meld与ctp对肝硬化患者手术预后的评估　　

史新河，康鹏，李朝军　　

(乌鲁木齐市第一人民医院外一科，新疆 乌鲁木齐 830000)　　

摘         要　　

目的：研究终末期肝病模型（meld）及child-turcotte-pugh(ctp)评分对肝硬化患者手术预后的评估。方法：对70例肝硬化病例，计算术前meld和ctp评分，分析二者相关性及不同分组下并发症发生率差异情况。以受试者工作特征曲线(roc)下面积衡量各模型的预测能力。结果：23例发生术后并发症。并发症、无并发症组meld与ctp分值比较差异有统计学意义。meld＜14、14≤meld＜24、meld≥24患者并发症发生率分别为10.0%（3/30）、35.7%（10/28）和83.3%（10/12）。ctp分级a级、b级、c级并发症发生率分别为10.3%（3/29）、36.0%（9/25）和68.8%（11/16）。各组间差异有统计学意义。meld与ctp评分显著相关（r=0. 874，p＜0.01）。roc下面积meld 为0.877,ctp为0.852,差异无统计学意义(u=0.157，p＞0.05)。结论：meld及ctp评分均能准确预测肝硬化患者围手术期并发症,临床应用宜相互结合，以进一步提高预测准确度。　　

关键词：肝硬化；终末期肝病模型；child-turcotte-pugh评分　　

application of the model for end-stage liver disease and child-turcotte-pugh system to evaluate the surgical prognosis of patients with cirrhosis　　

shi xin-he,kang peng, li chao-jun　　

 (department of surgery,　　first　 　hospital　　,xinjiang urumqi 830000)　　

abstract　　

ive: to investigate the relationship between the model for end-stage liver disease (meld) and child-turcotte-pugh (ctp) scoring used in predict the prognosis of patients with cirrhosis.　　

method: collected seventy patients with cirrhosis. calculation of meld and ctp score before surgery，analysis of correlation between the two models and difference of the different groups under the situation of incidence of complications .  use the area under the receiver operating characteristic curve (roc) to measure the predictive ability of each model . 　　

results: twenty three cases appeared post operative serious complications. complications and no complication group meld and ctp score difference has statistically significant.meld＜14,14≤meld＜24 and meld≥ 24 groups with complication rates were 10.0%（3/30）、35.7%（10/28）and 83.3%（10/12）. ctp score a、b and c groups with complication rates were 10.3%（3/29）、36.0%（9/25）and 68.8%（11/16）. the difference between each groups has statistically significant. meld score showed significant correlations with ctp（r=0. 874，p＜0.01）.the area under the roc:meld was 0.877, ctp  was 0.852, the difference between the two groups has no statistically significant(u=0.157，p＞0.05).　　

conclusion: both meld and ctp scores can accurately predict the short term prog- nosis of patients with liver cirrhosis.　　

key words: cirrhosis; model for end-stage liver disease(meld); 　　

child-turcotte-pugh (ctp) system　　

终末期肝病模型( meld )作为一种新型的肝脏储备功能评估方法，在肝脏疾病的预后评估中被证实有良好预测能力[1-6]。回顾性分析我院2004年1月至2010