Zhang Feng, Zhuge Yuzheng, Zou Xiaoping, Zhang Ming, Peng Chunyan, Li Zhenlei, Wang Tingting
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
Eur J Gastroenterol Hepatol. 2014 Aug;26(8):853-60. doi: 10.1097/MEG.0000000000000134.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established minimal-invasive procedure to treat complications of portal hypertension, and several scoring systems have been used to help choose suitable patients. However, its accuracy remains controversial.
To compare the performance of the Child-Turcotte-Pugh (CTP) classification system, model for end-stage liver disease (MELD) score, Emory score, Bonn TIPS early mortality (BOTEM) score, and serum bilirubin and platelet count (SB/PLT model) in predicting survival in Chinese patients with liver cirrhosis undergoing TIPS.
The clinical data of patients undergoing TIPS in our department were retrospectively analyzed to compare the five scoring systems on the basis of survival after TIPS.
A cohort of 159 patients was analyzed. The survival curves showed a statistical significance between classification B and C of CTP (χ=9.451, P=0.002), between MELD less than 10 and MELD at least 10 (χ=10.099, P=0.001), and between low-risk and moderate-risk groups of the Emory score (χ=4.656, P=0.031), indicating a better discriminatory ability. By ROC curves and a logistic regression model, the MELD score and the CTP system had better power to predict 3-, 12-, and 24-month survival. The MELD score and the CTP classification system had smaller values of -2 Ln(L), Akaike Information criterion, and Schwarz-Bayesian criterion, respectively.
The MELD score and the CTP classification system provide better prognostic stratification for a cohort of Chinese patients with advanced cirrhosis undergoing TIPS. However, the MELD score is not significantly superior to the CTP system.
经颈静脉肝内门体分流术（TIPS）是一种成熟的用于治疗门静脉高压并发症的微创手术，已有多种评分系统用于帮助选择合适的患者。然而，其准确性仍存在争议。
比较Child-Turcotte-Pugh（CTP）分类系统、终末期肝病模型（MELD）评分、埃默里评分、波恩TIPS早期死亡率（BOTEM）评分以及血清胆红素和血小板计数（SB/PLT模型）在预测接受TIPS的中国肝硬化患者生存情况方面的表现。
回顾性分析我科接受TIPS患者的临床资料，根据TIPS术后生存情况比较这五种评分系统。
共分析了159例患者。生存曲线显示CTP分类中B级和C级之间（χ=9.451，P=0.002）、MELD小于10与MELD至少为10之间（χ=10.099，P=0.001）以及埃默里评分的低风险和中风险组之间（χ=4.656，P=0.031）存在统计学差异，表明具有更好的区分能力。通过ROC曲线和逻辑回归模型，MELD评分和CTP系统在预测3个月、12个月和24个月生存率方面具有更好的效能。MELD评分和CTP分类系统的-2 Ln(L)值、赤池信息准则和施瓦茨贝叶斯准则分别较小。
MELD评分和CTP分类系统为接受TIPS的中国晚期肝硬化患者群体提供了更好的预后分层。然而，MELD评分并不显著优于CTP系统。
