切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 195 -199. doi: 10.3877/cma.j.issn.1674-0793.2020.03.007

所属专题： 专题评论； 文献；

论著

终末期肝病模型评分及MELD-Na评分评估肝衰竭肝移植短期预后的对比观察
陈永泰1, 许蜂蜂2, 王明2, 刘建勇3, 蔡秋程3, 杨芳3, 陈永标3, 江艺3,†()   
  1. 1. 350025　福州，福建医科大学福总临床医学院（900医院）
    2. 350025　福州，厦门大学附属东方医院（900医院）
    3. 350025　福州，中国人民解放军联勤保障部队第九〇〇医院肝胆外科
  • 收稿日期:2020-04-11 出版日期:2020-06-01
  • 通信作者: 江艺
  • 基金资助:
    福建省自然科学基金面上项目(2018J01351，2019J01533); 军区医学重大专项课题(14ZX22)

Comparative study of the model for end-stage liver disease and MELD-Na scores in evaluating the short-term prognosis of liver transplantation in patients with liver failure

Yongtai Chen1, Fengfeng Xu2, Ming Wang2, Jianyong Liu3, Qiucheng Cai3, Fang Yang3, Yongbiao Chen3, Yi Jiang3,†()   

  1. 1. Fuzong Clinical Medical College of Fujian Medical University, Fuzhou 330025, China
    2. DongFang Hospital Affiliated to Xiamen University, Fuzhou 330025, China
    3. Department of Hepatobiliary Surgery, 900 Hospital of the Joint Logistics Team, Fuzhou 330025, China
  • Received:2020-04-11 Published:2020-06-01
  • Corresponding author: Yi Jiang
  • About author:
    Corresponding author: Jiang Yi, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

陈永泰, 许蜂蜂, 王明, 刘建勇, 蔡秋程, 杨芳, 陈永标, 江艺. 终末期肝病模型评分及MELD-Na评分评估肝衰竭肝移植短期预后的对比观察[J]. 中华普通外科学文献(电子版), 2020, 14(03): 195-199.

Yongtai Chen, Fengfeng Xu, Ming Wang, Jianyong Liu, Qiucheng Cai, Fang Yang, Yongbiao Chen, Yi Jiang. Comparative study of the model for end-stage liver disease and MELD-Na scores in evaluating the short-term prognosis of liver transplantation in patients with liver failure[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(03): 195-199.

目的

探讨终末期肝病模型（model for end-stage liver disease, MELD）评分与MELD-Na评分对肝衰竭患者行肝移植短期预后（3个月）的临床价值。

方法

收集从2012年1月至2019年12月在中国人民解放军联勤保障部队第九〇〇医院因肝衰竭行肝移植的86例患者的术前及术中临床资料。采用受试者工作特征（ROC）曲线评价MELD和MELD-Na评分对短期预后的鉴别能力并根据Youden指数确定最佳的cut-off值。

结果

86例患者中早期死亡21例（24.4%）。术前MELD评分（P=0.001）和术中输血量（P<0.001）是肝衰竭行肝移植患者早期死亡的独立危险因素。MELD和MELD-Na评分预测肝移植术后早期死亡的ROC曲线下面积分别为0.696和0.686，差异无统计学意义（P=0.677）。MELD≥24.3组、MELD<24.3组的早期生存率分别为51.7%（15/29）和87.7%（50/57），MELD-Na≥25.7组、MELD<25.7组的早期生存率分别为54.9%（17/31）和87.3%（48/55），差异均有统计学意义（P<0.001），MELD评分与MELD-Na评分升高时，早期生存率降低。

结论

在预测肝衰竭行肝移植患者早期预后方面，MELD评分与MELD-Na评分预测能力无明显差异。MELD评分与术中输血量是患者早期死亡的独立危险因素。

关键词: 肝移植, 肝衰竭, 预后, 终末期肝病模型, MELD-Na评分
Objective

To discuss clinical value of the model for end-stage liver disease (MELD) and MELD-Na scores for predicting the short-term prognosis of liver transplantation in patients with liver failure.

Methods

The preoperative and intraoperative clinical data of 86 liver failure patients who underwent liver transplantation in the 900 Hospital of the Joint Logistics Team from January 2012 to December 2019 were collected in this retrospective analysis. Multivariate analysis were used to determine the risk factors of early death (within 3 months) after liver transplantation. The distinguishing ability of MELD and MELD-Na scores for early prognosis was evaluated by the receiver operating characteristic (ROC) curve, and the Youden index was used to determine the best cut-off value.

