肝硬化疾病评分模型的价值研究
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摘要
目的:运用物元分析法,建立肝硬化疾病评分模型(SLCD),提出一种新的肝脏损害及肝功能储备评分公式,既SLCD评分公式。
方法:采用复合因素法建立实验性大鼠肝硬化诱导模型,对肝硬化诱导过程中不同时相点大鼠肝组织损害程度和血清学肝功能储备变化进行动态观察。运用物元分析法获得实验性大鼠SLCD评分公式。
结果:实验性大鼠肝硬化模型复制成功。选取年龄、血清总胆红素(TBil)、血清白蛋白(Alb)、血清前白蛋白(PA)、凝血酶原时间国际标准化比值(PT-INR)、血清肌酐(SCr)等6个检测指标,成功构建了实验性大鼠SLCD及SLCD评分公式。评估程度以数值(R值)表达,随着病变程度和纤维化程度加重,R值逐渐降低。R=1表示肝脏组织正常;0.702≤R<1表示肝脏炎症反应和局灶性变性、坏死;0.542≤R<0.702表示肝脏出现纤维组织增生现象;0.352≤R<0.542有假小叶形成,为肝硬化期;R﹤0.352表示肝硬化后期。
结论:SLCD评分公式能较敏感而准确地反映实验性肝硬化大鼠肝脏损害及肝功能储备情况,若能在临床进一步证实其运用价值,则可为临床早期预防及治疗肝硬化疾病提供参考依据。
Objective To construct the scoring model of liver cirrhosis disease(SLCD), to find a new score formula which was the SLCD score formula for the liver impairment and function reserve with the Matter-Element Analysis method.
Methods To construct the rat liver cirrhosis model of experimental rat with composite factor method. In different phases of the rat liver cirrhosis model, to give a serological detection to the dynamic changes of liver impairment degree and liver function reserve, and a histological observation to the liver pathological alteration. To obtain the SLCD score formula by using the Matter-Element Analysis method.
Results The experimental rat liver cirrhosis model was successfully copied. The experimental rat SLCD and SLCD score formula were successfully constructed with six detection indexes which were weeks, TBil, Alb, PA, PT-INR, SCr. The score was expressed by R, with the pathological changes and fibrosis were aggregated, R was gradually decreased. R=1, it meant the liver tissue was normal; 0.702≤R<1, it meant there were inflammatory reaction, focal degeneration and necrosis in liver; 0.542≤R<0.702, it meant there was fibroplasia in liver; 0.352≤R<0.542, pseudolobules were formed and it was in the liver cirrhosis stage. R﹤0.352, it meant later stage of liver cirrhosis.
Conclusions The SLCD score formula was comparatively sensitive and exact in reflecting the liver impairment and liver function reserve of the experimental rat liver cirrhosis, if there would be clinical evidence on the application value, then it may be helpful for the early clinical prevention, diagnosis and treatment for the cirrhosis disease.
方法:采用复合因素法建立实验性大鼠肝硬化诱导模型,对肝硬化诱导过程中不同时相点大鼠肝组织损害程度和血清学肝功能储备变化进行动态观察。运用物元分析法获得实验性大鼠SLCD评分公式。
结果:实验性大鼠肝硬化模型复制成功。选取年龄、血清总胆红素(TBil)、血清白蛋白(Alb)、血清前白蛋白(PA)、凝血酶原时间国际标准化比值(PT-INR)、血清肌酐(SCr)等6个检测指标,成功构建了实验性大鼠SLCD及SLCD评分公式。评估程度以数值(R值)表达,随着病变程度和纤维化程度加重,R值逐渐降低。R=1表示肝脏组织正常;0.702≤R<1表示肝脏炎症反应和局灶性变性、坏死;0.542≤R<0.702表示肝脏出现纤维组织增生现象;0.352≤R<0.542有假小叶形成,为肝硬化期;R﹤0.352表示肝硬化后期。
结论:SLCD评分公式能较敏感而准确地反映实验性肝硬化大鼠肝脏损害及肝功能储备情况,若能在临床进一步证实其运用价值,则可为临床早期预防及治疗肝硬化疾病提供参考依据。
Objective To construct the scoring model of liver cirrhosis disease(SLCD), to find a new score formula which was the SLCD score formula for the liver impairment and function reserve with the Matter-Element Analysis method.
Methods To construct the rat liver cirrhosis model of experimental rat with composite factor method. In different phases of the rat liver cirrhosis model, to give a serological detection to the dynamic changes of liver impairment degree and liver function reserve, and a histological observation to the liver pathological alteration. To obtain the SLCD score formula by using the Matter-Element Analysis method.
Results The experimental rat liver cirrhosis model was successfully copied. The experimental rat SLCD and SLCD score formula were successfully constructed with six detection indexes which were weeks, TBil, Alb, PA, PT-INR, SCr. The score was expressed by R, with the pathological changes and fibrosis were aggregated, R was gradually decreased. R=1, it meant the liver tissue was normal; 0.702≤R<1, it meant there were inflammatory reaction, focal degeneration and necrosis in liver; 0.542≤R<0.702, it meant there was fibroplasia in liver; 0.352≤R<0.542, pseudolobules were formed and it was in the liver cirrhosis stage. R﹤0.352, it meant later stage of liver cirrhosis.
Conclusions The SLCD score formula was comparatively sensitive and exact in reflecting the liver impairment and liver function reserve of the experimental rat liver cirrhosis, if there would be clinical evidence on the application value, then it may be helpful for the early clinical prevention, diagnosis and treatment for the cirrhosis disease.
