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目的评估终末期肝病模型评分动态变化(delta MELD)对失代偿期肝硬化患者短期和中期生存预测的价值。方法以97例临床资料完整的住院失代偿期肝硬化患者为研究对象,分别计算每例患者入院当天及人院1个月后的MELD评分与Child-Turcotte-Pugh(CTP)评分,两次MELD评分的差值为delta MELD,以受试者工作曲线(ROC)下面积衡量delta MELD、MELD、CTP预测患者预后的能力,所有患者随访1年。结果97例患者随访3个月内有10例患者死亡,死亡组delta MELD(3.23±2.77)与生存组(0.15±0.39)比较差异有统计学意义(P<0.001);随访第1年内有18例患者死亡,死亡组delta MELD) (3.00±2.54)与生存组(0.12±0.42)比较差异有统计学意义(P<0.001);delta MELD、MELD、CTP评分对3个月预后评估的ROC曲线面积分别为0.835,0.782,0.745,对1年预后评估的ROC曲线下面积分别为0.812,0.768.0.721.delta MELD对肝硬化患者短期及中期预后评估价值显著优于初始MELD及CTP评分(P<0.01)。结论delta MELD可确切地预测肝硬化患者的短期和中期预后,且其评估价值优于初始MELD及CTP评分,值得扩大病例数作更客观评价,以期临床推广应用。
Objective To assess the value of delta MELD in the prediction of short-term and medium-term survival in patients with decompensated cirrhosis. Methods A total of 97 patients with in-patient decompensated cirrhosis were enrolled in this study. The MELD score and Child-Turcotte-Pugh (CTP) score of each patient on the day of admission and one month after hospitalization were calculated. The difference in MELD scores was delta MELD, and the ability to predict the prognosis of patients with delta MELD, MELD, and CTP was weighed under the receiver operating curve (ROC), and all patients were followed up for 1 year. Results 97 patients were followed up for 3 months and 10 patients died. There was a significant difference between the death MELD (3.23 ± 2.77) and the survival group (0.15 ± 0.39) (P <0.001). In the first year after follow-up, there were 18 (P <0.001). The ROC curve of delta MELD, MELD and CTP scores in evaluating the 3-month prognosis was significantly lower than that in the survival group (3.00 ± 2.54 vs 0.12 ± 0.42) Area were 0.835,0.782,0.745, respectively, and the area under the ROC curve for one-year prognosis was 0.812,0.768.0.721 respectively.delta The MELD value of short-term and mid-term prognosis of patients with cirrhosis was significantly better than that of initial MELD and CTP (P < 0.01). Conclusion The results of delta MELD can predict the short-term and mid-term prognosis of patients with cirrhosis accurately, and its evaluation value is superior to the initial MELD and CTP scores. It is worth to expand the number of cases for more objective evaluation, with a view to clinical application.