Results

Of the 86 patients, there were 21 patients (24.4%) of early death in the short-term after liver transplantation. Preoperative MELD score (P=0.001) and intraoperative blood transfusion volume (P<0.001) were independent risk factors of liver transplantation in patients with liver failure. The AUC of MELD and MELD-Na scores for predicting the short-term prognosis were 0.696 and 0.686 respectively, with no statistical significancebetween two AUCs (P=0.677). The early survival rates of MELD≥24.3 group and MELD<24.3 group were 51.7% (15/29) and 87.7% (50/57), respectively (P<0.001). The early survival rates of MELD-Na≥25.7 groupand MELD-Na < 25.7 group were 54.9% (17/31) and 87.3% (48/55), respectively (both P<0.001). When the MELD score and MELD-Na score increased, the mortality rate increased.

Conclusion

In predicting the early prognosis of liver failure patients undergoing liver transplantation, there is no significant difference between the MELD score and the MELD-Na score in predicting ability. MELD score and intraoperative blood transfusion are independent risk factors for early death.

Key words: Liver transplantation, Liver failure, Prognosis, Model for end-stage liver disease, MELD-Na score
表1 86例患者术前及术中资料的基本特征
指标 数值 指标 数值
白蛋白(g/L)a 33.6±5.7 血清Na+ 137(134, 140)
血肌酐(μmol/L) a 86.9±47.2 MELD评分 20.7(15.3, 27.1)
总胆红素(μmol/L) 234.8(89.9, 415.0) MELD-Na评分 23.0(15.7, 30.7)
ALT(U/L) 50(34, 88) 手术时间(min) 385(354, 431)
AST(U/L) 78(47, 150) 术中输液(ml) 3 985(2 700, 5 375)
INR 1.86(1.59, 2.37) 术中输血(ml) 4 391(3 368, 6 128)
表2 术前变量和术中变量的单变量分析
组别 性别(男/女，例) 年龄(岁) 白蛋白(g/L) 肌酐(μmol/L) 总胆红素(μmol/L) ALT(U/L) AST(U/L)
早期死亡组 15/2 48±12 34.2±6.3 105.2±67.7 313.3(185, 529) 58(46, 113) 113(68, 258)
非早期死亡组 39/25 50±10 33.3±5.5 80.9±37.1 206(78.9, 366.5) 48(31, 80) 73(41, 134)
统计值 1.079 -0.699 0.641 1.571 -2.186 -1.779 -2.111
P值 0.299 0.486 0.523 0.129 0.029 0.075 0.035
组别 INR 血清Na+(mmol/L) MELD评分 MELD-Na评分 手术时间(min) 术中输液量(ml) 术中输血量(ml)
早期死亡组 2.25(1.66, 3.01) 137.0(133.5, 142.6) 27.9(17.2, 36.3) 31.1(19.3, 36.5) 413(357, 464) 4 600(2 700, 5 875) 6 119(4 883, 10 571)
非早期死亡组 1.80(1.57, 2.35) 137.1(134.4, 139.6) 20.2(15.3, 23.9) 21.4(15.5, 27.1) 385(353, 426) 3 600(2 670, 4 950) 3 830(3 038, 5 431)
统计值 -1.945 -0.166 -3.652 -3.342 -1.086 -1.091 -3.694
P值 0.052 0.868 <0.001 0.001 0.278 0.275 <0.001
图1 MELD与MELD-Na评分预测肝移植术后肝衰竭短期生存的ROC曲线
表3 MELD与MELD-Na评分预测肝移植术后肝衰竭短期生存的ROC曲线分析
评分 曲线下面积 youden指数 Cut-off值 95%可信区间 敏感度 特异度
MELD 0.696 0.451 24.3 0.544~0.848 0.67 0.78
MELD-Na 0.686 0.405 25.7 0.540~0.831 0.67 0.74
图2 不同MELD分组的肝衰竭肝移植患者短期生存曲线
图3 不同MELD-Na分组的肝衰竭肝移植患者短期生存曲线
[1]
Ling Q, Dai H, Zhuang R, et al. Predicting short-term survival after liver transplantation on eight score systems: A national report from China Liver Transplant Registry[J]. Sci Rep, 2017, 7: 42253.
[2]
Burak KW, Meeberg GA, Myers RP, et al. Validation, current use and future directions of the Model for End-stage Liver Disease for liver transplant allocation in Canada[J]. Can J Gastroenterol Hepatol, 2015, pii: 16942.
[3]
Kalra A, Wedd JP, Biggins SW. Changing prioritization for transplantation: MELD-Na, hepatocellular carcinoma exceptions, and more[J]. Curr Opin Organ Transplant, 2016, 21(2): 120-126.
[4]
中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44.
[5]
陈永泰, 柯瑞盛, 蔡秋程, 等. 终末期肝病模型及MELD-Na评分在肝移植应用中的研究进展[J/CD]. 中华普通外科学文献（电子版）, 2019, 13(6): 488-491.
[6]
