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題 名 | A Comparison of Child-Turcotte-Pugh Classification with Four Models of End-Stage Liver Disease-Based Prognostic System for Spontaneous Bacterial Peritonitis in Cirrhosis=Child-Turcotte-Pugh分類和四種以MELD為基礎的評分系統在預測肝硬化病人併發自發性細菌性腹膜炎預後的比較 |
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作 者 | 黃建豪; 林俊彥; 沈一嫻; 陳威廷; 林宗男; 黃章雯; 何玉彬; 邱正堂; | 書刊名 | 臺灣消化醫學雜誌 |
卷 期 | 28:1 2011.03[民100.03] |
頁 次 | 頁15-23 |
分類號 | 415.534 |
關鍵詞 | Child-Turcotte-Pugh分類; MELD評分系統; 自發性細菌性腹膜炎; 肝硬化; Child-Turcotte-Pugh classification; Model for end-stage liver disease; MELD; Spontaneous bacterial peritonitis; Liver cirrhosis; |
語 文 | 英文(English) |
中文摘要 | 研究動機:Child-Turcotte-Pugh分類應用於肝硬化病人的預後評估已有40多年的歷史,然而它在一些臨床參數上的主觀性及鑑別力的不足,使得美國自2002年起採用MELD評分系統作爲肝移植器官分派的主要參考系統;在美國,MELD評分系統已被證實比Child-Turcotte-Pugh分類更可準確預測等待換肝病人的三個月死亡率。最近,血鈉已被證實可以增加肝硬化病人預後的預測力,包括MELD-Na,iMELD和MESO等三種結合MELD評分系統和血鈉的預測模式均被證實可有效預測肝硬化病人的短期死亡率。然而對肝硬化併發自發性細菌性腹膜炎的病患而言,不論是Child-Turcotte-Pugh分類或是4種以MELD評分系統爲根基的預測模式,是否依然可有效預測其住院或短期死亡率?此議題以往較少研究。 材料與Methods:此回溯性研究收集了2005至2006年,於林口長庚醫院出院診斷爲第一次自發性腹膜炎的病患,在剔除8位出院後失去追蹤的病人後,共190位明確符合自發性腹膜炎診斷條件的病患進入研究分析,其中有5位病患接受肝移植,但都在出院6個月後才開刀。所有自發性腹膜炎病患的診斷與治療均遵照當時的臨床指引。 Results:190位病人平均年齡是57.1±12.7歲,男性占77.4%,73.6%的病人有慢性病毒性肝炎。Child-Turcotte-Pugh分類或是4種以MELD評分系統爲根基的預測模式都可以有效預測住院或3個月、6個月死亡率。有74個病人在第一次診斷自發性細菌性腹膜炎的住院過程中死亡,而3個月和6個月累積死亡率分別爲52.6%和63.1%。就住院死亡率的預測來說,iMELD有最高的曲線下面積(Area Under Curve):0.765,且四種以MELD評分系統爲根基的預測模式中只有它比Child-Turcotte-Pugh分類有顯著的預測力;在3個月死亡率的預測方面,iMELD有最高的曲線下面積0.808,且四種以MELD評分系統爲根基的預測模式都比Child-Turcotte-Pugh分類有顯著的預測力;至於6個月死亡率的預測,iMELD仍然有最高的曲線下面積0.789,且四種以MELD評分系統爲根基的預測模式也都比Child-Turcotte-Pugh分類有顯著的預測力;至於MELD,MELD-Na,iMELD和MESO之間在住院或3個月和6個月累積死亡率的預測力比較,均沒有統計上的差別。 討論和Conclusions:肝硬化病人若合併腹水,其感染自發性細菌性腹膜炎的發生率和死亡率都相當高,即使即時的使用抗生素和積極的支持療法,住院死亡率仍在20至40%間;因此早期發現高危險群病人對預後可能會有很大幫助。本報告比較Child-Turcotte-Pugh分類和四種以MELD評分系統爲根基的預測模式何者較能預測肝硬化病患併發自發性細菌性腹膜炎,其住院或3個月和6個月累積死亡率。就住院死亡率的預測來說,iMELD的預測力最好;在3個月和6個月累積死亡率的預測方面,四種以MELD評分系統爲根基的預測模式都比Child-Turcotte-Pugh分類有顯著的預測力,但在MELD,MELD-Na,iMELD和MESO之間預測力的比較,則沒有統計上的差別。 |
英文摘要 | Background and Aims: For the prediction of the prognosis of spontaneous bacterial peritonitis (SBP) in patients of cirrhosis, no direct comparisons have been made among the five models, Child-Turcotte-Pugh classification (CTP), the model for end-stage liver disease (MELD), the model for end-stage liver disease with the incorporation of serum sodium (MELD-Na), the integrated model for end-stage liver disease (iMELD) score, and the model for end-stage liver disease to sodium (MESO) index. Materials and Methods: Between January 2005 and December 2006, 190 patients who met the criteria for liver cirrhosis with SBP for the first time were enrolled in this retrospective study. Patients' clinical and laboratory data were obtained at diagnosis, and the Child-Turcotte-Pugh (CTP) and 4 MELD-based scores were calculated accordingly. Patients were followed up until November 2009 or until death. Results: The in-hospital mortality rate was 38.9%. The cumulative 3-month and 6-month mortality rates were 52.6% and 63.1%, respectively. The CTP score and 4 MELD-based model scores could all significantly predict the in-hospital, 3-month, and 6-month mortality. For in-hospital mortality, only iMELD had a significantly higher area under curve (AUC) in comparison with the CTP score (p=0.039), and the other comparisons showed no significant difference. For 3-month and 6-month mortality, all 4 MELD-based models had significantly better prediction abilities than the CTP classification. iMELD had the best AUC, followed by MELD-Na, MESO, and MELD, but there were no statistical differences between them. Conclusions: All of the 4 MELD-based models, iMELD, MELD-Na, MESO, and MELD, have significantly better prediction abilities than the CTP classification on 3-month and 6-month mortality of SBP patients. For the prediction of in-hospital mortality, only iMELD had significantly superior prediction ability over the CTP score. |
本系統中英文摘要資訊取自各篇刊載內容。