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MELD、MELD-Na评分及KCH标准对妊娠期急性肝衰竭患者预后的评估价值
Value of MELD score, MELD-Na score, and King′s College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy
文章发布日期:2018年06月07日  来源:  作者:韩璞青,孙嫣  点击次数:385次  下载次数:71次

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【摘要】:目的 探讨MELD、MELD-Na评分及欧洲皇家学院医院标准(KCH标准)对妊娠期急性肝衰竭患者的预后评估价值。方法 选取广州医科大学附属第三医院2010年1月1日-2017年6月30日以妊娠合并急性肝衰竭为首要诊断入院的妊娠期患者50例,根据预后情况分为死亡组和生存组,根据MELD、MELD-Na及KCH标准对患者进行评分,评估不同模型与患者预后转归的关系。计量资料两组间比较采用t检验或Mann-Whithey U检验;计数资料组间比较采用χ2检验。绘制受试者工作特征曲线(ROC曲线),计算各模型的敏感度、特异度、阳性预测值和阴性预测值,用ROC曲线下面积(AUC)衡量3种模型对妊娠期肝衰竭患者预后的预测价值。结果 50例妊娠期急性肝衰竭患者中,死亡14例,生存36例,病死率为28.0%。与生存组入院时比较,死亡组MELD评分[(39.66±5.17)分 vs (29.63±6.19)分]、MELD-Na评分[(43.89±9.85)分 vs (31.32±7.29)分]均明显升高(t值分别为5.36、4.94,P值均<0.05);入院3 d后,死亡组患者MELD评分[(44.24±3.96)分 vs (28.74±3.84)分]、MELD-Na评分[(46.34±5.14)分 vs (32.42±4.95)分]亦显著高于生存组(t值分别为-12.68、-8.82,P值均<0.05)。满足KCH标准的患者其病死率与不满足KCH标准的患者病死率相比,差异无统计学意义(8/25 vs 6/25,χ2=0.397,P=0.754)。ROC曲线分析显示,基线MELD、MELD-Na及KCH标准的AUC分别为0.885[95%可信区间(95%CI):0.781~0.988,P<0.01]、0.873(95%CI:0.764~0.982,P<0.01)、0.548(95%CI:0.392~0.670,P<0.05),敏感度分别为71.4%、78.6%、57.1%,特异度分别为94.4%、88.9%、52.7%。将基线MELD和MELD-Na评分根据ROC曲线临界值进行分组,分析结果显示,随着MELD和MELD-Na分值升高,患者病死率亦增高(χ2值分别为21.337、17.294,P值均<0.001)。结论 MELD、MELD-Na评分及KCH标准均能在不同程度上反映妊娠期急性肝衰竭患者的预后,且MELD和MELD-Na评分具有更好的临床指导价值。
【Abstract】:Objective To investigate the value of the Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and King′s College Hospital (KCH) criteria in evaluating the prognosis of patients with acute liver failure (ALF) of pregnancy. Methods A total of 50 patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2010 to June 30, 2017 with ALF of pregnancy as the initial diagnosis were enrolled, and according to prognosis, they were divided into death group and survival group. The patients were evaluated using the MELD score, MELD-Na score, and KCH criteria, and the association between these models and prognosis was analyzed. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted; the sensitivity, specificity, positive predictive value, and negative predictive value of each model were calculated; the area under the ROC curve (AUC) was used to analyze the value of these three models in predicting the prognosis of patients with ALF of pregnancy. Results Of all 50 patients, 14 died and 36 survived, resulting in a mortality rate of 28.0%. Compared with the survival group on admission, the death group had significant increases in MELD score (39.66±5.17 vs 29.63±6.19, t=5.36, P<0.05) and MELD-Na score (43.89±9.85 vs 31.32±7.29, t=4.94, P<0.05). On day 3 after admission, the death group had significantly higher MELD score and MELD-Na score than the survival group (MELD score: 44.24±3.96 vs 28.74±3.84, t=-12.68, P<0.05; MELD-Na score: 46.34±5.14 vs 32.42±4.95, t=-8.82, P<0.05). There was no significant difference in mortality rate between the patients who met the KCH criteria and those who did not (8/25 vs 6/25, χ2=0.397, P=0.754). The ROC curve analysis showed that baseline MELD score had an AUC of 0.885 (95% confidence interval [CI]: 0.781-0.988, P<0.01), a sensitivity of 71.4%, and a specificity of 94.4%; MELD-Na score had an AUC of 0.873 (95% CI: 0.764-0.982, P<0.01), a sensitivity of 78.6%, and a specificity of 889%; KCH criteria had an AUC of 0.548 (95% CI: 0.392-0.670, P<0.05), a sensitivity of 57.1%, and a specificity of 52.7%. Baseline MELD score and MELD-Na score were divided into groups according to the cut-off value of ROC curve, and the analysis showed that the mortality rate of patients increased with the increases in MELD score and MELD-Na score (χ2=21.337 and 17.294, both P<0.001). Conclusion MELD score, MELD-Na score, and KCH criteria can predict the prognosis of patients with ALF of pregnancy, and MELD score and MELD-Na score have a better clinical value than the KCH criteria.
【关键字】:肝功能衰竭,急性;妊娠;预后
【Key words】:liver failure, acute; pregnancy; prognosis
【引证本文】:HAN PQ, SUN Y. Value of MELD score, MELD-Na score, and King′s College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy[J]. J Clin Hepatol, 2018, 34(7): 1508-1513. (in Chinese)
韩璞青, 孙嫣. MELD、MELD-Na评分及KCH标准对妊娠期急性肝衰竭患者预后的评估价值[J]. 临床肝胆病杂志, 2018, 34(7): 1508-1513.

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