meld与ctp评分系统对tips术后患者预后的评价作用的比较.docVIP

MELD与CTP评分系统在TIPS术后患者预后判断评价作用的比较的回顾性临床研究 李灵敏，肖天利，陈文生（第三军医大学西南医院全军消化病研究所，重庆 400038） 摘要：目的 评价终末期肝病评分模型（model for end-stage liver disease，MELD）与Child-Turcotte-Pugh（CTP）评分系统在肝硬化门脉高压患者行经颈静脉肝内门体静脉分流术（Transjugular intrahepatic portosystemic shunt，TIPS）的预后判断中的作用。方法 收集110例行TIPS术的门静脉高压患者基本资料、临床生化指标，计算MELD分值和CTP评分，并观察所有患者的临床转归，比较不同MELD评分（≤15分，＞15分）组及CTP分级（A、B和C级）组的生存率，通过ROC曲线下面积比较这二种模型在术后3个月、1年、2年预后中的预测作用。结果 1) 在随访中，有11名患者死亡，另外4例行肝移植，5例诊断为肝癌。2) MELD评分≤15分患者的生存率明显高于＞15分患者（P＝0.0127），CTP评分为A、B、C级的患者生存率差异显著（P＝0.0341）。3) ROC曲线下面积在3个月时MELD为0.866，CTP为0.863；在1年时MELD为0.755，CTP为0.739；在2年时MELD为0.729，CTP为0.750，差异均无统计学意义（P＞0.05）。结论 MELD与CTP均能较准确地预测TIPS患者的短期生存率，但MELD评分系统设计更客观、全面和科学，临床上值得推广应用。 关键词：门静脉高压；经颈静脉肝内门体分流术；终末期肝病模型 A Retrospective clinic study of MELD versus Child-Turcotte-Pugh score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt Li Ling-min，Xiao Tian-li, Chen Wen-sheng (Institute of Digestive Disease of PLA (Peoples Liberation Army), Southwest Hospital, Third Military Medical University, Chongqing 400038, China) Abstract: Objective To compare the predictive power of model for end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) on the cirrhotic patients who undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods A total of 110 patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) were analyzed. Data of all patients were analyzed retrospectively. The main statistical tests included: Kaplan-Merier analysis to compare survival respectively, and the area of ROC to compare the performance of the two models for predicting 3-month, 1-year, 2-year mortality. Results 1）In the follow-up, 11 patients died. 4 patients underwent orthotopic liver transplantations (OLT), 5 patients were diagnosed hepatocelluar carcinoma. 2）The survival of the patients whose MELD score under 15 were showed significantly higher than the patients above MELD score 15. 3）The area of ROC that predict survival was 0.866 and 0.863 at