發(fā)布時(shí)間：2018-01-27 03:01

  本文關(guān)鍵詞： 重型肝炎 終末期肝病模型 人工肝 預(yù)后　出處：《廣東醫(yī)學(xué)》2015年14期 　論文類型：期刊論文

【摘要】：目的觀察終末期肝病模型(MELD)評(píng)分系統(tǒng)預(yù)測重型乙型肝炎患者短期(治療3個(gè)月)預(yù)后情況,探討MELD評(píng)分系統(tǒng)對其短期預(yù)后的預(yù)測能力及臨床價(jià)值。方法對65例重型乙型肝炎患者分別進(jìn)行人工肝聯(lián)合常規(guī)內(nèi)科綜合治療(觀察組,n=33)和常規(guī)內(nèi)科綜合治療(對照組,n=32),應(yīng)用MELD評(píng)分系統(tǒng)對研究對象進(jìn)行評(píng)分,觀察兩組在治療前、治療后1個(gè)月評(píng)分變化及治療后3個(gè)月死亡情況。比較兩組治療前的總膽紅素(TBIL)、肌酐(Cr)、凝血酶原時(shí)間(PT)的國際標(biāo)準(zhǔn)化比率(INR)、血清鈉(Na+)及MELD評(píng)分值。計(jì)算ROC曲線下面積來進(jìn)一步評(píng)價(jià)MELD評(píng)分對乙型肝炎后重型肝炎患者人工肝治療3個(gè)月后預(yù)后的預(yù)測價(jià)值。結(jié)果治療后1個(gè)月兩組的MELD評(píng)分均較治療前有所下降,觀察組MELD20、20≤MELD30和30≤MELD40患者的評(píng)分與治療前比較差異有統(tǒng)計(jì)學(xué)意義(t=2.120、4.715、4.657,均P0.05),對照組20≤MELD30和30≤MELD40患者的評(píng)分與治療前比較差異有統(tǒng)計(jì)學(xué)意義(t=2.092、2.130,均P0.05);治療后,觀察組20≤MELD30和30≤MELD40患者的評(píng)分與對照組比較差異有統(tǒng)計(jì)學(xué)意義(t=2.092、2.130,均P0.05)。治療后3個(gè)月時(shí)觀察組不同分值病死率均≤對照組,但兩組比較差異無統(tǒng)計(jì)學(xué)意義(醊2=0.775,P=0.329)。應(yīng)用該模型判斷患者3個(gè)月內(nèi)死亡與否的最佳MELD臨界值,觀察組為32,敏感度為67.82%,特異度為85.19%;而對照組的最佳臨界值為24,敏感度為80.27%,特異度為69.33%。MELD分值預(yù)測觀察組死亡的ROC曲線下面積大于對照組。結(jié)論MELD評(píng)分能較好地預(yù)測重型肝炎患者人工肝聯(lián)合內(nèi)科綜合治療的短期(3個(gè)月)臨床預(yù)后,值得臨床推廣使用。
[Abstract]:Objective to observe the prognosis of patients with severe hepatitis B in the short term (3 months after treatment) by MELD- scoring system. To explore the predictive ability and clinical value of MELD scoring system for short-term prognosis. Methods 65 patients with severe hepatitis B were treated with artificial liver combined with routine medical treatment (observation group). MELD scoring system was used to evaluate the subjects of the study. The two groups were observed before treatment. The changes of score 1 month after treatment and death at 3 months after treatment were compared between the two groups before the treatment of total bilirubin TBILL, creatinine (Cr). The international standard ratio of prothrombin time (PTT) is INR). Serum Na). The area under the ROC curve was calculated to further evaluate the value of MELD score in predicting the prognosis of patients with severe hepatitis B after 3 months of artificial liver therapy. The MELD scores of all patients were lower than those before treatment. The scores of MELD20 鈮，

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