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目的:探讨终末期肝病模型(MELD)动态评分对慢性乙型重型肝炎患者肝移植时机的预测作用。方法:对122例因慢性乙型重型肝炎死亡患者分别于临终时,死前1周、2周、4周、8周和12周共6个时间点进行MELD评分,比较和分析各个时间点的MELD分值特点和动态变化。结果:死亡患者的MELD评分在临终时,死前1周、2周、4周、8周及12周,分别为39.52±9.93、30.11±6.21、27.28±6.54、26.85±5.43、24.32±8.02、23.82±5.57,死亡时MELD分值与死前1周、2周比较有统计学差异(P<0.01),死前1周与2周比较有统计学差异(P<0.01)。结论:慢性乙型重型肝炎临终前12周至死亡时,MELD评分呈进行性升高趋势,当MELD分值大于30,在1周至2周内分值仍升高的患者,死亡风险极高,应尽快行肝移植治疗。
Objective: To investigate the prediction of the timing of liver transplantation in patients with chronic severe hepatitis B by dynamic grading of end-stage liver disease (MELD). Methods: The MELD scores of 122 deaths from patients with chronic severe hepatitis B at the dying time, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks before death were compared. The MELD scores were compared and analyzed at different time points MELD score characteristics and dynamic changes. Results: The MELD scores of death patients were 39.52 ± 9.93, 30.11 ± 6.21, 27.28 ± 6.54, 26.85 ± 5.43, 24.32 ± 8.02 respectively at the end of dying, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks before death, 23.82 ± 5.57. The MELD score at death was statistically different from that at 1 week and 2 weeks before death (P <0.01). There was a significant difference between the 1 week and 2 weeks before death (P <0.01). CONCLUSIONS: The MELD score increases progressively from the twelfth week before death to the death from chronic hepatitis B. When the MELD score is greater than 30, the risk of death is extremely high in patients who are still elevated in scores from 1 week to 2 weeks. Liver transplantation as soon as possible.