MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后预测价值的Meta分析

张辉; 贾雷; 姚士伟; 崔培林; 徐有青

doi:10.3969/j.issn.1001-5256.2018.09.024

MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后预测价值的Meta分析

DOI: 10.3969/j.issn.1001-5256.2018.09.024

首都医科大学附属北京天坛医院消化内科

基金项目:

北京市优秀人才培养资助项目(2017000021469G217)；

详细信息

中图分类号: R575.3;R512.62
计量
- 文章访问数: 2036
- HTML全文浏览量: 18
- PDF下载量: 399
- 被引次数: 0
出版历程
- 收稿日期: 2018-04-02
- 出版日期: 2018-09-20

Value of MELD combined with serum sodium concentration in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure in China: A meta-analysis

Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University

Research funding:

摘要

摘要:
目的评价MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后的预测价值。方法检索Pub Med、Embase、中国知网、维普、万方等数据库2006年1月-2018年3月发表的中英文文献。应用诊断性试验准确性质量评价工具（QUADAS-2）评价文献质量,检验是否存在阈值效应。根据是否存在异质性分别采用随机效应模型或固定效应模型合并敏感度、特异度、阳性似然比、阴性似然比及诊断比值比,构建拟合受试者工作特征曲线,计算受试者工作特征曲线下面积（AUC）。采用Deek’s漏斗图非对称检验评估是否存在发表偏倚。结果共有8项研究符合纳入标准。共计1386例患者纳入本研究,其中男1173例,占84.6%。各研究纳入患者平均41.346.9岁。异质性检验提示存在显著异质性,采用随机效应模型合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.67[95%可信区间（95%CI）:0.590.75]、0.77（95%CI:0.630.87）、2.89（95%CI:1.844.54）、0.43（95%CI:0...
- 肝炎,乙型 /
- 肝功能衰竭 /
- MELD-Na评分 /
- 预后 /
- Meta分析
Abstract:
Objective To investigate the value of MELD combined with serum sodium concentration (MELD-Na) in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure (ACLF) in China. Methods Pub Med, Embase, CNKI, VIP, and Wanfang Data were searched for related articles in English and Chinese published from January 2006 to March 2018. The second version of Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of each article. The presence or absence of threshold effect was examined. According to the presence or absence of heterogeneity, a random effect model or a fixed effect model was used for pooling sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) . The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. The Deek's funnel plot asymmetry test was used to investigate the presence or absence of publication bias. Results A total of eight studies were included, with a total of 1386 patients, among whom there were 1173 (84. 6%) male patients. The mean age of the patients included in these studies ranged from 41. 3 to 46. 9 years. The tests for heterogeneity showed significant heterogeneity between studies and a random effect model was used for pooling. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR were 0. 67 (95% confidence interval [CI]: 0. 59-0. 75) , 0. 77 (95% CI: 0. 63-0. 87) , 2. 89 (95% CI: 1. 84-4. 54) , 0. 43 (95% CI: 0. 35-0. 52) , and 7. 32 (95% CI: 4. 33-12. 40) , respectively. The AUC was 0. 75 (95 CI: 0. 72-0. 79) . The Deek's funnel plot asymmetry test showed no significant publication bias. Conclusion MELD-Na score has a certain value in predicting the short-term outcome of patients with HBV-related ACLF in China.
- hepatitis B /
- liver failure /
- MELD-Na score /
- prognosis /
- Meta-analysis

HTML全文

参考文献(20)

[1]SARIN SK, KUMAR A, ALMEIDA JA, et al.Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) [J].Hepatol Int, 2009, 3 (1) :269-282.

[2]LIN F.Research advances in clinical diagnosis, prognostic evaluation, and treatment of liver failure[J].J Clin Hepatol, 2016, 32 (9) :1678-1683. (in Chinese) 林锋.肝衰竭的临床诊断, 预后评估和治疗进展[J].临床肝胆病杂志, 2016, 32 (9) :1678-1683.

[3]BIGGINS SW, KIM WR, TERRAULT NA, et al.Evidence-based incorporation of serum sodium concentration into MELD[J].Gastroenterology, 2006, 130 (6) :1652-1660.

[4]WHITING PF, RUTJES AW, WESTWOOD ME, et al.QUADAS-2:A revised tool for the quality assessment of diagnostic accuracy studies[J].Ann Intern Med, 2011, 155 (8) :529-536.

[5] GAO GS, ZHU HC.Value of MELD, MELD combined with serum sodium concentration, and integrated MELD scoring system in evaluating the short-term prognosis of patients with hepatitis B-related acute-on-chronic liver failure[J].Chin J Intern Med, 2010, 49 (12) :1057-1059. (in Chinese) 高国生, 朱海超.终末期肝病模型 (MELD) , MELD-Na及i MELD评分系统对乙型肝炎慢加急性肝衰竭患者短期预后的评价[J].中华内科杂志, 2010, 49 (12) :1057-1059.

