Kim W R, Poterucha J J, Wiesner R H, LaRusso N F, Lindor K D, Petz J, Therneau T M, Malinchoc M, Dickson E R
Division of Gastroenterology and Hepatology, Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN, USA.
Hepatology. 1999 Jun;29(6):1643-8. doi: 10.1002/hep.510290607.
The Child-Pugh classification is a simple, convenient prognostic measure in patients with liver cirrhosis. We investigated the relative role of the Child-Pugh classification and the Mayo model in the assessment of survival in patients with primary sclerosing cholangitis (PSC). Of the 173 patients described in the original Mayo PSC natural history model, 147 patients had sufficient information in the medical record to allow computation of the Child-Pugh score. We used our most recent modification of the Mayo model to compute the risk score, based on patient's age, serum levels of bilirubin, albumin, and aspartate aminotransferase and history of variceal bleeding. Using the risk score (R), patients were divided into the low- (R < 0), intermediate- (0 </= R < 2), and high-risk (R >/= 2) groups. Kaplan-Meier estimates and proportional hazards analysis were used to evaluate the two prognostic models. Although there was a statistically significant correlation between the Child-Pugh and Mayo risk scores, two-thirds of the patients had a Child-Pugh score of 5 or 6 and a relatively wide range of risk scores (-1.1-4.3). The probability of survival for 7 years in patients in the low-, intermediate-, and high-risk groups was 92%, 74%, and 40% for Child-Pugh class A (n = 96) and 100%, 62%, and 28% for Child-Pugh class B patients (n = 44), respectively. There were only a small number (n = 7) of Child-Pugh class C patients. In our age-adjusted multivariate analysis, each unit increase in the Mayo risk score was associated with a 2.5-fold increase in the risk of death (95% confidence interval: 1.8-3.4, P <.01), whereas Child-Pugh classification had no significant impact on survival (Child-Pugh B vs. A: risk ratio = 1.1 [95% confidence interval: 0.6-2.0]; Child-Pugh C versus A: risk ratio = 0.6 [95% confidence interval: 0. 2-1.8]). In contrast to the Child-Pugh classification, which was developed for advanced liver cirrhosis, the Mayo model provides valid survival information, particularly in patients early in the course of PSC.
Child-Pugh分级是评估肝硬化患者预后的一种简单、便捷的方法。我们研究了Child-Pugh分级和Mayo模型在原发性硬化性胆管炎（PSC）患者生存评估中的相对作用。在最初的Mayo PSC自然史模型中描述的173例患者中，147例患者的病历中有足够信息以计算Child-Pugh评分。我们使用Mayo模型的最新修订版，根据患者年龄、血清胆红素、白蛋白、天冬氨酸转氨酶水平以及静脉曲张出血史来计算风险评分。利用风险评分（R），将患者分为低风险组（R<0）、中风险组（0≤R<2）和高风险组（R≥2）。采用Kaplan-Meier估计法和比例风险分析来评估这两种预后模型。虽然Child-Pugh评分与Mayo风险评分之间存在统计学显著相关性，但三分之二的患者Child-Pugh评分为5或6，且风险评分范围相对较宽（-1.1至4.3）。Child-Pugh A级（n=96）患者低、中、高风险组的7年生存率分别为92%、74%和40%，Child-Pugh B级患者（n=44）分别为100%、62%和28%。Child-Pugh C级患者数量较少（n=�）。在我们的年龄校正多变量分析中，Mayo风险评分每增加一个单位，死亡风险增加2.5倍（95%置信区间：1.8至3.4，P<.01），而Child-Pugh分级对生存无显著影响（Child-Pugh B级与A级：风险比=1.1[95%置信区间：0.6至2.0]；Child-Pugh C级与A级：风险比=0.6[95%置信区间：0.2至1.8]）。与针对晚期肝硬化开发的Child-Pugh分级不同，Mayo模型提供了有效的生存信息，尤其是对于PSC病程早期的患者。
