CAJ | 학술논문

目的：比较终末期肝病模型（MELD）、MELD-Na模型、iMELD模型评分系统预测慢性肝功能衰竭患者短期（治疗3个月）预后的价值。方法选取159例乙肝后慢性肝衰竭患者，以治疗3个月后患者恢复状态分成存活组（108例）和死亡组（51例）。比较2组治疗前的总胆红素（TBIL）、肌酐（Cr）、凝血酶原时间（PT）、PT的国际标准化比率（INR）、血清钠(Na+)、MELD、MELD-Na和iMELD评分值。计算受试者工作特征（ROC）曲线下的面积来进一步评价MELD模型、MELD-Na评分及iMELD评分对乙肝后慢性肝衰竭人工肝治疗3个月后预后的预测价值。结果死亡组较存活组的TBIL（μmol/L：330.9±181.9 vs 245.5±127.7）、Cr（μmol/L：84.9±63.8 vs 81.2±49.3）、INR（2.50±1.01 vs 2.09±0.57）、MELD（26.2±6.5 vs 22.0±5.8）、MELD-Na（35.9±31.5 vs 25.3±8.7）及iMELD评分（49.5±17.4 vs 42.4±10.9）增高，血清Na+水平（mmol/L：131.9±24.1 vs 133.8±11.0）降低（P<0.01）。患者病死率随着MELD、MELD-Na和iMELD评分升高而增加。MELD、MELD-Na及iMELD评分预测乙肝后慢性肝衰竭患者近期死亡危险性的最佳临界值分别为25.8、31.0和53.5。3种评分的曲线下面积（AUC）差异均无统计学意义。结论 MELD、MELD-Na和iMELD评分均能较好地预测肝衰竭患者经过人工肝联合内科综合治疗后的短期临床预后。
목적：비교종말기간병모형（MELD）、MELD-Na모형、iMELD모형평분계통예측만성간공능쇠갈환자단기（치료3개월）예후적개치。방법선취159례을간후만성간쇠갈환자，이치료3개월후환자회복상태분성존활조（108례）화사망조（51례）。비교2조치료전적총담홍소（TBIL）、기항（Cr）、응혈매원시간（PT）、PT적국제표준화비솔（INR）、혈청납(Na+)、MELD、MELD-Na화iMELD평분치。계산수시자공작특정（ROC）곡선하적면적래진일보평개MELD모형、MELD-Na평분급iMELD평분대을간후만성간쇠갈인공간치료3개월후예후적예측개치。결과사망조교존활조적TBIL（μmol/L：330.9±181.9 vs 245.5±127.7）、Cr（μmol/L：84.9±63.8 vs 81.2±49.3）、INR（2.50±1.01 vs 2.09±0.57）、MELD（26.2±6.5 vs 22.0±5.8）、MELD-Na（35.9±31.5 vs 25.3±8.7）급iMELD평분（49.5±17.4 vs 42.4±10.9）증고，혈청Na+수평（mmol/L：131.9±24.1 vs 133.8±11.0）강저（P<0.01）。환자병사솔수착MELD、MELD-Na화iMELD평분승고이증가。MELD、MELD-Na급iMELD평분예측을간후만성간쇠갈환자근기사망위험성적최가림계치분별위25.8、31.0화53.5。3충평분적곡선하면적（AUC）차이균무통계학의의。결론 MELD、MELD-Na화iMELD평분균능교호지예측간쇠갈환자경과인공간연합내과종합치료후적단기림상예후。
Objective To investigate the value of model for end-stage liver disease (MELD) score, MELD with in-corporation of serum sodium (MELD-Na) score and integrated MELD (iMELD) score for evaluation of prognosis of chronic liver failure. Methods A total of 159 consecutive patients with chronic liver failure were included in the study and divided into two groups (death group and survival group) according to the prognosis. The levels of total bilirubin (TBIL), serum creati-nine (Cr), prothrombin time (PT), PT international normalized ratio (INR), serum sodium (Na+), age, MELD, MELD-Na and iMELD were calculated respectively and the comparative analysis was performed. Areas under the receiver operating charac-teristic curve (AUC-ROC) of MELD, MELD-Na and iMELD were used to assess the prognosis in patients with chronic liver failure. Results The values of TBIL (μmol/L:330.9±181.9 vs 245.5±127.7),Cr (μmol/L:84.9±63.8 vs 81.2±49.3),INR (2.50±1.01 vs 2.09±0.57),MELD (26.2±6.5 vs 22.0±5.8),MELD-Na (35.9±31.5 vs 25.3±8.7) and iMELD (49.5±17.4 vs 42.4±10.9) were significantly higher in death group than those in survival group (P < 0.01). The serum level of Na+ was signif- icantly lower in death group than that of survival group (P < 0.01). The mortality of liver failure was higher in patients with the increased scores of MELD, MELD-Na and iMELD. The area under curve (AUC) values generated by the ROC curves was no difference respectively (P > 0.05) for MELD score (AUC=0.691), MELD-Na score (AUC=0.690) and iMELD score (AUC= 0.674) . The cut-off scores of three systems were 25.8 (MELD), 31.0 (MELD-Na) and 53.5 (iMELD) respectively, which could discriminate higher and lower mortality accurately. Conclusion MELD, MELD-Na and iMELD scores can predict short-term clinical outcomes of liver failure patients undergoing artificial liver comprehensive medical treatment.