比较CTP评分、CTP分级、MELD评分、iMELD评分对食管静脉曲张破裂出血短期预后的评估

摘要

Objective To evaluate the prognostic value of Child-Turcotte-Pugh score (CTP score), CTP classification and the model for end-stage live disease (MELD) score, integrated MELD (iMELD) score in patients with esophageal varices bleeding (EVB) during one month of hospitalization.Methods Clinical data of 101 patients with EVB were collected respectively from February 2009 to April 2010.The CTP score and CTP classification, MELD score,iMELD score were calculated on the first day of admission.The final outcome during one month of hospitalization was the endpoint in this study.The predictive prognosis was compared using receiver operating characteristic curve ( ROC ) by the area under the curve ( AUC ) of four parameters.The correlation in them was analyzed.Cutoffs of CTP score and MELD score, iMELD score were calculated to determine the prognostic death risk.Mortality rates of different groups which were dived according to these cutoffs were assessed.Results The CTP score had the highest AUC (0.949), followed by the CTP classification (0.932) , iMELD score (0.914) and MELD score (0.851).The CTP score had a significantly higher AUC compared with the MELD score ( P ＜ 0.05 ).The iMELD score had a enhanced AUC compared with MELD score, but not markedly ( P ＞ 0.05).They correlated with each other well.The cutoffs for the CTP score and MELD score were 8 and 14 respectively.Patients with the CTP score greater than 8 or MELD score larger than 14 had a significantly higher mortality (3.6％ vs 50％ , 7.1％ vs 53.8％ ,P ＜ 0.01 ).Conclusion CTP score, CTP classification, MELD score, iMELD score can exactly predict the mortality of EVB during one month of hospitalization.The CTP score is a better prognostic model for outcome prediction compared with the other three models.%目的 比较Child-Turcotte-Pugh评分(CTP评分)、Child-Turcotte-Pugh 分级(CTP分级)、终末期肝病模型(MELD)评分系统、integrated MELD(iMELD)评分系统对食管静脉曲张破裂出血(EVB)住院30天内预后的评估价值.方法 回顾性收集101例2009年2月～2010年4月在我院住院的肝硬化食管静脉曲张破裂出血患者的病历资料,分别计算其入院当日的CTP评分、CTP分级、MELD评分、iMELD评分,以入院30天内的最后结局好转或死亡为研究终点,用受试者工作曲线(ROC)曲线下面积比较4种方法对结局的预测能力.比较4种方法的相关性.获取CTP评分和MELD及iMELD评分判断预后的最佳界值点,根据最佳界值点分组,比较组间的死亡率.结果 CTP评分、CTP分级、iMELD评分、MELD评分4种方法的曲线下面积分别是0.949、0.932、0.914、0.851,其中CTP评分显著优于MELD评分,差异有统计学意义(P<0.05),iMELD 评分优于MELD评分,但差异无统计学意义.4种方法有很好的相关性.CTP评分的最佳界值点是8分,MELD评分是14分,当CTP评分>8分,或MELD评分>14分,死亡率明显提高(3.6% vs 50%;7.1% vs 53.8%),差异有统计学意义(P<0.01).结论 CTP评分、CTP分级、iMELD评分、MELD评分4种方法均有较好的死亡辨别能力.CTP评分较其他3种方法(CTP分级、MELD评分、iMELD评分)可以更好地预测肝硬化食管静脉曲张破裂出血住院30天内的结局.