MELD联合多项血清学指标对失代偿期肝硬化患者食管静脉曲张短期再出血的预测

食管静脉曲张破裂出血（EVB）是失代偿期肝硬化患者的常见并发症，预测EVB的危险性对合理选择药物或手术方式、改善疗效和判断预后极为重要。目的：评估MELD评分联合多项血清学指标对失代偿期肝硬化患者首次EVB后短期内再出血的预测价值。方法：收集失代偿期肝硬化的EVB患者168例，其中随访3个月后再出血者51例。检测白细胞、血红蛋白、血小板（PLT）、白蛋白、胆红素、肌酐、ALT、AST、凝血酶原时间国际标准化比值、D．二聚体、血清钠指标，计算MELD评分。应用单因素和Logistic多因素回归分析筛选再出血的独立危险因素，建立回归方程并拟合ROC曲线，比较回归方程和单独MELD评分的曲线下面积（AUC）。结果：D-二聚体（OR=1．2714）、MELD（OR=2．3340）、Na（OR=0．8136）、PLT（OR=0．9431）是引起食管静脉曲张再出血的独立预测因子，回归模型为LogisticP=0．1073＋0．3013×D-二聚体＋1．1132XMELD-0．0688×Na-0．0396×PLT，其AUC明显高于单独MELD评分（0．873对0．738，P=0．0028），敏感性为66．7％，特异性96．1％。结论：MELD评分联合D-二聚体、血清钠、PLT对失代偿期肝硬化患者首次EVB后短期内再出血有较好的预测能力。

MELD Combined with Multiple Serological Indices for Predicting Esophageal Variceal Rebleeding Occurred within A Short Period in Patients with Decompensated Liver Cirrhosis

Esophageal variceal bleeding （EVB） is one of the commonly seen complications in patients with deeompensated liver cirrhosis. It is important to predict the risk of EVB for the rational choosing of drugs or surgery, improving therapeutic efficacy and prognosis. Aims： To investigate the predicting value of MELD combined with multiple serological indices for predicting esophageal varieeal rebleeding （EVRB） occurred within a short period in decompensated liver cirrhotic patients. Methods： One hundred and sixty-eight patients with decompensated liver cirrhotic EVB were enrolled, including 51 patients with rebleeding during a 3-month follow up. White blood cell count, hemoglobin, platelet （PLT）, albumin, bilirubin, ereatinine, ALT, AST, international normalized ratio for prothrombin time, D-dimer, and serum sodium were determined. MELD score was calculated. Independent risk factors for rebleeding were screened by univariate and multivariate Logistic regression analysis, regression model and ROC curve were established. Area under curve （AUC） of regression model and MELD score alone was compared. Results： D-dimer （OR = 1. 2714）, MELD （OR =2. 3340）, serum sodium （ OR = 0. 8136）, PLT （ OR = 0. 9431 ） were independent predictors of rebleeding. Regression model was Logistic P =0. 1073 ＋0.3013 ~ D-dimer ＋ 1. 1132 ~ MELD -0.0688 ~ Na -0.0396 ~ PLT, AUC of model was significantly higher than that of MELD score alone （0. 873 vs. O. 738, P =0.0028） ; sensitivity and specificity of ROC curve were 66.7% and 96.1%, respectively. Conclusions： MELD score combined with D-dimer, serum sodium, PLT can be used for predicting EVRB occurred within a short period in decompensated liver cirrhotic patients.