中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2014年
3期
212-217
,共6页
肝功能衰竭%预后%终末期肝病模型%终末期肝病模型联合血清钠
肝功能衰竭%預後%終末期肝病模型%終末期肝病模型聯閤血清鈉
간공능쇠갈%예후%종말기간병모형%종말기간병모형연합혈청납
Liver failure%Prognosis%Model for end-stage liver disease%Model for end-stage liver disease-Na
目的 比较基线及动态终末期肝病模型(MELD)及其联合血清钠(MELD-Na)在评价肝衰竭近期预后中的价值.方法 回顾性分析2003年4月至2012年4月新疆医科大学第一附属医院322例肝衰竭住院患者的资料,计算患者确诊时和一周后的MELD、MELD-Na评分,并计算△MELD 、△MELD-Na分值.应用受试者工作特征(ROC)曲线评价各评分系统预测患者3个月预后的价值,同时绘制Kaplan-Meier(K-M)生存曲线.结果 急性和亚急性、慢加急性、慢性肝衰竭患者3个月时的病死率分别为77.4％(24/31),41.7％(50/120)和56.1％(96/171),比较差异有统计学意义(x2=14.273,P ＜0.01).对于急性和亚急性肝衰竭患者,各评分系统预测患者近期预后的ROC曲线下面积(AUC)为0.699～0.836,差异无统计学意义(Z=0.507,0.622,0.712,0.727,0.779,0.599,P＞0.05).对于慢加急性肝衰竭,△MELD和△MELD-Na的AUC分别为0.889和0.897,均高于基线MELD和MELD-Na的AUC(Z=3.110和3.500,P＜0.05),但△MELD和△MELD-Na的AUC比较差异无统计学意义(Z =0.310,P ＞0.05);K-M生存曲线显示,当△MELD＞ 3.5分时,患者3个月内病死率为87.8％,平均生存时间为34.05 d.对于慢性肝衰竭,△MELD预测患者近期预后的AUC为0.871,优于△MELD-Na(Z=4.229,P＜0.05);K-M生存曲线显示,当△MELD＞ 4.5分时,患者3个月内病死率为89.9％,平均生存时间为29.08 d.结论 对于急性和亚急性肝衰竭,各评分预测效果均可;对于慢加急性肝衰竭,△MELD和△MELD-Na均优于相应的基线评分系统;对于慢性肝衰竭,△MELD的预测能力最佳.
目的 比較基線及動態終末期肝病模型(MELD)及其聯閤血清鈉(MELD-Na)在評價肝衰竭近期預後中的價值.方法 迴顧性分析2003年4月至2012年4月新疆醫科大學第一附屬醫院322例肝衰竭住院患者的資料,計算患者確診時和一週後的MELD、MELD-Na評分,併計算△MELD 、△MELD-Na分值.應用受試者工作特徵(ROC)麯線評價各評分繫統預測患者3箇月預後的價值,同時繪製Kaplan-Meier(K-M)生存麯線.結果 急性和亞急性、慢加急性、慢性肝衰竭患者3箇月時的病死率分彆為77.4％(24/31),41.7％(50/120)和56.1％(96/171),比較差異有統計學意義(x2=14.273,P ＜0.01).對于急性和亞急性肝衰竭患者,各評分繫統預測患者近期預後的ROC麯線下麵積(AUC)為0.699～0.836,差異無統計學意義(Z=0.507,0.622,0.712,0.727,0.779,0.599,P＞0.05).對于慢加急性肝衰竭,△MELD和△MELD-Na的AUC分彆為0.889和0.897,均高于基線MELD和MELD-Na的AUC(Z=3.110和3.500,P＜0.05),但△MELD和△MELD-Na的AUC比較差異無統計學意義(Z =0.310,P ＞0.05);K-M生存麯線顯示,噹△MELD＞ 3.5分時,患者3箇月內病死率為87.8％,平均生存時間為34.05 d.對于慢性肝衰竭,△MELD預測患者近期預後的AUC為0.871,優于△MELD-Na(Z=4.229,P＜0.05);K-M生存麯線顯示,噹△MELD＞ 4.5分時,患者3箇月內病死率為89.9％,平均生存時間為29.08 d.結論 對于急性和亞急性肝衰竭,各評分預測效果均可;對于慢加急性肝衰竭,△MELD和△MELD-Na均優于相應的基線評分繫統;對于慢性肝衰竭,△MELD的預測能力最佳.
