CTP、MELD、MELD-Na、iMELD评分系统对酒精性肝硬化患者短期预后价值的比较

摘要

Objective To evaluate the clinical value of Child-Pugh( CTP), MELD model, the MELD-Na model and the integrated MELD( iMELD) model on short-term prognostic prediction in patients with decompensated alcoholic liver cirrhosis. Methods The patients were assessed with Child-Pugh (CTP), MELD,MELD-Na and iMELD scores;The accuracy of the four scoring systems on predicting survival were analyzed and compared each other by using the area under the receiver operating characteristic (ROC) curve(AUC). Results Forty-nine patients died within 3 months,whose MELD-Na score( 19.42 ±9.32) were higher than those of survivors(8.79 ±4.34,P<0.01). The scores in dead group were also higher than those in the survival group by CTP,MELD and iMELD scoring system. The AUC values generated from ROC curves for iMELD, MELD-Na and MELD score were higher than those for the Child-Pugh score(P <0. 05). There were no significant differences between iMELD, MELD-Na and MELD scoring system. Conclusion The results suggest that Child-Pugh、MELD、MELD-Na、iMELD score can accurately predict the short-term prognosis in patients with decompensated alcoholic liver cirrhosis, while MELD, MELD-Na, iMELD score is superior to the Child-Pugh score.%目的 比较Child-Turcotte-Pugh评分(CTP评分)、终末期肝病模型(MELD)评分系统、MELD-Na评分系统、integrated MELD(iMELD)评分系统对酒精性失代偿期肝硬化患者短期预后的预测价值.方法 分别计算105例酒精性失代偿期肝硬化患者的CTP、MELD、MELD-Na和iMELD分值,采用Kaplan-Meier法比较生存率,运用ROC曲线及曲线下面积(AUC)比较4种评分系统判断酒精性肝硬化患者短期预后的价值.结果 105例患者随访3个月内死亡49例,死亡组MELD-Na评分[(19.42±9.32)分]与生存组[(8.79±4.34)分]比较差异有统计学意义(P＜0.01),死亡组与生存组的CTP、MELD以及iMELD评分比较差异亦有统计学意义.ROC曲线AUC比较,iMELD评分(0.854)＞MELD-Na评分(0.844)＞MELD评分(0.839)＞CTP评分(0.762).结论 CTP、MELD、MELD-Na和iMELD评分均可有效地预测酒精性失代偿期肝硬化患者的短期预后,且MELD、MELD-Na和iMELD评分对短期评估效率优于CTP评分,能更准确地反映病情的轻重,更具有临床应用价值.