[6]HE WP, HU JH, TONG JJ, et al.Comparison of MELD-Na versus MELDNa in the prediction of short-term prognosis for acuteon-chronic hepatitis B liver failure[J].Natl Med J China, 2011, 91 (17) :1173-1177. (in Chinese) 何卫平, 胡瑾华, 童晶晶, 等.比较MELD-Na评分和MELD-Na评分对乙型肝炎慢加急性肝衰竭短期预后的预测价值[J].中华医学杂志, 2011, 91 (17) :1173-1177.

[7]TANG CH, LI ZB, LIU F, et al.Evaluation of short-term prognosis in patients with acute-on-chronic hepatitis B liver failure by four scoring models[J].J Clin Hepatol, 2012, 15 (6) :514-515. (in Chinese) 唐长华, 李志彬, 刘芳, 等.四种评分模型对慢加急性乙型肝炎肝衰竭患者短期预后的评价[J].实用肝脏病杂志, 2012, 15 (6) :514-515.

[8] LI C, YOU SL, LIU HL, et al.The value of the baseline MELDscores, MELD-Na scores and i MELD scores in short-tern prognosis in hepatitis B virus related acute-on-chronic liver failure patients[J].Chin Crit Care Med, 2014, 26 (8) :539-543. (in Chinese) 李晨, 游绍莉, 刘鸿凌, 等.基线MELD, MELD-Na, i MELD 3种模型对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的评估价值[J].中华危重病急救医学, 2014, 26 (8) :539-543.

[9]CHEN K, CAO X, ZHENG Y, et al.Comparative study of the MELD-Na and Child-Turcotte-Pugh scores as short-term prognostic indicators of acute-on-chronic hepatitis B liver failure[J].Chin J Hepatol, 2014, 22 (11) :801-805. (in Chinese) 陈铿, 曹欣, 郑茵, 等.MELD-Na与CTP评分评估乙型肝炎慢加急性肝衰竭短期预后的对比研究[J].中华肝脏病杂志, 2014, 22 (11) :801-805.

[10]LIU H, SONG LW, CAO WK, et al.The predictive values of four scoring systems in short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure[J].J Clin Hepatol, 2015, 31 (9) :1418-1421. (in Chinese) 刘欢, 宋立文, 曹武奎, 等.四种评分系统对乙型肝炎相关慢加急性肝衰竭患者短期预后的评估价值[J].临床肝胆病杂志, 2015, 31 (9) :1418-1421.

[11]CHEN XB, ZHANG H, YANG JH, et al.Predictive value of three scoring models for end-stage liver disease for short term prognosis in patients with acute-on-chronic hepatitis B liver failure[J].Chin J Infect Dis, 2015, 33 (8) :471-475. (in Chinese) 陈学兵, 张浩, 杨家红.三种终末期肝病评分模型对乙型肝炎慢加急性肝功能衰竭患者短期预后的预测价值[J].中华传染病杂志, 2015, 33 (8) :471-475.

[12]CHEN C, LI J, ZHOU L, et al.Values of different scores for diagnosing short-term prognosis of HBV-related acute-on-chronic liver failure[J].Tianjin Med J, 2017, 45 (4) :413-417. (in Chinese) 陈辰, 李嘉, 周莉, 等.不同评分系统对乙型肝炎相关慢加急性肝衰竭短期预后的诊断价值[J].天津医药, 2017, 45 (4) :413-417.

[13]OHNISHI H, SUGIHARA J, MORIWAKI H, et al.Acute liver failure[J].Ryoikibetsu Shokogun Shirizu, 1994, 7:243-246.

[14]MALINCHOC M, KAMATH PS, GORDON FD, et al.A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology, 2000, 31 (4) :864-871.

[15]KAMATH PS, WIESNER RH, MALINCHOC M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.

[16]RUF AE, KREMERS WK, CHAVEZ LL, et al.Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone[J].Liver Transpl, 2005, 11 (3) :336-343.

[17]WONG VW, CHIM AM, WONG GL, et al.Performance of the new MELD-Na score in predicting 3-month and 1-year mortality in chinese patients with chronic hepatitis B[J].Liver Transpl, 2007, 13 (9) :1228-1235.

[18]HSU CY, LIN HC, HUANG YH, et al.Comparison of the model for end-stage liver disease (MELD) , MELD-Na and MELDNa for outcome prediction in patients with acute decompensated hepatitis[J].Dig Liver Dis, 2010, 42 (2) :137-142.

[19]KIM SY, YIM HJ, LEE J, et al.Comparison of CTP, MELD, and MELD-Na scores for predicting short term mortality in patients with liver cirrhosis[J].Korean J Gastroenterol, 2007, 50 (2) :92-100.

[20]WANG J, WANG AJ, LI BM, et al.MELD-Na:Effective in predicting rebleeding in cirrhosis after cessation of esophageal variceal hemorrhage by endoscopic therapy[J].J Clin Gastroenterol, 2014, 48 (10) :870-877.

施引文献

资源附件(0)

访问统计