科学家发现预测肝移植转归的早期指标

一项新研究发现测定可能接受肝移植的患者的血清钠，能够比以前测定的3种指标更好地预测移植的愈后。

自从2002年开始，美国肝脏配给中心已经根据患者的MELD(终末期肝病模型)评分，来预测等待移植的肝硬化患者的3个月死亡率，该评分使用了3种生化指标。这3种指标是血清胆红素、血清肌酐、以及凝血酶原时间。当前的研究提示添加血清钠和低钠血症（血清钠水平降低）有助于增加MELD评分预测等待移植患者死亡可能的准确性。

该研究由位于阿根廷Buenos Aires的Fundacion Favaloro肝脏中心的Andres E. Ruf医生主持，涵盖了1995年6月～2003年1月登记等待肝移植的262例肝硬化患者。在登记的时候检测了血清胆红素、肌酐、和钠用于计算MELD评分。使用了2种不同的统计学方法分析了等待时间未3～6月患者的血清钠、低钠血症和MELD预测死亡的效能。这项研究的结果显示：当MELD增加血清钠和低钠血症的时候，能够显著增加评分预测短期死亡的准确性。

作者指出：“在我们的研究中，在3个月内死亡患者中低钠血症发病率（63％）显著高于3个月内存活的患者（13％）。类似的是，患低钠血症的患者与那些血清钠水平正常的患者相比更显著的发生终末期肝衰竭。”研究人员还指出，尽管低钠血症最终反应的是肾功能损害，在等待肝移植的终末期肝硬化患者中，这个指标做为早期指标，能够比血清肌酐更为准确地预测患者转归较差。

The results of this study appear in the March 2005 issue of Liver Transplantation, published by John Wiley & Sons, Inc. and is available online via Wiley InterScience.

Markers Predict Outcome of Liver Transplant
 
A new study has found that measuring serum sodium in potential liver transplant patients is better able to predict those with a poor prognosis than the three markers previously used.

Since 2002, liver allocation in the United States has been based on a patient’s score on the MELD (model for end-stage liver disease), which uses levels of three biochemical markers to predict three-month mortality in patients with cirrhosis of the liver listed for transplantation. Those three markers are serum bilirubin, serum creatinine, and prothrombin time. The current study was intended to show if adding serum sodium and hyponatremia (low sodium level in the blood) would increase the accuracy of the MELD score to predict the risk of death on the waiting list.

Led by Andres E. Ruf, M.D., of the Liver Unit of the Fundacion Favaloro in Buenos Aires (Argentina), the study included 262 patients with cirrhosis who were listed for liver transplantation between June 1995 and January 2003. Serum bilirubin, creatinine, and sodium were measured at the time of listing and used to calculate a MELD score. The efficacy of serum sodium, hyponatremia, and MELD to predict death within three and six months of listing was analyzed with two different statistical methods. Results of the study showed that when added to the MELD, serum sodium and hyponatremia significantly increased the accuracy of the score in predicting short-term mortality.

“In our study, the prevalence of hyponatremia was significantly higher in patients who died within 3 months (63%) than in those who survived 3 months (13%),” the authors noted. “Similarly, patients with hyponatremia had significantly more advanced liver failure compared to those with normal serum sodium.” They add that although hyponatremia ultimately reflects renal impairment, it appears to be a more accurate and early marker of poor outcome than serum creatinine in transplant candidates with advanced cirrhosis.

The results of this study appear in the March 2005 issue of Liver Transplantation, published by John Wiley & Sons, Inc. and is available online via Wiley InterScience.