终末期肝病模型评分系统预测人工肝治疗重型肝炎短期预后的价值

发布时间：2018-01-27 03:01

  本文关键词： 重型肝炎 终末期肝病模型 人工肝 预后　出处：《广东医学》2015年14期 　论文类型：期刊论文

【摘要】：目的观察终末期肝病模型(MELD)评分系统预测重型乙型肝炎患者短期(治疗3个月)预后情况,探讨MELD评分系统对其短期预后的预测能力及临床价值。方法对65例重型乙型肝炎患者分别进行人工肝联合常规内科综合治疗(观察组,n=33)和常规内科综合治疗(对照组,n=32),应用MELD评分系统对研究对象进行评分,观察两组在治疗前、治疗后1个月评分变化及治疗后3个月死亡情况。比较两组治疗前的总胆红素(TBIL)、肌酐(Cr)、凝血酶原时间(PT)的国际标准化比率(INR)、血清钠(Na+)及MELD评分值。计算ROC曲线下面积来进一步评价MELD评分对乙型肝炎后重型肝炎患者人工肝治疗3个月后预后的预测价值。结果治疗后1个月两组的MELD评分均较治疗前有所下降,观察组MELD20、20≤MELD30和30≤MELD40患者的评分与治疗前比较差异有统计学意义(t=2.120、4.715、4.657,均P0.05),对照组20≤MELD30和30≤MELD40患者的评分与治疗前比较差异有统计学意义(t=2.092、2.130,均P0.05);治疗后,观察组20≤MELD30和30≤MELD40患者的评分与对照组比较差异有统计学意义(t=2.092、2.130,均P0.05)。治疗后3个月时观察组不同分值病死率均≤对照组,但两组比较差异无统计学意义(醊2=0.775,P=0.329)。应用该模型判断患者3个月内死亡与否的最佳MELD临界值,观察组为32,敏感度为67.82%,特异度为85.19%;而对照组的最佳临界值为24,敏感度为80.27%,特异度为69.33%。MELD分值预测观察组死亡的ROC曲线下面积大于对照组。结论MELD评分能较好地预测重型肝炎患者人工肝联合内科综合治疗的短期(3个月)临床预后,值得临床推广使用。
[Abstract]:Objective to observe the prognosis of patients with severe hepatitis B in the short term (3 months after treatment) by MELD- scoring system. To explore the predictive ability and clinical value of MELD scoring system for short-term prognosis. Methods 65 patients with severe hepatitis B were treated with artificial liver combined with routine medical treatment (observation group). MELD scoring system was used to evaluate the subjects of the study. The two groups were observed before treatment. The changes of score 1 month after treatment and death at 3 months after treatment were compared between the two groups before the treatment of total bilirubin TBILL, creatinine (Cr). The international standard ratio of prothrombin time (PTT) is INR). Serum Na). The area under the ROC curve was calculated to further evaluate the value of MELD score in predicting the prognosis of patients with severe hepatitis B after 3 months of artificial liver therapy. The MELD scores of all patients were lower than those before treatment. The scores of MELD20 鈮，

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