Comparison of four scoring models in predicting short-term prognosis of chronic severe hepatitis B patients
-
摘要: 目的比较四种评分模型(MELD、MELD-Na、SMSVH及CTP)对慢性重型乙型肝炎患者短期预后的预测价值。方法记录住院后确诊慢性重型乙型肝炎85例患者的临床指标并随访3个月的生存情况,分为生存组和死亡组,并用MELD、MELD-Na、SMSVH和CTP评分模型进行评分。应用受试者工作特征曲线(ROC)评价每一个模型的预测能力,根据各自的最佳临界值用Kaplan-Meier(K-M)分析患者生存时间、生存率,并算出总预测正确率。结果死亡组MELD-Na、MELD、SMSVH和CTP的平均分值明显高于生存组(P<0.01)。四者ROC曲线下面积分别为0.848、0.833、0.802和0.75。四者的预测能力比较,差异无统计学意义(χ2=6.64,P=0.084)。四者的总预测正确率分别为(82.35%、77.64%、77.65%、71.76%),差异亦无统计学意义(χ2=2.737,P=0.434)。结论 MELD、MELD-Na、SMSVH和CTP评分模型对慢性重型乙型肝炎患者短期预后判断有较好的作用,四种评分模型预测价值无统计学差异,四者预测价值相当。Abstract: Objective Compare the clinical values of four scoring models, including the model for endstage liver disease (MELD) , MELD-Na, Scoring model of severe viral hepatitis (SMSVH) and Child-Turcotte-Pugh (CTP) scoring models, to predict the short-term prognosis of the patients with chronic severe hepatitis B.Methods Clinical information of 85 inpatient patients with chronic severe hepatitis B were recordedand followed up for 3 months.The patients were then divided into survival group and death group.All the patients were evaluated according to MELD, MELD-Na, SMSVH and CTP scoring models.The receiver operating characteristic curve (ROC) were used to compare the predictive ability of each model.Estimate the survival time and the survival rate by Kaplan-Meier (K-M) method and calculatethe total predictive agreement rate according to respective optimum cut-off value.Results The average scores of MELD-Na, MELD, SMSVH and CTP scoring models in the death group were greater than that in the survival group (P < 0.01) .The area under the curve (AUC) were 0.848, 0.833, 0.802 and 0.752 respectively.There were no difference of the predictive power and total predictive agreement rates of four models (χ2 = 6.64, P = 0.084) (χ2 = 2.737, P = 0.434) .The total predictive agreement rates of four models were 82.35%, 77.64%, 77.65% and 71.76% respectively.Conclusion MELD-Na, MELD, SMSVH and CTP scoring models has better effect in predicting short-term prognosis of the patients with chronic severe hepatitis B.There were no significant differences in predictive power.The clinical value of four scoring models were approximate.
-
Key words:
- hepatitis B /
- chronic /
- prognosis
-
[1]中华医学会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) ∶56~62. [2]中华医学会感染病学分会肝衰竭与人工肝组、中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华肝脏病杂, 2006, 14 (9) ∶643~646. [3] 陆再英, 钟南山.内科学[M].第7版.北京:人民卫生出版社, 2008∶453. [4] 杨长青, 袁敏.肝硬化的预后评估[J].肝脏, 2008增刊:62~67. [5]周莉, 董培玲, 丁惠国, 等.重型病毒性肝炎患者预后评分模型与晚期肝病模型的比较[J].临床荟萃, 2006, 21 (8) ∶539~542. [6]Biggins SW, Kim WR, Terrault NA, et al.Evidencebased incorporation of serum concentation into MELD[J].Gastroenterology, 2006, 130 (6) ∶1652-1660.
本文二维码
计量
- 文章访问数: 4153
- HTML全文浏览量: 8
- PDF下载量: 809
- 被引次数: 0