重型病毒性肝炎患者预后模型的临床应用分析

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Kaplan-Meier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。

Model for predicting survival of patients with severe virus hepatitis and its clinical application

OBJECTIVE: To study prospectively the short-time survival of patients with severe virus hepatitis using model of severe liver diseases (MSLD) established by our previous study. METHODS: One hundred and three patients with severe hepatitis were included by cohort study. Of them, there were 85 patients with severe chronic hepatitis patients, 10 acute and 8 subacute severe hepatitis patients, respectively. The follow-up endpoint was 6 months. The cutoff score of the MSLD was determined by receiver operating characteristic cure (ROC) statistic analysis, and the survival of severe hepatitis patients in 2 weeks, 4 weeks, 3 months and 6 months were estimated by Kaplan-Meier statistic analysis. RESULTS: The cutoff MSLD score for predicting survival was 5. The survival curves of group A (total MSLD score< or =4) was significantly better than group B (total MSLD score> or =5, P<0.000). After treatment for 2 weeks, the survival rate in 2 weeks and 4 weeks was 37.9% and 3.5%, respectively, if MSLD score had no change or increased. The survival rate in 2 weeks, 4 weeks and 3 months was respectively 61.5%, 15.4%, 5.8% if the MSLD score decreased 1. Then, the survival in 2 weeks, 4 weeks, 3 months and 6 months was respectively 95.0%, 90.0%, 63.9% and 52.4% if MSLD score decreased 2 or more. CONCLUSION: It is suggested that MSLD may be valuable in predicting 6-month survival of severe virus hepatitis patients. It may be used to determine the efficacy of medical treatment and to guide clinical decision.