【摘要】 目的评估终末期肝病模型(ModelforEnd-StageLiverDisease,MELD)评分系统慢性重型病毒性肝炎患者短期(3个月)预后的预测能力及临床应用价值,并求出作为判断患者3个月内死亡与否的MELD最佳临界值。方法分析我院2003年~2005年收治的391例慢性重型病毒性肝炎患者的临床资料,应用MELD模型公式对每个患者进行评分,观察3月内的死亡率。结果236例在3个月内死亡,病死率为60·6%。MELD分值在小于30、30~40和大于40的患者的病死率分别为38·1%(86/226)、87·6%(106/121)和100%(44/44)。应用该模型预测患者3个月内死亡与否的最佳MELD临界值为28,c-statistic为0·837,敏感性为69·2%,特异性为86·4%。MELD分值与血清胆红素、肌酐、凝血酶原时间呈明显正相关,与预后情况呈显著负相关。结论MELD分值能够作为反映重型肝炎患者病情严重程度的指标,患者短期内(3个月)死亡危险性随MELD分值的增加而上升,MELD模型能较准确预测慢性重型病毒性肝炎患者短期的临床预后。更多还原

【Abstract】 Objective To study the clinical practical use of the model for end_stage liver disease (MELD) and assess its validity in predicting the prognosis of the chronic severe hepatitis patients. The optimal cut_off values of MELD to discriminate between deceased and surviving patients is calculated by using ROC curve.Methods The clinical data of 391 patients with chronic severe hepatitis among 2003～2005 in our hospital were analyzed, and they were graded with MELD formula. The death rate was observed within three months. Results Two humdred and thirty six patients died within 3_month and the mortality was 60.6%.The mortality of the patients whose MELD score were less than 30, 30～40 and higher than 40 were 38.1%(86/226), 87.6% (106/121) and 100% (44/44) respectively. The optimal cut_off value of MELD score to predict the prognosis of patients was 28 whose sensitivity and specificity were 69.2% and 86.4% respectively, and c_statistic was 0.837(95% CI 0.798～0.875). MELD scores had positive relation to serum bilirubin, serum creatinine, prothrombrin time, and they had negative relation to the prognosis of the patients.Conclusion The MELD score can act as a disease’s severity index for patients with chronic severe hepatitis,and the mortality of the patient increases with the higher MELD score.The MELD can accurately predict the short_term prognisis of patients with chronic severe hepatitis.更多还原