MELD、MESO、iMELD 对失代偿期 肝硬化患者短期预后的评估价值

Value of MELD, MESO and iMELD in evaluation of short-term prognosis of patients with decompensated liver cirrhosis

摘要:

目的 评估终末期肝病模型（MELD）、终末期肝病模型与血清钠比值（MESO）、综合终末期肝 病模型评分（iMELD）对失代偿期肝硬化患者短期预后的价值。方法 分别计算112 例失代偿期肝硬化患者 的MELD、MESO、iMELD 分值，运用ROC 曲线及曲线下面积（AUC）比较3 种评分系统判断失代偿期肝 硬化患者短期预后的价值。结果 112 例患者随访3 和6 个月的死亡组与生存组的MELD、MESO、iMELD 评分比较差异有统计学意义。随访3 和6 个月患者的ROC 曲线AUC 比较，iMELD 评分>MESO 评分 >MELD 评分（P <0.05）。结论 MELD、MESO、iMELD 评分均可有效地预测失代偿期肝硬化患者的短期预 后，iMELD 评分优于MESO 评分，MESO 评分优于MELD 评分，经改良后的MELD 能够提高临床预测能力， 具有更高的临床应用价值。

Abstract:

Objective To evaluate the clinical value of model for end-stage liver disease (MELD), MELD to serum sodium ratio (MESO) and integrated MELD (iMELD) in prediction of short-term prognosis of patients with decompensated liver cirrhosis. Methods MELD, MESO and iMELD scores were assessed in 112 patients with decompensated liver cirrhosis. The accuracy of the three scoring systems in predicting survival was analyzed and compared using the area under the receiver operating characteristic (ROC) curve (AUC). Results There were significant differences in MELD, MESO and iMELD scores between the death group and the survival group after follow-up for 3 and 6 m. The AUC value of iMELD score was higher than those of MESO and MELD scores, the AUC value of MESO score was higher than that of MELD score after follow-up for 3 and 6 m (P < 0.05). Conclusions MELD, MESO and iMELD scores can accurately predict the short-term prognosis in patients with decompensated liver cirrhosis, while iMELD score is superior to the MESO score, and MESO score is superior to the MELD score.