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目的探讨在判断HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者预后方面,终末期肝病模型(model for end-stage liver disease,MELD)评分的动态变化是否优于基线MELD评分。方法前瞻性收集2009—2011年在我国4家医院住院治疗的HBV-ACLF患者的临床资料,包括临床表现、实验室检查及转归等,研究MELD评分动态变化与转归的关系。结果①纳入的82例90 d病死率为37.80%。死亡组患者基线MELD评分为(25.50±4.77)分,与存活组[(23.72±4.68)分]相比,差异无统计学意义(P=0.101)。但是从入组第7天开始,死亡组MELD评分逐渐升高,存活组MELD评分逐渐下降,此后各时间点2组MELD评分相比差异均有统计学意义。②低危组(基线MELD评分≤23分者)从第14天开始,存活患者MELD评分显著低于死亡患者[(16.04±4.00)分vs(29.39±12.30)分,P<0.05],高危组(基线MELD评分>23分者)从第7天开始,存活患者MELD评分显著低于死亡患者[(22.38±4.91)分vs(28.92±6.76)分,P=0.001],并且随着时间推移,差距逐渐增加。结论判断HBV-ACLF的预后应在基线MELD评分基础上,注意其动态变化,这将有助于提高预测的准确性。
Objective To investigate the dynamic change of MELD score in the prognosis of patients with HBV-related acute-on-chronic liver failure (HBV-related acute-on-chronic liver failure) Is better than the baseline MELD score. Methods The clinical data of HBV-ACLF patients hospitalized in 4 hospitals in China from 2009 to 2011 were prospectively collected, including clinical manifestations, laboratory tests and prognosis. The relationship between the dynamic changes of MELD score and outcome was studied. Results ① 82 cases of 90 d mortality was 37.80%. The baseline MELD score of death group was (25.50 ± 4.77) points, which was not significantly different from that of survival group [(23.72 ± 4.68) points] (P = 0.101). However, from the 7th day after admission, the MELD score of death group gradually increased and the MELD score of survivors decreased gradually. There was significant difference in MELD score between two groups at each time point afterwards. ② In the low-risk group (baseline MELD score ≤23), the MELD score of surviving patients was significantly lower than that of the patients who died at the 14th day [(16.04 ± 4.00) vs (29.39 ± 12.30) points, P <0.05] (MELD score> 23 points) From the 7th day onwards, the MELD score of survivors was significantly lower than that of the patients who died [(22.38 ± 4.91) vs (28.92 ± 6.76), P = 0.001], and with the passage of time, The gap gradually increased. Conclusion The prognosis of HBV-ACLF should be based on the baseline MELD score, pay attention to its dynamic changes, which will help to improve the accuracy of the prediction.