【摘要】：目的：比較基線及動(dòng)態(tài)終末期肝病模型(Model for end-stage liver disease, MELD)、MELD-Na評(píng)分在評(píng)價(jià)肝衰竭近期預(yù)后中的價(jià)值,尋找較好的預(yù)后判斷方法。方法：回顧性分析322例肝衰竭住院患者病例資料,按照肝衰竭不同類型分開敘述,分別計(jì)算不同階段的MELD、MELD-Na評(píng)分,并計(jì)算△MELD、△MELD-Na分值,比較3個(gè)月時(shí)存活組和死亡組各評(píng)分的差異,并應(yīng)用ROC曲線評(píng)價(jià)每個(gè)模型的預(yù)測(cè)價(jià)值。結(jié)果：急性、亞急性,慢加急性和慢性肝衰竭預(yù)后差異較大(X2=14.273,P=-0.001),短期病死率分別為77.4%、41.7%和56.1%。急性、亞急性肝衰竭患者中,各評(píng)分系統(tǒng)相互比較時(shí)P值均0.05,無法評(píng)價(jià)各評(píng)分系統(tǒng)優(yōu)劣；慢加急性肝衰竭中,△MELD、△MELD-Na分值的AUC分別為0.889、0.897,二者無明顯差異(Z=0.310,P=0.7562)；慢性肝衰竭中,AMELD分值的AUC為0.871(靈敏度和特異性為0.740,0.893),優(yōu)于AMELD-Na分值(Z=4.229,P0.05)。結(jié)論：對(duì)急性、亞急性肝衰竭,各評(píng)分預(yù)測(cè)效果均可,但相互之間無統(tǒng)計(jì)學(xué)差異,有待進(jìn)一步研究支持；對(duì)慢加急性肝衰竭,MELD和MELD-Na評(píng)分預(yù)測(cè)能力相似,△MELD、△MELD-Na分值預(yù)測(cè)能力較好；對(duì)慢性肝衰竭,MELD評(píng)分優(yōu)于MELD-Na評(píng)分,且△MELD預(yù)測(cè)準(zhǔn)確性好。
[Abstract]:Objective: to compare the value of (Model for end-stage liver disease, MELD), MELD-Na score between baseline and dynamic end-stage liver disease models in evaluating the short-term prognosis of liver failure and to find a better prognostic method. Methods: the data of 322 inpatients with liver failure were analyzed retrospectively. According to the different types of liver failure, the MELD,MELD-Na scores of different stages were calculated, and the MELD, MELD-Na scores were calculated. The scores of survival group and death group were compared at 3 months, and the predictive value of each model was evaluated by ROC curve. Results: the prognosis of acute, subacute, slow plus acute and chronic liver failure was significantly different (X2 + 14. 273 P + 0.001). The short-term mortality was 77.4% and 56.1%, respectively. In patients with acute and subacute hepatic failure, the P value of each scoring system was 0.05, which could not be evaluated, the AUC of MELD, MELD-Na score in chronic and acute hepatic failure patients was 0.889 鹵0.897, and there was no significant difference between the two groups (Z _ (0.310) P _ (0.7562). In chronic liver failure, the AUC of AMELD score was 0.871 (sensitivity and specificity 0.740g 0.893), which was superior to AMELD-Na score (ZH 4.229 P 0.05). Conclusion: for acute and subacute liver failure, each score can predict the effect, but there is no statistical difference between each other, so it needs further research support, for slow and acute liver failure, MELD and MELD-Na scores have similar predictive ability. For chronic liver failure, MELD score was better than MELD-Na score, and MELD prediction accuracy was good.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.3

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