论文部分内容阅读
目的探讨终末期肝病模型(MELD)评分对妊娠合并重型肝炎短期预后的评价作用。方法计算1994年1月至2007年6月中山大学附属第三医院等6家医院66例妊娠合并重型肝炎患者入院时MELD分值,以及其中26例行剖宫产术、5例阴道分娩的晚期妊娠患者分娩前后的MELD分值及其差值(ΔMELD),分析其与预后的关系,并应用c-统计值评价MELD评分对妊娠合并重型肝炎预后的预测价值。结果66例入院时MELD分值,死亡组(37.14±9.86)高于存活组(22.45±7.42),差异有统计学意义(P<0.01)。31例院内分娩患者中,存活组与死亡组分娩前MELD分值分别为19.57±10.64、30.38±5.71,两组比较差异有统计学意义(P<0.01);26例剖宫产患者中,术后存活组MELD分值逐渐下降,而死亡组MELD分值逐渐上升,两组间手术前后MELD分值差异均有统计学意义(P<0.01)。术后3dMELD分值同术前的差值(△MELD)在存活组与死亡组间差异有统计学意义。c-统计值均>0.8。结论MELD评分对妊娠合并重型肝炎的短期预后显示出非常好的预测价值。剖宫产术后3d同术前MELD分值的差值对于评价预后也有着非常好的预测价值。
Objective To evaluate the evaluation of the end-stage liver disease (MELD) score on the short-term prognosis of severe hepatitis in pregnancy. Methods Sixty-six patients with pregnancy-associated severe hepatitis admitted to hospital from January 1994 to June 2007 in the Third Affiliated Hospital of Sun Yat-sen University were enrolled in the MELD score and 26 of them were treated with cesarean section and 5 with advanced vaginal delivery The MELD score and its difference (ΔMELD) before and after delivery in pregnant women were analyzed. The relationship between MELD score and prognosis was analyzed. The predictive value of MELD score in predicting the prognosis of severe hepatitis during pregnancy was evaluated by c-statistics. Results The MELD scores of 66 patients at admission were significantly higher than those of survivors (37.14 ± 9.86 vs 22.45 ± 7.42, P <0.01). Among the 31 patients with intrapartum delivery, the MELD scores of survivors and deaths before delivery were 19.57 ± 10.64 and 30.38 ± 5.71, respectively, with significant difference between the two groups (P <0.01). Among 26 cesarean section patients, MELD scores decreased gradually in the post-survival group, but MELD scores in the death group increased gradually. There was significant difference in MELD scores between the two groups before and after operation (P <0.01). There was significant difference between postoperative 3dMDD score and preoperative difference (△ MELD) in survival group and death group. c-statistics> 0.8. Conclusion The MELD score shows very good predictive value for the short-term prognosis of severe hepatitis with pregnancy. The difference of preoperative MELD score 3d after cesarean section also has a very good predictive value for the evaluation of prognosis.