CAJ | 학술논문

目的探讨MELD-Na评分和Child-Turcorto-Pugh(CTP)评分对乙型肝炎慢加急性肝衰竭短期预后的临床价值. 方法回顾性分析2010年1月至2012年12月住院的乙型肝炎慢加急性肝衰竭患者339例,研究MELD-Na评分与CTP评分对疾病短期预后的预测价值.计量资料采用t检验;计数资料采用x2检验;相关性分析采用Spearman秩相关分析;受试者工作特征曲线下面积比较采用正态Z检验. 结果肝衰竭晚期MELD-Na评分显著高于中期及早期(P值均＜0.01),肝衰竭中期MELD-Na评分显著高于早期(P＜0.01),肝衰竭早、中、晚期CTP评分比较差异无统计学意义(P＞ 0.05);肝衰竭分期与MELD-Na评分的相关性(rs=0.485,P＜ 0.01)比CTP评分的相关性高(rs=0.306,P＜ 0.01);肝衰竭早、中、晚期患者短期病死率差异有统计学意义(P＜0.01);死亡组MELD-Na评分高于生存组(P＜0.01),死亡组与生存组相比CTP评分无统计学意义(P＞0.05);随着MELD-Na、CTP评分的增加,短期病死率逐渐升高(P＜0.01);MELD-Na和CTP评分的曲线下面积分别为0.813、0.823,预测能力差异无统计学意义(P＞0.05). 结论相比CTP评分,MELD-Na评分在预测乙型肝炎慢加急性肝衰竭短期预后上略占优势;应用上可以MELD-Na为主,两评分模型互为补充,并密切结合临床实际.
목적 탐토MELD-Na평분화Child-Turcorto-Pugh(CTP)평분대을형간염만가급성간쇠갈단기예후적림상개치. 방법 회고성분석2010년1월지2012년12월주원적을형간염만가급성간쇠갈환자339례,연구MELD-Na평분여CTP평분대질병단기예후적예측개치.계량자료채용t검험;계수자료채용x2검험;상관성분석채용Spearman질상관분석;수시자공작특정곡선하면적비교채용정태Z검험. 결과 간쇠갈만기MELD-Na평분현저고우중기급조기(P치균＜0.01),간쇠갈중기MELD-Na평분현저고우조기(P＜0.01),간쇠갈조、중、만기CTP평분비교차이무통계학의의(P＞ 0.05);간쇠갈분기여MELD-Na평분적상관성(rs=0.485,P＜ 0.01)비CTP평분적상관성고(rs=0.306,P＜ 0.01);간쇠갈조、중、만기환자단기병사솔차이유통계학의의(P＜0.01);사망조MELD-Na평분고우생존조(P＜0.01),사망조여생존조상비CTP평분무통계학의의(P＞0.05);수착MELD-Na、CTP평분적증가,단기병사솔축점승고(P＜0.01);MELD-Na화CTP평분적곡선하면적분별위0.813、0.823,예측능력차이무통계학의의(P＞0.05). 결론 상비CTP평분,MELD-Na평분재예측을형간염만가급성간쇠갈단기예후상략점우세;응용상가이MELD-Na위주,량평분모형호위보충,병밀절결합림상실제.
Objective To compare the clinical values of the model for end-stage liver disease (MELD)-Na scoring system and the Child-Turcotte-Pugh (CTP) scoring system for predicting the short-term prognosis of acuteon-chronic hepatitis B liver failure.Methods A total of 339 patients with acute-on-chronic hepatitis B liver failure and admitted to the Eighth People's Hospital of Guangzhou and Nanfang Hospital of Southem Medical University between January 2010 and December 2012 were included in this retrospective analysis.The short-term predictive values of MELD-Na and CTP scores were compared for this patient population.Results The mean MELD-Na score in the advanced stage of liver failure was significantly higher than those in the early and middle stages,respectively (both P ＜ 0.01).The mean MELD-Na score in the middle stage of liver failure was also significantly higher than that in the early stage (P ＜ 0.01).In contrast,the mean CTP scores for the three stages of liver failure were not significantly different (all P ＞ 0.05).The MELD-Na score showed a stronger correlation with the stage of liver failure (rs =0.485,P＜ 0.01) than did the CTP score (rs =0.306,P＜ 0.01).The short-term mortality rates were significantly different for the three stages of liver failure (P＜ 0.01).The mean MELD-Na score of the death group was significantly higher than that of the survival group (P ＜ 0.01).The CTP scores,however,were not significantly different between the death and survival groups (P ＞ 0.05).The short-term mortality rate of liver failure was significantly higher for patients with increased scores for the MELD-Na and CTP systems (both P ＜ 0.01).The areas under the curve of the MELD-Na and CTP scores were 0.813 and 0.823,respectively.The MELD-Na and CTP score have similar predictive values (P ＞ 0.05).Conclusion The MELD-Na scoring system is slightly superior to the CTP scoring system for predicting short-term prognosis of acute-on-chronic hepatitis B liver failure.The predictive value may improve for both the MELD-Na score and the CTP score when combined with expert clinical practice and experience.