目的:探讨肝移植患者终末期肝病模型(MELD)与术后营养状态的关系,以期为临床提供更精确的评估工具和管理策略。方法:收集2019年1月至2023年7月于本中心接受肝移植术的99例患者的临床资料,使用腰大肌身高指数对患者术后生存及营养状态进...目的:探讨肝移植患者终末期肝病模型(MELD)与术后营养状态的关系,以期为临床提供更精确的评估工具和管理策略。方法:收集2019年1月至2023年7月于本中心接受肝移植术的99例患者的临床资料,使用腰大肌身高指数对患者术后生存及营养状态进行预测;依据病因、MELD评分进行亚组分析。结果:少肌症组和无少肌症组在年龄、白蛋白水平、L3-PMI以及生存时间上有统计学意义(p 3-PMI为A组3.51 ± 0.75、B组2.47 ± 0.76、C组2.76 ± 0.96,酒精性肝硬化患者L3-PMI为A组3.13 ± 0.45、B组2.25 ± 0.28、C组3.01 ± 1.92,A与B组之间比较差异有统计学意义(p 3-PMI为A组3.74 ± 0.83、B组2.88 ± 0.53、C组2.09 ± 0.36,三组组间比较均有统计学意义(p 3-PMI可以有效评价患者营养状况和术后生存状态;MELD评分与术后营养状况存在显著的相关性,高MELD评分的患者往往术后营养状况较低,容易发生营养障碍。Objective: To explore the relationship between end-stage liver disease (MELD) model and postoperative nutritional status in liver transplant patients, in order to provide more accurate assessment tools and management strategies for clinical practice. Method: Clinical data of 99 patients who underwent liver transplantation at our center from January 2019 to July 2023 were collected, and the lumbar muscle height index was used to predict the postoperative survival and nutritional status of the patients;Perform subgroup analysis based on etiology and MELD score. Result: There were statistically significant differences (p 3-PMI, and survival time between the sarcopenia group and the non sarcopenia group. In the MELD scoring subgroups, the L3-PMI of patients with liver malignant tumors was 3.51 ± 0.75 in group A, 2.47 ± 0.76 in group B, and 2.76 ± 0.96 in group C. The L3-PMI of patients with alcoholic cirrhosis was 3.13 ± 0.45 in group A, 2.25 ± 0.28 in group B, and 3.01 ± 1.92 in group C. There was a statistically significant difference between group A and group B (p 3-PMI of decompensated patients with hepatitis B cirrhosis was 3.74 ± 0.83 in group A, 2.88 ± 0.53 in group B, and 2.09 ± 0.36 in group C. The comparison among the three groups was statistically significant (p 3-PMI can effectively evaluate the nutritional status and postoperative survival status of patients;There is a significant correlation between MELD score and postoperative nutritional status. Patients with high MELD scores often have lower postoperative nutritional status and are prone to nutritional disorders.展开更多
目的比较MELD-Na模型、MELD模型和Child-Pugh积分对我国失代偿期肝硬化患者短期预后的预测价值。方法回顾性收集自2003年1月～2005年12月在天津第三中心医院住院的206例失代偿期肝硬化患者的病历资料。分别计算其入院时的MELD-Na积分、M...目的比较MELD-Na模型、MELD模型和Child-Pugh积分对我国失代偿期肝硬化患者短期预后的预测价值。方法回顾性收集自2003年1月～2005年12月在天津第三中心医院住院的206例失代偿期肝硬化患者的病历资料。分别计算其入院时的MELD-Na积分、MELD积分和Child-Pugh积分,同时了解其3个月内的病死率。以受试者运行曲线(receiver operating characteristic,ROC)下面积(area under the curve,AUC)衡量各评分系统预测失代偿期肝硬化患者短期预后的能力。结果所观察的患者在3个月内共死亡39例。死亡组患者MELD-Na积分、MELD积分和Child-Pugh积分(9.26±12.03、21.49±6.75、11.18±1.76)与生存组(18.65±9.69、15.83±4.99、9.16±2.19)相比有显著性差异(P<0.001)。MELD-Na积分、MELD积分和Child-Pugh积分对失代偿期肝硬化患者3个月预后评估的ROC曲线下面积分别为0.777、0.760、0.759;运用正态性Z检验比较其各自的AUC,MELD-Na模型分别与MELD模型和Child-Pugh评分相比均有显著性差异(P<0.001),而MELD模型和Child-Pugh评分相比无差异(P=0.80)。通过选取敏感性和特异性之和最大时ROC曲线上的截断点对应的值作为将肝硬化患者区分高、低危组群的方法,确定MELD-Na模型、MELD模型和Child-Pugh评分所对应的cut-off值分别为23、18和10,以此临界点所区分的高危和低危患者的生存率之间均存在明显差异(P<0.001)。结论 MELD-Na积分、MELD积分和Child-Pugh积分均可有效地预测失代偿期肝硬化患者的短期预后,而MELD-Na评分的短期评估效率优于其他3种,能更准确地反映病情的轻重,临床应用价值更高。展开更多
