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目的评估终末期肝病模型(MELD)近期变化趋势和幅度(ΔMELD)对我国失代偿期肝硬化患者短期(3个月)预后的预测价值。方法回顾性分析具有完整病例资料和随访结果的168例失代偿期肝硬化患者,计算每例患者入院时的MELD值及Child-Pugh评分和分级,1个月后再次行MELD评分,根据2次MELD值之差计算ΔMELD。运用Kaplan-Meier生存分析,计算不同MELD、ΔMELD值间及不同Child-Pugh分级间患者的3个月生存率。并以受试者工作曲线(ROC曲线)及其曲线下面积(AUC)比较MELD、ΔMELD、Child-Pugh评分和分级预测失代偿期肝硬化患者3个月生存率的准确性。结果MELD值各组中除<10组与10～20组外,其他各组间3个月生存率差异均有统计学意义(P<0.05);ΔMELD值各组和Child-Pugh各级间3个月生存率差异均有统计学意义(P<0.05)。ΔMELD、MELD、Child-Pugh分级判断失代偿期肝硬化患者3个月预后的ROC曲线下面积分别为0.825、0.779、0.626,任何两个曲线下面积比较差异均有统计学意义(P<0.05)。结论ΔMELD是一个判断失代偿期肝硬化患者短期(3个月)预后的较好指标,其准确性优于MELD和Child-Pugh评分和分级。
Objective To evaluate the predictive value of short-term (3 months) prognosis of patients with decompensated cirrhosis in China by assessing the recent trend and magnitude (MELD) of end-stage liver disease (MELD). Methods A total of 168 patients with decompensated cirrhosis with complete case data and follow-up were retrospectively analyzed. The MELD and Child-Pugh score and grade at admission of each patient were calculated. The MELD score was again performed after 1 month. According to 2 The difference between MELD values calculates ΔMELD. Kaplan-Meier survival analysis was used to calculate the 3-month survival rates among patients with different MELD, ΔMELD values and between Child-Pugh grading. The accuracy of 3-month survival rate of patients with decompensated cirrhosis was compared by MELD, ΔMELD and Child-Pugh scores by receiver operating curve (ROC curve) and its area under curve (AUC). Results There was significant difference in the 3-month survival rates between MELD groups except <10 and 10-20 groups (P <0.05). The levels of MELD in each group were significantly lower than those in Child-Pugh group 3 The monthly survival rates were statistically significant (P <0.05). The area under the ROC curve of ΔMELD, MELD, and Child-Pugh classification in evaluating the 3-month prognosis of patients with decompensated cirrhosis were 0.825,0.779,0.626 respectively, and the area under any two curves was statistically significant (P <0.05 ). Conclusions ΔMELD is a good indicator of short-term (3 months) prognosis in patients with decompensated cirrhosis, and its accuracy is better than MELD and Child-Pugh scores and grading.