목적 비교기선급동태종말기간병모형(MELD)급기연합혈청납(MELD-Na)재평개간쇠갈근기예후중적개치.방법 회고성분석2003년4월지2012년4월신강의과대학제일부속의원322례간쇠갈주원환자적자료,계산환자학진시화일주후적MELD、MELD-Na평분,병계산△MELD 、△MELD-Na분치.응용수시자공작특정(ROC)곡선평개각평분계통예측환자3개월예후적개치,동시회제Kaplan-Meier(K-M)생존곡선.결과 급성화아급성、만가급성、만성간쇠갈환자3개월시적병사솔분별위77.4％(24/31),41.7％(50/120)화56.1％(96/171),비교차이유통계학의의(x2=14.273,P ＜0.01).대우급성화아급성간쇠갈환자,각평분계통예측환자근기예후적ROC곡선하면적(AUC)위0.699～0.836,차이무통계학의의(Z=0.507,0.622,0.712,0.727,0.779,0.599,P＞0.05).대우만가급성간쇠갈,△MELD화△MELD-Na적AUC분별위0.889화0.897,균고우기선MELD화MELD-Na적AUC(Z=3.110화3.500,P＜0.05),단△MELD화△MELD-Na적AUC비교차이무통계학의의(Z =0.310,P ＞0.05);K-M생존곡선현시,당△MELD＞ 3.5분시,환자3개월내병사솔위87.8％,평균생존시간위34.05 d.대우만성간쇠갈,△MELD예측환자근기예후적AUC위0.871,우우△MELD-Na(Z=4.229,P＜0.05);K-M생존곡선현시,당△MELD＞ 4.5분시,환자3개월내병사솔위89.9％,평균생존시간위29.08 d.결론 대우급성화아급성간쇠갈,각평분예측효과균가;대우만가급성간쇠갈,△MELD화△MELD-Na균우우상응적기선평분계통;대우만성간쇠갈,△MELD적예측능력최가.
Objective To evaluate the model for end-stage liver disease (MELD) and MELD combined with serum natrium level (MELD-Na) in predicting short-term prognosis of liver failure.Methods Clinical data of 322 patients with liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2012 were retrospectively analyzed.MELD and MELD-Na scores were calculated at diagnosis and one week after the diagnosis,and then △MELD and △MELD-Na were determined.Receiver operating characteristics (ROC) curve and Kaplan-Meier survival curve were used to evaluate the value of the above scores in predicting 3-month prognosis.Results The 3-month mortality rates of acute/sub-acute,acute-on-chronic and chronic liver failure were 77.4％ (24/31),41.7％ (50/120) and 56.1％ (96/171),respectively,and the difference was of statistical significance (x2 =14.273,P ＜0.01).For acute/sub-acute liver failure,the areas under ROC curve (AUCs) were 0.699-0.836 for each scoring system in predicting short-term prognosis,and no significant difference was observed (Z =0.507,0.622,0.712,0.727,0.779 and 0.599,P ＞0.05).For acute-on-chronic liver failure,AUCs were 0.889 and 0.897 for △MELD and △MELD-Na in predicting short-term prognosis,which were higher than those of MELD and MELD-Na scores at the baseline (Z =3.110 and 3.500,P ＜ 0.05),but no significant difference was observed between △MELD and △MELD-Na (Z =0.310,P ＞ 0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 3.5 was 87.8％,and the average survival time was 34.05 d.For chronic liver failure,AUC of △MELD was 0.871 in predicting short-term prognosis,which was higher than that of △MELD-Na (Z =4.229,P ＜0.05) ; Kaplan-Meier survival curve showed that the 3-month mortality rate for patients with △MELD ＞ 4.5 was 89.9％,and the average survival time was 29.08 d.Conclusion For acute/sub-acute liver failure,MELD,MELD-Na,△MELD and △MELD-Na are all satisfactory in predicting short-term prognosis; for acute-on-chronic liver failure,△MELD and △MELD-Na are better than MELD,MELD-Na scores at the baseline; and for chronic liver failure,△MELD is the best indicator.
