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目的探讨MELD评分及Child-Pugh分级对失代偿期肝硬化患者预后评估的应用价值。方法回顾性分析2000-01～2004-11北京大学人民医院收治的失代偿期肝硬化患者41例死亡病例及71例好转出院病例MELD评分及Child-Pugh分级并进行比较。结果MELD分值死亡者(17.93±8.22),出院者(11.18±6.54)(t=4.781,P=0.000)。Child-Pugh分值死亡者(10.07±1.84),出院者(8.04±2.09)(t=5.179,P=0.000)。MELD≤9分者占死亡患者的14.63%,占出院患者的42.25%(χ2=9.09,P=0.003)。20～29分者占死亡患者的26.83%,占出院患者的8.45%(χ2=6.819,P=0.009)。ChildA级占死亡患者的21.95%,占出院患者的56.34%(χ2=12.488,P=0.000)。ChildC级占死亡患者的29.27%,占出院患者的5.63%(χ2=11.857,P=0.001)。结论死亡与存活患者MELD与Child-Pugh评分显著不同。低MELD评分患者预后好于高MELD评分者。ChildA级患者预后优于ChildC级者。MELD评分可对失代偿期肝硬化患者病情严重程度及预后作出判断。
Objective To investigate the value of MELD and Child-Pugh classification in the prognosis evaluation of patients with decompensated cirrhosis. Methods A total of 41 deaths and 71 MELs and Child-Pugh grading from patients with decompensated cirrhosis who were admitted to Peking University People’s Hospital from January 2000 to 2004 were retrospectively analyzed. Results The MELD score of death was (17.93 ± 8.22) and discharged (11.18 ± 6.54) (t = 4.781, P = 0.000). Child-Pugh scores were (10.07 ± 1.84), discharged (8.04 ± 2.09) (t = 5.179, P = 0.000). MELD ≤ 9 points accounted for 14.63% of deaths, accounting for 42.25% of discharged patients (χ2 = 9.09, P = 0.003). 20 ~ 29 points accounted for 26.83% of deaths, accounting for 8.45% of discharged patients (χ2 = 6.819, P = 0.009). ChildA grade accounted for 21.95% of deaths, accounting for 56.34% of discharged patients (χ2 = 12.488, P = 0.000). ChildC accounted for 29.27% of deaths, accounting for 5.63% of discharged patients (χ2 = 11.857, P = 0.001). Conclusion The MELD and Child-Pugh scores of death and survival patients were significantly different. Patients with a lower MELD score have a better prognosis than those with a high MELD score. Child class A patients with prognosis better than ChildC class. The MELD score can determine the severity and prognosis of patients with decompensated cirrhosis.