CAJ | 학술논문

目的探讨Child-Turcotte-Pugh (CTP)分级、终末期肝病模型(MELD)评分以及终末期肝病模型-血清钠(MELD-Na)积分预测肝移植患者短期生存(≤3个月)的能力,分析预后相关因素,寻找能准确判断预后的指标.方法回顾性分析于单一治疗中心接受肝移植治疗的73例终末期肝病患者资料.三种评分标准的预测价值系用受试者工作特征(ROC)曲线下面积衡量.相关因素比较采用Logistic回归分析.统计学处理采用SAS 9.1.3软件.结果 73例患者术后3个月内死亡11例,病死率为15.1％.术前CTP分级、MELD评分及MELD-Na积分预测短期生存的ROC曲线下面积分别为0.817、0.839、0.860,三者相互比较,P值均大于0.05,差异无统计学意义.单因素分析提示术前血清钠、血尿素氮、凝血酶原时间国际标准化比值(PT-INR)、CTP评分、MELD评分和MELD-Na积分与预后的相关性具有统计学意义.多元Logistic逐步回归分析提示只有术前MELD-Na积分与3个月预后显著相关(P=0.001,β=-2.496,OR=0.085,95％ CI:0.019～0.370).结论 MELD-Na积分系统对患者肝移植短期效果的预测能力强,但与CTP分级、MELD评分相比并无明显优势;术前MELD-Na积分是肝移植患者术后短期生存的独立危险因素,积分越高短期死亡风险越大.此评分系统可以为有限供体的分配提供参考.
목적 탐토Child-Turcotte-Pugh (CTP)분급、종말기간병모형(MELD)평분이급종말기간병모형-혈청납(MELD-Na)적분예측간이식환자단기생존(≤3개월)적능력,분석예후상관인소,심조능준학판단예후적지표.방법 회고성분석우단일치료중심접수간이식치료적73례종말기간병환자자료.삼충평분표준적예측개치계용수시자공작특정(ROC)곡선하면적형량.상관인소비교채용Logistic회귀분석.통계학처리채용SAS 9.1.3연건.결과 73례환자술후3개월내사망11례,병사솔위15.1％.술전CTP분급、MELD평분급MELD-Na적분예측단기생존적ROC곡선하면적분별위0.817、0.839、0.860,삼자상호비교,P치균대우0.05,차이무통계학의의.단인소분석제시술전혈청납、혈뇨소담、응혈매원시간국제표준화비치(PT-INR)、CTP평분、MELD평분화MELD-Na적분여예후적상관성구유통계학의의.다원Logistic축보회귀분석제시지유술전MELD-Na적분여3개월예후현저상관(P=0.001,β=-2.496,OR=0.085,95％ CI:0.019～0.370).결론 MELD-Na적분계통대환자간이식단기효과적예측능력강,단여CTP분급、MELD평분상비병무명현우세;술전MELD-Na적분시간이식환자술후단기생존적독립위험인소,적분월고단기사망풍험월대.차평분계통가이위유한공체적분배제공삼고.
Objective To evaluate the predictive effect of preoperative CTP score,MELD score and MELD-Na score on short-term prognosis (≤ 3 months) after liver transplantation,to analyze factors which correlated with survival,and to seek indicators that accurately predicted short-term outcomes.Methods The clinical data of 73 consecutive patients with end-stage liver diseases who underwent liver transplantation in a single center were retrospectively analyzed.The area under the ROC curve (AUC) was used to determine the predictive power.Correlated factors were analyzed by multivariate logistic regression.The statistical processing package used was SAS 9.1.3 software.Results 11 (15.1％) of 73 patients died within 3 months after liver transplantation.The areas under the ROC curve of the preoperative CTP score,MELD score and MELD-Na score for predicting short-term survival were 0.817,0.839 and 0.860 respectively.There was no significant difference among these 3 scoring systems.On univariate analysis,indicators significantly correlated with early mortality were preoperative serum sodium,serum urea,PT-INR,CTP score,MELD score and MELD-Na score.On logistic multiple regression,only MELD-Na score remained as a significant indicator (P =0.001,β =-2.496,OR =0.085,95％ CI:0.019 ～ 0.370).Conclusions The MELD-Na scoring system showed superior predictability of early mortality in patients who underwent liver transplantation.The preoperative MELD-Na score was an independent risk factor of short-term survival.The higher the MELD-Na score,the higher was the early mortality.