MELD评分预测急性毒蕈中毒患者短期临床预后(1)
[摘要]目的 探讨终末期肝病模型(MELD)评分对预测急性毒蕈中毒所致肝功能损害患者短期预后的临床价值。方法 将我院感染消化科2014年7月～2017年9月收治的20例急性毒蕈中毒患者纳入研究，按照出院时生存与否分为生存组与死亡组，比较两组患者的相关观察指标。结果 12例生存，8例病情恶化死亡。两组的ALT、AST、TBil、Alb、SCr、WBC差异无统计学意义(P>0.05)，两组的MELD和凝血酶原活动度(PTA)差异有统计学意义(P=0.001，P=0.047)。以MELD绘制其判断患者短期预后的ROC曲线，曲线下面积为0.927。以MELD<14.57分作为预测毒蕈中毒患者预后良好的临界阈值，其灵敏度为100%，特异度为75%。结论 MELD评分可以有效预测急性毒蕈中毒所致肝功能损害患者的短期预后。
[关键词]急性毒蕈中毒；终末期肝病模型评分；预后
[中图分类号] R155.3 [文献标识码] A [文章编号] 1674-4721(2018)3(b)-0034-04
MELD score predicting short-term clinical prognosis in patients with acute mushroom poisoning
TIAN Xiao-li1 WU Song-lin2 WU Gang1
1.Department of Infection，Affiliated Hospital of Southwest Medical University，Sichuan Province，Luzhou 646000，China；2.Department of Critical Care Medicine，Affiliated Hospital of Southwest Medical University，Sichuan Province，Luzhou 646000，China
[Abstract]Objective To investigate the clinical value of model for end-stage liver disease (MELD) score predicting short-term prognosis in patients with acute mushroom poisoning which leads to liver function damage.Methods From July 2014 to September 2017，20 cases with acute mushroom poisoning admitted into infection and digestive department in our hospital were enrolled the study.According to whether there was survival or death at discharge，they were divided into the survival group and death group.The differences of clinical manifestation and experimental examinations were compared.Results There were 12 patients were survival and 8 patients dead due to deterioration of the condition.There was no great difference in alanine transaminase (ALT)，aspartate aminotransferase (AST)，total bilirubin (TBil)，albumin (Alb)，creatinine (SCr)，and white blood cell (WBC).MELD and prothrombin time activity (PTA) were displayed statistical differences (P=0.001，P=0.047).The receiver operating characteristic (ROC) curve was drawn with MELD to determine the short-term prognosis，and the area under the curve was 0.927.MELD<14.57 points was selected as a predictor of mushroom poisoning threshold of patients with good prognosis，and the sensitivity and specificity was 100% and 75% respectively.Conclusion MELD score can effectively predict the short-term prognosis in patients with liver function damage caused by acute mushroom poisoning.
[Key words]Acute mushroom poisoning；Model for end-stage liver disease；Prognosis
毒蕈，又称为毒蘑菇，因为其外观形态与食用蕈相似，易被误采及误食而导致中毒。根据其中毒后的临床表现，临床上常分为4型，分别为胃肠炎型、神经精神型、溶血型及中毒性肝炎型，以后者最严重，病死率可高达50%～90%[1]。毒蕈中毒所致肝衰竭多为急性肝衰竭，病死率高，对于毒蕈中毒所致肝功能损害乃至肝衰竭患者的临床预后指标目前尚无报道。目前研究最广泛的用于预测终末期肝病中短期病死率的是终末期肝病模型(model for end-stage liver disease，MELD)評分，也常用于重型肝炎预后的判断[2-4]。为此，本研究旨在通过分析临床常用的MELD评分与肝功能损害为主的毒蕈中毒患者预后的相关性，进一步探索MELD预测急性毒蕈中毒所致肝功能损害患者短期预后的临床价值。, 百拇医药(田小利 吴松林 吴刚)
[关键词]急性毒蕈中毒；终末期肝病模型评分；预后
[中图分类号] R155.3 [文献标识码] A [文章编号] 1674-4721(2018)3(b)-0034-04
MELD score predicting short-term clinical prognosis in patients with acute mushroom poisoning
TIAN Xiao-li1 WU Song-lin2 WU Gang1
1.Department of Infection，Affiliated Hospital of Southwest Medical University，Sichuan Province，Luzhou 646000，China；2.Department of Critical Care Medicine，Affiliated Hospital of Southwest Medical University，Sichuan Province，Luzhou 646000，China
[Abstract]Objective To investigate the clinical value of model for end-stage liver disease (MELD) score predicting short-term prognosis in patients with acute mushroom poisoning which leads to liver function damage.Methods From July 2014 to September 2017，20 cases with acute mushroom poisoning admitted into infection and digestive department in our hospital were enrolled the study.According to whether there was survival or death at discharge，they were divided into the survival group and death group.The differences of clinical manifestation and experimental examinations were compared.Results There were 12 patients were survival and 8 patients dead due to deterioration of the condition.There was no great difference in alanine transaminase (ALT)，aspartate aminotransferase (AST)，total bilirubin (TBil)，albumin (Alb)，creatinine (SCr)，and white blood cell (WBC).MELD and prothrombin time activity (PTA) were displayed statistical differences (P=0.001，P=0.047).The receiver operating characteristic (ROC) curve was drawn with MELD to determine the short-term prognosis，and the area under the curve was 0.927.MELD<14.57 points was selected as a predictor of mushroom poisoning threshold of patients with good prognosis，and the sensitivity and specificity was 100% and 75% respectively.Conclusion MELD score can effectively predict the short-term prognosis in patients with liver function damage caused by acute mushroom poisoning.
[Key words]Acute mushroom poisoning；Model for end-stage liver disease；Prognosis
毒蕈，又称为毒蘑菇，因为其外观形态与食用蕈相似，易被误采及误食而导致中毒。根据其中毒后的临床表现，临床上常分为4型，分别为胃肠炎型、神经精神型、溶血型及中毒性肝炎型，以后者最严重，病死率可高达50%～90%[1]。毒蕈中毒所致肝衰竭多为急性肝衰竭，病死率高，对于毒蕈中毒所致肝功能损害乃至肝衰竭患者的临床预后指标目前尚无报道。目前研究最广泛的用于预测终末期肝病中短期病死率的是终末期肝病模型(model for end-stage liver disease，MELD)評分，也常用于重型肝炎预后的判断[2-4]。为此，本研究旨在通过分析临床常用的MELD评分与肝功能损害为主的毒蕈中毒患者预后的相关性，进一步探索MELD预测急性毒蕈中毒所致肝功能损害患者短期预后的临床价值。, 百拇医药(田小利 吴松林 吴刚)