ΔMELD评估食管胃底静脉曲张破裂出血短期预后的临床研究

摘要

目的：探讨△MELD对食管胃底静脉曲张破裂出血患者短期预后的预测价值。方法选择本院2011年1月~2013年12月发生食管胃底静脉曲张破裂出血的56例患者为研究对象，根据患者的临床资料建立CTP评分、MELD评分、△MELD评分3种方式，比较3种评分对预测患者短期预后的准确性。结果56例患者在住院及随访期间死亡21例，死亡率为37.5%。两组1、3、6个月的CTP评分、MELD评分比较差异有统计学意义(P<0.01)；两组3、6个月的△MELD评分比较差异有统计学意义(P<0.01)。3个月ROC曲线下面积由大到小依次为△MELD(0.88±0.18)，MELD(0.85±0.07)，CTP(0.76±0.11)；6个月ROC曲线下面积由大到小依次为△MELD(0.95±0.04)，MELD(0.85±0.21)，CTP(0.61±0.09)。结论△MELD指标是评估食管胃底静脉曲张破裂出血患者短期预后的良好指标，其准确性优于MELD评分和CTP评分，值得临床深入研究。%Objective To explore predictive value of △MELD evaluate short-term prognosis of esophageal-gastric fun-dus variceal bleeding. Methods 56 cases of patients with esophageal-gastric fundus variceal bleeding in our hospital from January 2011 to December 2013 were selected as research objects.Three scoring manners (CTP score,MELD score and△MELD score)were set up according to clinical dates of patients.Three scoring manners to predict short-term prog-nosis of patients with accuracy was compared. Results In 56 patients,21 patients were dead during hospitalization or follow-up visit,and the mortality was 37.5%.The CTP score,MELD score at 1,3,6-month in two groups was compared respectively,with statistical difference (P<0.01).△MELD score at 3,6-month in two groups was compared respectively, with statistical difference(P<0.01).The area under the ROC curve at 3 months from big to little was△MELD(0.88±0.18), MELD(0.85±0.07),CTP(0.76±0.11)respectively.The area under the ROC curve at 6 months from big to little was△MELD (0.95±0.04),MELD (0.85±0.21),CTP (0.61±0.09)respectively. Conclusion The△MELD is good indicator to evaluate the short-term prognosis for patients with esophageal-gastric fundus variceal bleeding.Its accuracy is better than that of MELD score and CTP score.It is worthy of further clinical research.