MELD与CTP对肝硬化患者手术预后的评估.docxVIP

MELD与CTP对肝硬化患者手术预后的评估　　MELD与CTP对肝硬化患者手术预后的评估史新河，康鹏，李朝军　　(乌鲁木齐市第一人民医院外一科，新疆乌鲁木齐830000)摘要　　目的：研究终末期肝病模型及Child-Turcotte-Pugh(CTP)评分对肝硬化患者手术预后的评估。方法：对70例肝硬化病例，计算术前MELD和CTP评分，分析二者相关性及不同分组下并发症发生率差异情况。以受试者工作特征曲线(ROC)下面积衡量各模型的预测能力。结果：23例发生术后并发症。并发症、无并发症组MELD与CTP分值比较差异有统计学意义。MELD＜14、14≤MELD＜24、MELD≥24患者并发症发生率分别为10.0%、35.7%和83.3%。CTP分级A级、B级、C级并发症发生率分别为10.3%、36.0%和68.8%。各组间差异有统计学意义。MELD与CTP评分显著相关。ROC下面积MELD为0.877,CTP为0.852,差异无统计学意义(U=0.157，P＞0.05)。结论：MELD及CTP评分均能准确预测肝硬化患者围手术期并发症,临床应用宜相互结合，以进一步提高预测准确度。　　关键词：肝硬化；终末期肝病模型；Child-Turcotte-Pugh评分　　Applicationofthemodelforend-stageliverdiseaseandChild-Turcotte-Pughsystemtoevaluatethesurgicalprognosisofpatientswithcirrhosis　　SHIXin-he,KANGPeng,LIChao-jun　　(DepartmentofSurgery,FirstHospital,XinjiangUrumqi830000)Abstract　　Objective:Toinvestigatetherelationshipbetweenthemodelforend-stageliverdisease(MELD)andChild-Turcotte-Pugh(CTP)scoringusedinpredicttheprognosisofpatientswithcirrhosis.　　Method:Collectedseventypatientswithcirrhosis.CalculationofMELDandCTPscorebeforesurgery，analysisofcorrelationbetweenthetwomodelsanddifferenceofthedifferentgroupsunderthesituationofincidenceofcomplications.Usetheareaunderthereceiveroperatingcharacteristiccurve(ROC)tomeasurethepredictiveabilityofeachmodel.　　Results:Twentythreecasesappearedpostoperativeseriouscomplications.ComplicationsandnocomplicationgroupMELDandCTPscoredifferencehasstatisticallysignificant.MELD＜14,14≤MELD＜24andMELD≥24groupswithcomplicationrateswere10.0%、35.7%and83.3%.CTPscoreA、BandCgroupswithcomplicationrateswere10.3%、36.0%and68.8%.Thedifferencebetweeneachgroupshasstatisticallysignificant.MELDscoreshowedsignificantcorrelationswithCTP.TheareaundertheROC:MELDwas0.877,CTPwas0.852,Thedifferencebetweenthetwogroupshasnostatisticallysignificant(U=0.157，P＞0.05).　　Conclusion:BothMELDandCTPscorescanaccuratelypredicttheshorttermprog-nosisofpatientswithlivercirrhosis.　　Keywords:Cirrhosis;modelforend-stageliverdisease(MELD);　　Child-Turcotte-Pugh(CTP)system　　终末期肝病模型(MELD)作为一种新型的肝脏储备功能评估方法，在肝脏疾病的预后评估中被证实