四种基于MELD的评分系统对慢加急性乙型肝炎肝衰竭患者短期生存的预测价值分析

摘要

Objective To validate the prediction of short-term survival by four scoring systems based on models for end-stage liver disease(MELD)in patients with acute-on-chronic hepatitis B-induced liver failure (HBV-ACLF). Methods 67 patients with HBV-ACLF were enrolled in this study between April 2015 and October 2017. The clinical parameters were collected for calculation of MELD,iMELD,MELD-Na and MESO scores,respectively. The predictive efficacy on forecasting survival of patients with HBV-ACLF by the four scoring systems was analyzed by receiver operating characteristic curve(ROC)supported by MedCalc15.8 software. Results 45(67.2%)out of 67 patients with HBV-ACLF died within 12 weeks;the scores of MELD,iMELD, MELD-Na and MESO models at presentation in survival group were(22.12±3.24),(41.59±5.30),(22.55±4.07) and(1.64±0.24),much lower than[(30.47±9.01),(51.88±11.09),(32.35±11.58)and(2.28±0.70),respectively,P<0.01]in the dead group;the area under the ROC curve(AUC)in forecasting the survival of patients with HBV-ACLF by the four models were 0.814,0.802,0.806 and 0.817 respectively,the cut -off -values were 22.70,47.76,22.16 and 1.69,and the Jordan index were 0.5040,0.5535,0.4808 and 0.4818,respectively,suggesting no significant differences between them(P>0.05). Conclusion The four scoring systems base on MELD have good predictive efficacy on forecasting 12 weeks'survival in patients with HBV-ACLF,which hints they might be applied in clinical practice.%目的 比较终末期肝病模型(MELD)及其衍生模型iMELD、MELD-Na和MESO对乙型肝炎相关性慢加急性肝衰竭(HBV-ACLF)患者12周生存预后的评估价值.方法 按照现行中国肝衰竭诊治指南的诊断标准纳入67例HBV-ACLF患者,收集患者诊断成立时的相关实验室检测指标,分别计算MELD、iMELD、MELD-Na和MESO模型评分,应用MedCalc 15.8软件分析比较受试者工作特征曲线(ROC),确定MELD及其衍生评分系统对ACLF患者12周死亡风险预测的最佳截断点和约登指数,以评价不同评分预测ACLF患者短期生存的效能.结果 在治疗12周内,在67例HBV-ACLF患者中,死亡45例(67.2%);入组时,生存组MELD、iMELD、MELD-Na和MESO评分分别为(22.12±3.24)、(41.59±5.30)、(22.55±4.07)和(1.64±0.24),显著低于死亡组[分别为(30.47± 9.01)、(51.88±11.09)、(32.35±11.58)和(2.28±0.70),P<0.01];MELD、iMELD、MELD-Na和MESO模型预测患者12周生存的ROC曲线下面积分别为0.814、0.802、0.806和0.817,其最佳截断点分别为22.70、47.76、22.16和1.69,约登指数分别为0.5040、0.5535、0.4808和0.4818,提示四种模型的预测效能比较,均无显著性差异(P>0.05).结论 MELD、iMELD、MELD-Na和MESO四种评分系统对于HBV-ACLF患者12周生存情况均具有良好的预测能力,可根据实际情况,选择应用.