[终末期肝病模型对肝硬化腹水患者自发性细菌性腹膜炎的预测价值]
[The predictive value of end-stage liver disease model for spontaneous bacterial peritonitis in cirrhotic patients with ascites].
作者信息
Wang Xin, Wang Bang-Mao, Jiang Kui, Zhang Jie, Fang Wei-Li, Wang Tao, Li Xin-Yuan
机构信息
Department of Gastroenterology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
出版信息
Zhonghua Nei Ke Za Zhi. 2009 Aug;48(8):629-32.
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. We aimed to investigate the predictive value of model for end-stage liver disease (MELD) score at admission in predicting incidence rate of SBP in cirrhotic patients with ascites, so as to evaluate its use in early diagnosis and prognosis of this complication.
METHODS
A retrospective study enrolling 254 consecutive patients with cirrhosis and ascites between June 2003 and June 2006 was carried out. The data collected included the age, sex, etiology of liver disease, serum creatinine, total bilirubin, prothrombin time with international normalized ratio and ascitic fluid analysis of the patients. The patients were graded with MELD formula into 4 groups (MELD < or = 9, 10-19, 20-29, MELD > or = 30). The incidence rate of SBP was compared in the 4 groups according to the MELD score. The predictive accuracy in patients with and without SBP was evaluated with receiver operating characteristic (ROC) curve.
RESULTS
SBP developed in 65 (26%) patients during hospitalization. The clinical characteristics were similar between the patients with and without SBP. The mean MELD score for patients with SBP was 23 and for those without was 14 (P < 0.01). Patients with 10-19 had an odds ratio of 1.44 (P > 0.05) for SBP, as compared with patients with MELD < or = 9. The frequency of spontaneous bacterial peritonitis was higher in the patients with MELD > or = 20 than those with MELD < or = 19. The incidence rate of SBP with MELD < or = 19, 20-29 and MELD > or = 30 were 12.5%, 52.38%, and 66.67% respectively. Patients with MELD > or = 30 had an odds ratio of 14 (95% CI 5.41-36.20) for SBP, as compared with patients with MELD < or = 19. Patients with 20-29 had an odds ratio of 7.7 (95% CI 4.17-14.20) for SBP, as compared with patients with MELD < or = 19. Area under curve (AUC) of MELD was 0.774 (95% CI 0.689-0.855).
CONCLUSION
The cirrhotic patients with complicating ascites with higher MELD score have a greater risk of SBP. High MELD score might be an useful predictor of SBP in cirrhotic patients with ascites.
目的
自发性细菌性腹膜炎（SBP）是肝硬化腹水患者的一种严重并发症。早期识别高危患者对于改善预后至关重要。我们旨在研究入院时终末期肝病模型（MELD）评分对肝硬化腹水患者SBP发生率的预测价值，以评估其在该并发症早期诊断和预后评估中的应用。
方法
对2003年6月至2006年6月连续收治的254例肝硬化腹水患者进行回顾性研究。收集的数据包括患者的年龄、性别、肝病病因、血清肌酐、总胆红素、国际标准化比值的凝血酶原时间及腹水分析。根据MELD公式将患者分为4组（MELD≤9、10 - 19、20 - 29、MELD≥30）。比较4组患者根据MELD评分的SBP发生率。采用受试者工作特征（ROC）曲线评估有或无SBP患者的预测准确性。
结果
65例（26%）患者在住院期间发生SBP。有或无SBP患者的临床特征相似。发生SBP患者的平均MELD评分为23，未发生SBP患者的平均MELD评分为14（P<0.01）。与MELD≤9的患者相比，MELD为10 - 19的患者发生SBP的比值比为1.44（P>0.05）。MELD≥20的患者自发性细菌性腹膜炎的发生率高于MELD≤19的患者。MELD≤19、20 - 29和MELD≥30的患者SBP发生率分别为12.5%、52.38%和66.67%。与MELD≤19的患者相比，MELD≥30的患者发生SBP的比值比为14（95%CI 5.41 - 36.20）。与MELD≤19的患者相比，MELD为20 - 29的患者发生SBP的比值比为7.7（95%CI 4.17 - 14.20）。MELD的曲线下面积（AUC）为0.774（95%CI 0.689 - 0.855）。
结论
MELD评分较高的肝硬化腹水合并症患者发生SBP的风险更大。高MELD评分可能是肝硬化腹水患者SBP的一个有用预测指标。
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