引文
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[2]. Aruna Subramanian, Mark Sulkowski, Burc Barin, et al. MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates[J]. Gastroenterology, 2010, 138(1):159-164.
[3]. Juan F, Gallegos Orozco, Hugo E, Vargas. Liver Transplantation: From Child to MELD[J]. Medical Clinics of North America, 2009, 93(4):931-950.
[4].李灵敏,肖天利,陈文生.MELD与CTP评分系统对TIPS术后患者预后的评价作用[J].第三军医大学学报, 2009, 31(8):733-736.
[5]. O Cuomo, A Perrella, and G Arenga. Model for End-Stage Liver Disease (MELD) Score System to Evaluate Patients With Viral Hepatitis on the Waiting List: Better Than the Child-Turcotte-Pugh (CTP) System[J]. Transplantation Proceedings, 2008, 40:1906-1909.
[6].蔡文.物元分析[M].广州:广东高等教育出版社, 1987, 3-56.
[7].王英凯,迟宝荣,孙波等.肝硬化大鼠模型的建立及其稳定性[J].吉林大学学报(医学版), 2005, 31(6):893-896.
[8].强占荣,易彩霞,林中等.急慢性肝病患者血清白蛋白、前白蛋白及胆碱酯酶的变化特点[J].广西医学, 2010, 32(5):513-515.
[9].周锡进,杨文龙,何金秋.肝脏储备功能相关评价系统在终末期肝病中的应用进展[J].江西医药, 2009, 44:505-509.
[10].陈吐芬,龚作炯. MELD评分与CTP分级评价人工肝治疗重型肝炎预后的对比研究[J].肝脏, 2008, 13(1):7-10.
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[2]. Aruna Subramanian, Mark Sulkowski, Burc Barin, et al. MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates[J]. Gastroenterology, 2010, 138(1):159-164.
[3]. Juan F, Gallegos Orozco, Hugo E, Vargas. Liver Transplantation: From Child to MELD[J]. Medical Clinics of North America, 2009, 93(4):931-950.
[4].李灵敏,肖天利,陈文生.MELD与CTP评分系统对TIPS术后患者预后的评价作用[J].第三军医大学学报, 2009, 31(8):733-736.
[5]. O Cuomo, A Perrella, and G Arenga. Model for End-Stage Liver Disease (MELD) Score System to Evaluate Patients With Viral Hepatitis on the Waiting List: Better Than the Child-Turcotte-Pugh (CTP) System[J]. Transplantation Proceedings, 2008, 40:1906-1909.
[6].蔡文.物元分析[M].广州:广东高等教育出版社, 1987, 3-56.
[7].王英凯,迟宝荣,孙波等.肝硬化大鼠模型的建立及其稳定性[J].吉林大学学报(医学版), 2005, 31(6):893-896.
[8].强占荣,易彩霞,林中等.急慢性肝病患者血清白蛋白、前白蛋白及胆碱酯酶的变化特点[J].广西医学, 2010, 32(5):513-515.
[9].周锡进,杨文龙,何金秋.肝脏储备功能相关评价系统在终末期肝病中的应用进展[J].江西医药, 2009, 44:505-509.
[10].陈吐芬,龚作炯. MELD评分与CTP分级评价人工肝治疗重型肝炎预后的对比研究[J].肝脏, 2008, 13(1):7-10.
[1].Child III CG, Tureotte JG. Surgery and Portal HyPertension. In: Child III CG, ed. The liver and Portal hyPertension. PhiladelPhia: Saunders,1964.50.
[2].王陆军,杨永平,肝硬化患者Child-Turcotte分级与病理诊断预后及纤维化指标关系的研究[J].第三军医大学学报,2003,25(10):895-897.
[3].周锡进,等.肝脏储备功能相关评价系统在终末期肝病中的应用进展[J].江西医药,2009,44(5):505-509.
[4].Pugh RN, Murray-Lyon iM, Dawson JL, et al. Transection of the oesoPhagus for bleeding oesoPhageal variees. Br J Surg, 1973,60:646-649.
[5].严德辉,等.Child-Pugh分级、终末期肝病模型与肝硬化患者术后并发症的关系[J].肝胆外科杂志,2008,16(1):48-49.
[6].何代霞,等.分级对失代偿期肝硬化预后的评估[J].华西医学,2009,24(4):894-896.
[7].蒋忠胜,等.评价终末期肝病肝脏储备功能的进展[J].医学综述,2006,12(17):1075-1077.
[8]. Strahl S, Maier KP. Risk-classification in liver cirrhosis. Praxis,2006,95:1275-1281.
[9].Brown R S Jr, Kumar K S, Russo M W, et al. Model for end-stage Liver Disease Severity, Posttransplantation Outcome, and Resourse Utilization in United Network forOrgan Sharing Status 2A Patients[J].Liver Transpl,2002,8:278-284.
[10].Malinchoc M, Kamath P S, Gordon F D, et al. A Model to Predict Poor Survival in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunts[J].Hepatology,2000,31:864-871.
[11].Kamath P S, Wiesner R H, Malinchoc M, et al. A Model to Predict Survival in Patients with End-stage Liver Disease[J].Hepatology,2001,33:464-470.
[12].周存金,等.终末期肝病模型的临床应用进展[J].国际消化病杂志,2008,28(4):330-332.
[13].张友祥,王渭康,王冯滨.重型肝炎患者人工肝治疗前后的终末期肝病模型分析[J].中华传染病杂志,2007,2:78-80.
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