终末期肝病模型评分差值对失代偿期肝硬化患者预后评估的价值

目的 评价终末期肝病模型（MELD）近期变化（AMELD）对我国失代偿期肝硬化患者短期（3个月）预后的预测价值。方法回顾性分析具有完整病历资料和随访结果的116例失代偿期肝硬化患者，计算每例患者入院时的MELD值及Child—Pugh评分，1个月后再次行MELD评分，根据两次MELD值之差计算AMELD。并以受试者工作曲线（ROC曲线）及曲线下面积（AUC）比较MELD、Child—Pugh、AMELD预测失代偿期肝硬化患者3个月生存率的准确性。结果116例患者随访3个月内有34例患者死亡，死亡组AMELD（3．43±2．58）与生存组（0．33±0．55）比较差异有统计学意义（P〈0．001）；AMELD、MELD、Child Pugh评分对3个月预后评估的Auc分别为0．845、0．787、0．712，AMELD对失代偿期肝硬化患者短期预后评估价值显著优于初始MELD及Child—Pugh评分（P〈0．01）。结论AMELD是判断失代偿期肝硬化患者短期预后的一个较好的指标，其准确性优于MELD及Child—Pugh评分和分级。

The delta value of model of end stage liver disease in predicting the prognosis of patients with decompensated cirrhosis

Objective To evaluate the prognostic meaning of delta model of end stage liver disease （AMELD） in patients with decompensated cirrhosis. Methods One hundred and sixteen patients with decompensated cirrhosis were retrospectively analyzed. MELD and Child-Pugh score and classification were calculated for each patient at admission and 1 month after. The delta MELD was calculated by subtraction of two MELD scores. The accuracy of MELD, delta MELD and Child-Pugh classification on predicting prognosis in 3 month was assessed by comparing the area under the receiver operating charaeterstic curve （AUC）. Results Thirty four patients died within 3 months, whose delta MELD （3.43 ± 2.58） were higher than those of survivors（0. 33 ± 0. 55） （P〈0. 001 ）. For predicting 3 month prognosis, the AUC of delta MELD, MELD and Child Pugh were 0. 845,0. 787 and 0. 712,respectively（P〈0.01 ）. Conclusion Delta MELD is a useful prognostic indicator for decompensated liver cirrhosis. Predicting the prognosis using AMELD is superior to initial MELD and Child-Pugh score and classification.