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目的 探讨终末期肝病模型 (MELD)对肝硬化住院患者预后评估的价值。方法 1999- 0 1～ 2 0 0 3-0 1同济大学东方医院消化科分别记录 16 7例肝硬化患者入院当天的MELD评分和Child Pugh评分 ,检验两种评分系统的相关性 ,以受试者工作特征曲线 (ROC)下面积衡量各评分系统预测患者预后的能力。结果 16 7例住院患者中上消化道出血、肝性脑病、肝肾综合征及自发性腹膜炎等并发症的发生率分别为 33 5 %、2 0 9%、4 8%、6 6 %。在住院期间有 33名患者死亡 ,主要死因是上消化道出血、肝性脑病、肝肾综合征及自发性腹膜炎 ,分别占 39 4 %、30 3%、2 1 2 %、9 1%。生存组MELD及Child Pugh评分分别为 14 1± 5 2 6、8 74± 2 15 ,死亡组分别为 2 3 8± 10 2 ,11 0 3± 2 36 (P <0 0 1) ,MELD评分和Child Pugh评分显著相关 (r =0 71,P <0 0 1)。MELD评分与Child Pugh评分的ROC曲线下面积分别为 0 82 9、0 75 6 (P <0 0 5 )。结论 MELD是住院肝硬化患者生存预后评估的一个较好的预测指数 ,其评估效率优于Child Pugh评分 ,值得临床应用。
Objective To investigate the prognostic value of end-stage liver disease (MELD) in hospitalized cirrhotic patients. Methods 1999 -0 1 ~ 2 0 0 3-0 1 Department of Gastroenterology, Dongfang Hospital, Tongji University were recorded on the day of admission of 16 7 patients with liver cirrhosis MELD score and Child Pugh score to test the correlation between the two scoring system to test subjects The following area measures the ability of each scoring system to predict patient outcomes under the ROC. Results The incidence of complications such as upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome and spontaneous peritonitis in 167 hospitalized patients were 33.5%, 29.0%, 48% and 66% respectively. During the period of hospitalization, 33 patients died. The main causes of death were upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome and spontaneous peritonitis, accounting for 39.4%, 30.3%, 21.2% and 9.1% respectively. The MELD and Child Pugh scores in the survival group were 14 1 ± 52 6,8 74 ± 2 15 and those in the death group were respectively 23 8 ± 10 2 and 113 ± 2 36 (P 0 01). The MELD score and Child Pugh score was significantly correlated (r = 0 71, P <0.01). The area under the ROC curve for MELD and Child Pugh scores was 0 82 9 and 0 756, respectively (P 0 05). Conclusion MELD is a better predictor of survival prognosis in hospitalized patients with cirrhosis, its evaluation efficiency is better than that of Child Pugh score, which is worthy of clinical application.