肝病的肝功能评估课件.ppt

关于肝病的肝功能评估
第一页，共30页幻灯片
1964年 Child-Turcotte 肝功能分级
1973年 Child-Turcott-Pugh (CTP)
1997年 UNOS 成人(>18岁)肝病严重程度分D score survival (%) survival (%) survival (%)
Perioperative Mortality and long-term survival after Hepatic Resection for HCC
Journal Of Gastrointestinal Surgery 2005 Dec; Vol. 9 (9), pp. 1207-15
The perioperative mortality for patients with MELD score ≥9 was significantly greater than that for patients with MELD score ≤8 (<).
The long-term survival for patients with MELD score ≥9 was significantly shorter than that for patients with MELD score ≤8 (<). .
37 0 (0)
45 13 (29)
≤8 89 63 51
≥9 46 34 23
第八页，共30页幻灯片
Outcome post-transplant dependent on △MELD between listing and transplant
△MELD ≤+1 △MELD > +1 P-value
90 day survival (%)
180 day survival (%)
1 year survival (%)
2 year survival (%)
3 year survival (%)
Transpl Int, 2006 Dec; Vol. 19 (12), pp. 988-94;





Change in MELD score whilst on the transplant waiting list has a significant effect on survival post-transplant
第九页，共30页幻灯片
MELD的局限性
没有包括任何临床症状的判断，也没有考虑到患者的生
活质量
对于合并有严重的门脉高压、顽固性腹水以及肝性脑病的病人，在实行器官分配原则时，应当增加除MELD之外的其它附加条件
第十页，共30页幻灯片
Four clinical stages of cirrhosis
stage 1 :patients without varices or ascites (mortality is about 1% per year)
Stage 2 : patients