术前MELD评分对肝包虫病患者手术后并发症和远期预后的评估价值

肝脏 ›› 2023, Vol. 28 ›› Issue (2): 229-232.

术前MELD评分对肝包虫病患者手术后并发症和远期预后的评估价值

于鹏, 段绍斌

830011 乌鲁木齐新疆医科大学附属中医医院(新疆维吾尔自治区中医医院)普外一科

收稿日期:2022-04-20 出版日期:2023-02-28 发布日期:2023-04-10
通讯作者: 段绍斌
基金资助:
省部共建中亚高发病成因与防治国家重点实验室开放课题项目合同书(SKL-HIDCA-2020-ZY24)

Value of preoperative MELD score in evaluating postoperative complications and long-term prognosis of patients with hepatic echinococcosis

YU Peng, DUAN Shao-bin

The First Department of General Surgery, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University (Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region), Urumqi 830011, China

Received:2022-04-20 Online:2023-02-28 Published:2023-04-10
Contact: DUAN Shao-bin

摘要/Abstract

摘要： 目的探讨术前终末期肝病模型(MELD)评分对肝包虫病患者手术后并发症和远期预后的评估价值。方法比较肝包虫病患者术后各类并发症的术前MELD评分情况,将所有肝包虫病患者术后5年内出现肝包虫病复发或死亡作为状态变量,术前MELD作为检验变量,进行两者的ROC分析,获得术前MELD评分预测肝包虫病患者术后生存情况的最佳诊断截点,根据最佳诊断截点,将患者分为两组,比较两组肝包虫病患者一般临床资料,Kaplan-Meier生存分析比较两组肝包虫病患者术后5年的无复发生存率和总生存率。结果本研究共纳入97例行肝切除手术的肝包虫病患者,男性66例(68.0%),女性31例(32.0%),年龄27~68岁,平均年龄(43.2±12.6)岁,97例肝包虫病手术患者术后出现肝功能不全35例(36.1%),胆瘘20例(20.6%),胸腹腔积液32例(33.0%),感染16例(16.5%),术后出现肝功能不全患者术前MELD评分(12.3±3.1)明显高于术后肝功能正常患者(6.2±1.1)(t/χ²值=11.236/<0.001)。ROC分析显示,术前MELD评分预测肝包虫病患者术后生存价值的曲线下面积(AUC)为 0.832(95% CI: 0.754~0.886),最佳诊断截点为10.3,根据术前MELD评分的最佳诊断截点,将患者分为MEID评分≥10.3分组39例(40.2%)和MEID评分<10.3分组58例(59.8%),Kaplan-Meier生存分析显示,两组患者术后5年无复发生存率比较无明显差异(78.9%、58.2%、56.3% vs 100%、76.9%、65.5%,P>0.05),MEID评分≥10.3分组肝包虫病患者术后1年、3年、5年总生存率明显低于MEID评分<10.3分组患者(100%、75.6%、63.4% vs 100%、92.3%、83.2%, P<0.05)。结论术前MELD评分能较为准确的评估肝包虫病患者术后发生肝功能不全的风险和远期总生存率。

关键词: 术前MELD评分, 肝包虫病, 术后并发症, 远期预后

Abstract: Objective To investigate the value of the preoperative MELD(model for end-stage liver disease) score in the evaluation of postoperative complications and long-term prognosis in patients with liver hydatid disease. Methods The preoperative MELD scores of various complications in patients with hepatic echinococcosis were compared. The five-year recurrence or death of all patients suffering from hepatic echinococcosis after operation was taken as the state variable and the preoperative MELD score was used as the test variable. The ROC analysis of the two was carried out to obtain the optimal cut-off values for predicting the postoperative survival of patients. The participants were divided into two groups. The general clinical data of patients between the two groups were compared, and the 5-year recurrence free survival rate and overall survival rate of postoperative patients between the two groups were compared by Kaplan-Meier survival analysis. Results In this study, 97 patients with hepatic echinococcosis, 66 males (68.0%) and 31 females (32.0%), aged 27-68 years, with an average age of (43.2 ± 12.6) were enrolled. Major complications included liver dysfunction in 35 (36.1%) cases , biliary fistula in 20 (20.6%) cases, pleural and peritoneal effusion in 32 (33.0%) cases and infection in 16 (16.5%) cases. The preoperative MELD score of patients with postoperative liver dysfunction (12.3 ± 3.1) was significantly higher than that of patients with normal liver function (6.2 ± 1.1) (t/χ²=11.236 / <0.001), ROC analysis showed that the area under the curve (AUC) of preoperative MELD score predicting the postoperative survival value of patients with hepatic hydatid disease was 0.832 (95% CI: 0.754 ~ 0.886), and the optimal cut-off value was 10.3. According to the optimal cut-off value of preoperative MELD score, patients were divided into two groups based on their MELD scores: group A, MELD score ≥ 10.3(n=39, 40.2%) and group B, MELD < 10.3(n=58, 59.8%). Kaplan Meier survival analysis showed that there was no significant difference in the 5-year recurrence- free survival rate of patients between the two groups (78.9%, 58.2%, 56.3% vs 100%, 76.9%, 65.5%, all P>0.05). The 1-year, 3-year and 5-year overall survival rate in group A was significantly lower than that in group B(100%, 75.6%, 63.4% vs 100%, 92.3%, 83.2%, all P<0.05). Conclusion The preoperative MELD score can accurately evaluate the risk of postoperative liver dysfunction and long-term overall survival rate of patients with hepatic echinococcosis.

Key words: Preoperative MELD score, Hepatic hydatid, Postoperative complications, Long-term prognosis

于鹏, 段绍斌. 术前MELD评分对肝包虫病患者手术后并发症和远期预后的评估价值[J]. 肝脏, 2023, 28(2): 229-232.

YU Peng, DUAN Shao-bin. Value of preoperative MELD score in evaluating postoperative complications and long-term prognosis of patients with hepatic echinococcosis[J]. Chinese Hepatolgy, 2023, 28(2): 229-232.

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