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目的研究终末期肝病模型(MELD)联合血清胆固醇(CHOL)检测对重型肝炎患者短期预后的预测价值。方法入选105例重型肝炎患者,根据随访3个月的存活情况分组。观察死亡组与存活组血清总胆红素(TBil)、肌酐(Cr)、凝血酶原时间国际标准化比率(INR)、CHOL,并计算MELD评分。应用受试者工作特征曲线(ROC曲线)评价MELD评分及CHOL对重型肝炎死亡的预测能力及最佳临界值。结果 MELD分值越高,重型肝炎病死率越高。死亡组血清TBil、INR及MELD评分值明显高于存活组,CHOL低于存活组(P<0.05);MELD评分和CHOL对重型肝炎患者3个月预后评估的ROC曲线下面积分别为0.825和0.785;MELD评分预测重型肝炎患者死亡的最佳临界值为25分,CHOL预测重型肝炎患者死亡的最佳临界值为1.65μmol/L;当MELD评分≥25分,同时CHOL≤1.65μmol/L,判断重型肝炎患者预后的敏感性和特异性分别为92.52%和90.23%。结论 MELD评分和CHOL是预测重型肝炎患者短期生存率的较好指标。
Objective To investigate the predictive value of end-stage liver disease (MELD) combined with serum cholesterol (CHOL) in short-term prognosis of patients with severe hepatitis. Methods A total of 105 patients with severe hepatitis were enrolled in this study. The patients were divided into three groups according to their survival. The serum total bilirubin (TBil), creatinine (Cr), international normalized ratio of prothrombin time (INR) and CHOL between the death group and the survival group were observed and the MELD score was calculated. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive ability and the best cut-off value of MELD score and CHOL on severe hepatitis death. Results The higher the MELD score, the higher the mortality rate of severe hepatitis. The serum TBil, INR and MELD score in death group were significantly higher than those in survival group and CHOL was lower than that in survival group (P <0.05). The area under ROC curve of MELD and CHOL in severe hepatitis were 0.825 and 0.785 . The best cut-off value of MELD score predicting the death of patients with severe hepatitis was 25 points. The best cutoff value of CHOL predicting the death of severe hepatitis patients was 1.65μmol / L. When the MELD score was ≥25 points and CHOL≤1.65μmol / L, The prognosis of patients with severe hepatitis sensitivity and specificity were 92.52% and 90.23%. Conclusion The MELD score and CHOL are good predictors of short-term survival in patients with severe hepatitis.