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目的评价重型肝炎患者预后评分模型(MSLD)的临床应用价值。方法应用我们已建立的MSLD,采用队列研究方法前瞻性分析103例重型肝炎患者的生存时间,其中慢性者85例,亚急性者8例,急性者10例,随访终点为6个月。根据受试者工作特征曲线(ROC)确定MSLD最佳危险值;应用KaplanMeier进行统计分析,预测患者2周、4周、3个月和6个月的生存率。结果MSLD分数值=5为最佳危险值;MSLD总分≤4分(A组)和MSLD总分≥5分(B组)两组患者的生存曲线有明显差异(近期及远期危险性差异均有显著性(P均<0.000)。经内科治疗2周后,总分无变化或增加者的2周和4周生存率分别为37.9%和3.5%;总分降低1分者的2周、4周和3个月生存率分别为61.5%、15.4%和5.8%;总分降低2分以上者的2周、4周、3个月和6个月的生存率分别为95.0%、90.0%、63.9%和52.4%(P均<0.001)。结论MSLD对预测重型肝炎患者近期预后(6个月内)具有重要意义,并可作为预测内科治疗重型肝炎疗效的指标之一。
Objective To evaluate the clinical value of prognosis scoring model (MSLD) in patients with severe hepatitis. Methods Using our established MSLD, we prospectively analyzed the survival time of 103 patients with severe hepatitis using a cohort study. Among them, 85 patients were chronic, 8 patients were subacute and 10 patients were acute. The mean follow-up time was 6 months. According to the receiver operating characteristic curve (ROC) to determine the best MSLD risk value; using KaplanMeier statistical analysis to predict the patients 2 weeks, 4 weeks, 3 months and 6 months survival rate. Results The score of MSLD = 5 was the best risk value. There was a significant difference in survival curves between MSLD score 4 points (group A) and MSLD score 5 points (group B) (short-term and long-term risk difference (P <0.000) .After 2 weeks of medical treatment, the 2 weeks and 4 weeks survival rate of no change or increase of the total score was 37.9% and 3.5% respectively; the total score decreased 1 point for 2 weeks The survival rates at 4 weeks and 3 months were 61.5%, 15.4% and 5.8% respectively. Survival rates at 2 weeks, 4 weeks, 3 months and 6 months with a total score of 2 points or less were 95.0% and 90.0%, respectively %, 63.9% and 52.4%, respectively (all P <0.001) .Conclusion MSLD is of great significance in predicting the recent prognosis (within 6 months) of patients with severe hepatitis and can be used as an index to predict the efficacy of medical treatment of severe hepatitis.