、MELD-Na评分在预测慢性重型肝炎预后方面具有肯定的临床应用价值,且MELD-Na评分优于MESO指数和MELD评分.
목적 비교종말기간병모형(MELD)평분、Child-Turcotte-Pugh(CTP)평분、Mayo평분、MESO지수화MELD-Na평분계통예측만성중형간염환자예후적개치.방법 회고성분석온주의학원부속제일의원213례만성중형간염환자적림상자료,계산기MELD、CTP、Mayo、MESO화MELD-Na평분,비교각평분계통재사망조화생존조중적차이,통과수시자공작특정(ROC)곡선,곡선하면적(AUC)급절단치진행비교분석.계량자료적비교사용성조t검험,각평분계통지간AUC적비교사용MEDCLAC연건.결과 사망조적MELD、CTP、Mayo、MESO、MELD-Na평분분별시(30.6±9.5)、(11.3±1.5)、(10.4±1.3)、(2.3±0.8)화(39.0±11.8)분,균고우생존조적(21.1±6.8)、(10.6±1.6)、(9.0±1.5)、(1.6±0.5)화(22.6±8.2)분,차이유통계학의의(t=7.31,t=3.10,t=6.70,t=7.90,t=10.21,균P＜0.01);각평분계통적AUC분별위0.810、0.623、0.749、0.829화0.885;Youden지수분별위0.507、0.175、0.389、0.528화0.650.결론 CTP평분판단만성중형간염적예후상불이상;Mayo평분구유일정적예측능력;MELD、MESO、MELD-Na평분재예측만성중형간염예후방면구유긍정적림상응용개치,차MELD-Na평분우우MESO지수화MELD평분.
Objective To investigate the roles of five scoring systems including model for endstage liver disease (MELD), Child-Turcotte-Pugh (CTP), Mayo, MESO and MELD-Na scoring systems, in predicting the prognosis of patients with chronic severe hepatitis. Methods The clinical data of 213 patients with chronic severe hepatitis were retrospectively studied. The five scoring systems were applied respectively to evaluate the scores in survival group and death group. The capability of these five scoring systems to predict the prognosis of severe hepatitis were compared by the receiver operating characteristic (ROC) curve, area under curve (AUC) and cut-off value.Measurement data were compared by group t test. The comparisons of AUC among scoring systems were done using MEDCLAC software. Results The scores of death group evaluated by MELD, CTP,Mayo, MESO or MELD-Na scoring systems (30.6 ± 9.5, 11.3 ± 1.5, 10.4 ± 1.3, 2.3 ± 0.8 and 39.0 ± 11.8, respectively) were consistently higher than those of survival group (21.1± 6.8, 10.6 ±1.6, 9.0±1.5, 1.6±0.5 and 22.6±8.2, respectively) (P＜0.01). The values of AUC of these five systems were 0.810, 0.623, 0.749, 0.829 and 0.885, respectively. The Youden's indexes of these five systems were 0.507, 0.175, 0.389, 0.528 and 0.650, respectively. Conclusions The CTP scoring systems can not predict the prognosis of chronic severe hepatitis very well. The Mayo scoring systems can partially predict the prognosis. On the contrary, MELD, MESO and MELD-Na systems can successfully predict the disease prognosis, and the score of MELD-Na system shows the best correlation with the prognosis.