Fung J, Mak LY, Chan AC, et al. Model for End-stage Liver Disease with additional criteria to predict short-term mortality in severe flares of chronic hepatitis B[J]. Hepatology, 2019 [Epub ahead of print].
[7]
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index[J]. Am J Transplant, 2006, 6(4): 783-790.
[8]
杨磊, 张志伟, 陈孝平. BCLC-B期和C期肝细胞癌患者预后影响因素分析及手术价值探讨[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(2): 108-112.
[9]
Baganate F, Beal EW, Tumin D, et al. Early mortality after liver transplantation: defining the course and the cause[J]. Surgery, 2018, 164(4): 694-704.
[10]
Niewiński G, Graczyńska A, Morawiec S, et al. Renaissance of modified charlson comorbidity index in prediction of short- and long-term survival after liver transplantation?[J]. Med Sci Monit, 2019, 25: 4521-4526.
[11]
Boecker J, Czigany Z, Bednarsch J, et al. Potential value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation[J]. PLoS One, 2019, 14(3): e0214221.
[12]
Klein KB, Stafinski TD, Menon D. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature[J]. PLoS One, 2013, 8(12): e80661.
[13]
Wang P, Huang G, Tam N, et al. Influence of preoperative sodium concentration on outcome of patients with hepatitis B virus cirrhosis after liver transplantation[J]. Eur J Gastroenterol Hepatol, 2016, 28(10): 1210-1215.
[14]
Nagai S, Chau LC, Schilke RE, et al. Effects of allocating livers for transplantation based on model for end-stage liver disease-sodium scores on patient outcomes[J]. Gastroenterology, 2018, 155(5): 1451-1462, e3.
[15]
Al-Saeedi M, Yassein T, Schultze D, et al. Impact of inter-laboratory variability on model of end-stage liver disease (meld) score calculation[J]. Ann Transplant, 2016, 21: 675-682.
[16]
Pandey CK, Singh A, Kajal K, et al. Intraoperative blood loss in orthotopic liver transplantation: the predictive factors[J]. World J Gastrointest Surg, 2015, 7(6): 86-93.
[17]
Han S, Kwon JH, Jung SH, et al. Perioperative fresh red blood cell transfusion may negatively affect recipient survival after liver transplantation[J]. Ann Surg, 2018, 267(2): 346-351.
[18]
Real C, Sobreira Fernandes D, Sá Couto P, et al. Survival predictors in liver transplantation: time-varying effect of red blood cell transfusion[J]. Transplant Proc, 2016, 48(10):3303-3306.
[19]
Buchholz BM, Gerlach UA, Chandrabalan VV, et al. Revascularization time in liver transplantation: independent prediction of inferior short- and long-term outcomes by prolonged graft implantation[J]. Transplantation, 2018, 102(12): 2038-2055.
[20]
Donohue CI, Mallett SV. Reducing transfusion requirements in liver transplantation[J]. World J Transplant, 2015, 5(4): 165-182.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[3] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[4] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[5] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[6] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[7] 江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.
[8] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[9] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[10] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[11] 胡宝茹, 尚乃舰, 高迪. 中晚期肝细胞癌的DCE-MRI及DWI表现与免疫治疗预后的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 399-403.
[12] 陆萍, 邹健. 凝血和纤维蛋白溶解标志物的动态变化对急性胰腺炎患者预后的评估价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 427-432.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号