终末期肝病模型及CTP评分系统对土三七相关肝窦阻塞综合征患者预后的预测价值

刘贞利; 范作鹏; 柳雅立; 张晶

doi:10.3969/j.issn.1001-5256.2020.11.013

终末期肝病模型及CTP评分系统对土三七相关肝窦阻塞综合征患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2020.11.013

首都医科大学附属北京佑安医院肝病中心三科

基金项目:

2018年度院内中青年人才孵育项目（YNKTTS20180115）；

详细信息

中图分类号: R575
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出版历程
- 收稿日期: 2020-04-26
- 出版日期: 2020-11-20

Value of Model for End-Stage Liver Disease and Child-Turcotte-Pugh score in predicting the prognosis of patients with hepatic sinus obstruction syndrome associated with Gynura segetum( Lour. ) Merr.

Third Department of Department of Hepatology,Beijing YouAn Hospital,Capital Medical University

Research funding:

摘要

摘要:
目的研究应用终末期肝病模型（MELD评分）和Child-Tureotte-Pugh评分（CTP评分）系统预测肝窦阻塞综合征患者预后的临床价值。方法选取2012年1月-2018年7月北京佑安医院、北京地坛医院、解放军总医院第五医学中心、天津市第三中心医院、新乡医学院第一附属医院5家医院收治的土三七相关肝窦阻塞综合征患者49例,随访3年,终点事件为死亡。根据患者入院时的实验室检查及临床资料,计算患者MELD和CTP评分,根据CTP评分将患者分为3组:CTP A级组（评分5～6分）（n=8）、CTP B级组（评分7～9分）（n=23）及CTP C级组（评分≥10分）（n=18）;根据随访期间患者临床结局分为死亡组（n=12）和生存组（n=37）。计量资料组间比较采用Mann-Whitney U检验,等级资料采用Kruskal-Wallis H检验。受试者工作特征曲线下面积（AUC）用于判定CTP、MELD评分对死亡的预测能力。Kaplane-Meier生存曲线用于判定不同CTP、MELD评分患者的长期预后情况,采用log-rank进行比较。应用受试者工作特征曲线分析两种评分系统对患者死亡的预...
- 肝静脉闭塞性疾病 /
- 终末期肝病模型 /
- Child-Pugh评分
Abstract:
Objective To investigate the value of Model for End-Stage Liver Disease( MELD) and Child-Turcotte-Pugh( CTP) score in predicting the prognosis of patients with hepatic sinusoidal obstruction syndrome( HSOS) associated with Gynura segetum( Lour.) Merr.Methods A total of 49 patients with HSOS associated with Gynura segetum( Lour.) Merr. who were admitted to Beijing YouAn Hospital,Beijing Ditan Hospital,The Fifth Medical Center of Chinese PLA General Hospital,Tianjin Third Central Hospital,and The First Affiliated Hospital of Xinxiang Medical University from January 2012 to July 2018 were enrolled and followed up for three years,with death as the outcome event. MELD and CTP scores were calculated according to the laboratory examination and clinical data on admission,and according to CTP score,the patients were divided into CTP class A( CTP score 5-6) group( n = 8),CTP class B( CTP score 7-9) group( n = 23),and CTP class C( CTP score ≥10) group( n = 18). The patients were divided into death group( n = 12) and survival group( n = 37) according to the clinical outcome during follow-up. The Mann-Whitney U test was used for comparison of continuous data between groups,and the Kruskal-Wallis H test was used for ranked data. The area under the receiver operator characteristic( ROC) curve( AUC) was used to investigate the ability of CTP and MELD scores in predicting death. The Kaplan-Meier survival curves were used to determine the long-term prognosis of patients with different CTP and MELD scores,and the log-rank test was used for comparison. The ROC curve was used to evaluate the performance of these two scoring systems in predicting death. Results A total of 12 patients died during the 3-year follow-up period. The patients with HSOS had a median MELD score of 13. 443( 8. 792-18. 379),and the death group had a significantly higher MELD score than the survival group [19. 84( 15. 49-25. 41) vs 11. 58( 8. 60-15. 79),Z =-3. 511,P < 0. 001]. The patients with HSOS had a CTP score of 6-12,and of all 49 patients,8( 16. 3%) had CTP class A HSOS,23( 46. 9%) had CTP class B HSOS,and18( 36. 7%) had CTP class C HSOS. The mortality rate of the patients increased significantly with the increase in CTP score( χ2= 16. 078,P < 0. 05). The mortality rates of the patients with CTP class A,B,and C HSOS were 0. 0%,13. 0%,and 50. 0%,respectively( χ2=10. 343,P < 0. 05). The Kaplan-Meier analysis showed that the patients with a MELD score of < 14. 294 4 had a significantly better 3-year prognosis than those with a MELD score of ≥14. 294 4( χ2= 14. 893,P < 0. 001). The higher the CTP score,the poorer the 3-year prognosis of patients( χ2= 11. 083,P < 0. 05). CTP class had an AUC of 0. 780( 95% confidence interval [CI]: 0. 639-0. 922) in predicting the prognosis of HSOS patients,while MELD score had an AUC of 0. 840( 95% CI: 0. 722-0. 958),and there was no significant difference between the two scores( Z = 2. 63,P > 0. 05). Conclusion Both MELD and CTP scores can predict the risk of death in patients with HSOS,with similar performance in predicting the prognosis of patients,and further studies are needed to validate their clinical value.
- hepatic veno-occlusive disease /
- model for end stage liver disease /
- Child-Tureotte-Pugh

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参考文献(20)

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