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终末期肝病模型(MELD)

Authors
Kiran Bambha, MD, MS
Patrick S Kamath, MD
Section Editor
Bruce A Runyon, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
王晔, 主治医师

引言

预后模型有助于估计疾病严重程度和生存情况，还可作为有用的医疗决策工具指导患者治疗。这些模型是采用统计学方法确定感兴趣变量(如人口统计学数据、临床数据和实验室检查值)对特定结局(如死亡)的影响而建立起来。

目前已有数个预后模型应用于卫生保健领域。其中一些针对总体健康状况，例如急性生理和慢性健康状况评估系统(Acute Physiology and Chronic Health Evaluation System, APACHEⅢ)[1]，而另一些则针对特定疾病。在肝病领域中，后者的例子包括原发性胆汁性肝硬化、原发性硬化性胆管炎和酒精性肝病患者生存状况的预测模型[2-5]。在肝硬化患者医护中，常用的2个模型是Child-Turcotte-Pugh(Child-Turcotte-Pugh, CTP)评分和终末期肝病模型(Model for End-stage Liver Disease, MELD)评分[6-10]。

本专题将综述MELD评分的建立、使用、影响、改良和局限性，尤其是关于其在肝移植器官分配中的应用。与肝移植患者选择相关的其他问题将单独讨论。 (参见“成人肝移植：患者选择和术前评估”)

MELD概述

MELD是一种通过前瞻性方法建立并验证的慢性肝病严重程度评分系统，其采用患者血清胆红素、血清肌酐和凝血酶原时间国际标准化比值(international normalized ratio, INR)的实验室数据来预测患者的3个月生存率(计算器 1和计算器 2)。对于肝硬化患者，MELD评分增加与肝功能障碍严重程度增加和3个月死亡风险增加相关(图 1)[11]。鉴于MELD预测肝硬化患者短期生存情况的准确性，美国器官共享联合网络(United Network for Organ Sharing, UNOS)于2002年采用该评分，对美国等待肝脏移植的患者进行优先排序。 (参见下文‘采用MELD评分进行器官分配’)

MELD评分的建立 — MELD最初建立时是用于预测经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt, TIPS)后的3个月死亡率，是根据231例行择期TIPS术的肝硬化患者的数据推导得出。随后，该模型又在一个独立的、来自荷兰的TIPS术患者队列中得以验证[8]。最初的模型包括血清胆红素、血清肌酐、INR和肝脏疾病病因(胆汁淤积性或酒精性 vs 其他病因)。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-29.
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