文摘目的:探讨肝移植患者终末期肝病模型(MELD)与术后营养状态的关系,以期为临床提供更精确的评估工具和管理策略。方法:收集2019年1月至2023年7月于本中心接受肝移植术的99例患者的临床资料,使用腰大肌身高指数对患者术后生存及营养状态进行预测;依据病因、MELD评分进行亚组分析。结果:少肌症组和无少肌症组在年龄、白蛋白水平、L3-PMI以及生存时间上有统计学意义(p 3-PMI为A组3.51 ± 0.75、B组2.47 ± 0.76、C组2.76 ± 0.96,酒精性肝硬化患者L3-PMI为A组3.13 ± 0.45、B组2.25 ± 0.28、C组3.01 ± 1.92,A与B组之间比较差异有统计学意义(p 3-PMI为A组3.74 ± 0.83、B组2.88 ± 0.53、C组2.09 ± 0.36,三组组间比较均有统计学意义(p 3-PMI可以有效评价患者营养状况和术后生存状态;MELD评分与术后营养状况存在显著的相关性,高MELD评分的患者往往术后营养状况较低,容易发生营养障碍。Objective: To explore the relationship between end-stage liver disease (MELD) model and postoperative nutritional status in liver transplant patients, in order to provide more accurate assessment tools and management strategies for clinical practice. Method: Clinical data of 99 patients who underwent liver transplantation at our center from January 2019 to July 2023 were collected, and the lumbar muscle height index was used to predict the postoperative survival and nutritional status of the patients;Perform subgroup analysis based on etiology and MELD score. Result: There were statistically significant differences (p 3-PMI, and survival time between the sarcopenia group and the non sarcopenia group. In the MELD scoring subgroups, the L3-PMI of patients with liver malignant tumors was 3.51 ± 0.75 in group A, 2.47 ± 0.76 in group B, and 2.76 ± 0.96 in group C. The L3-PMI of patients with alcoholic cirrhosis was 3.13 ± 0.45 in group A, 2.25 ± 0.28 in group B, and 3.01 ± 1.92 in group C. There was a statistically significant difference between group A and group B (p 3-PMI of decompensated patients with hepatitis B cirrhosis was 3.74 ± 0.83 in group A, 2.88 ± 0.53 in group B, and 2.09 ± 0.36 in group C. The comparison among the three groups was statistically significant (p 3-PMI can effectively evaluate the nutritional status and postoperative survival status of patients;There is a significant correlation between MELD score and postoperative nutritional status. Patients with high MELD scores often have lower postoperative nutritional status and are prone to nutritional disorders.
文摘目的比较MELD-Na模型、MELD模型和Child-Pugh积分对我国失代偿期肝硬化患者短期预后的预测价值。方法回顾性收集自2003年1月～2005年12月在天津第三中心医院住院的206例失代偿期肝硬化患者的病历资料。分别计算其入院时的MELD-Na积分、MELD积分和Child-Pugh积分,同时了解其3个月内的病死率。以受试者运行曲线(receiver operating characteristic,ROC)下面积(area under the curve,AUC)衡量各评分系统预测失代偿期肝硬化患者短期预后的能力。结果所观察的患者在3个月内共死亡39例。死亡组患者MELD-Na积分、MELD积分和Child-Pugh积分(9.26±12.03、21.49±6.75、11.18±1.76)与生存组(18.65±9.69、15.83±4.99、9.16±2.19)相比有显著性差异(P<0.001)。MELD-Na积分、MELD积分和Child-Pugh积分对失代偿期肝硬化患者3个月预后评估的ROC曲线下面积分别为0.777、0.760、0.759;运用正态性Z检验比较其各自的AUC,MELD-Na模型分别与MELD模型和Child-Pugh评分相比均有显著性差异(P<0.001),而MELD模型和Child-Pugh评分相比无差异(P=0.80)。通过选取敏感性和特异性之和最大时ROC曲线上的截断点对应的值作为将肝硬化患者区分高、低危组群的方法,确定MELD-Na模型、MELD模型和Child-Pugh评分所对应的cut-off值分别为23、18和10,以此临界点所区分的高危和低危患者的生存率之间均存在明显差异(P<0.001)。结论 MELD-Na积分、MELD积分和Child-Pugh积分均可有效地预测失代偿期肝硬化患者的短期预后,而MELD-Na评分的短期评估效率优于其他3种,能更准确地反映病情的轻重,临床应用价值更高。
