消化
词汇介绍
拓展阅读
解析
model 英 [ˈmɒdl] 美 [ˈmɑ:dl]
释义 n. 模型；典型；模范；模特儿；样式
vt. 模拟；塑造；模仿
vi. 做模型；做模特儿
adj. 模范的；作模型用的
例句 Epidemiologic and animal model studies provide evidence for this model.流行病学和动物模型研究为该模型提供了证据。
end-stage 英 [end-steɪdʒ] 美 [ɛnd-stedʒ]
释义 n. 末期
例句 The renal fibrosis is the end-result of all chronic renal disease and the primary cause of the end-stage chronic renal failure.肾脏纤维化是所有慢性肾脏疾病发展的最终结果，是导致终末期肾功能衰竭的主要原因之一。
liver 英 [ˈlɪvə(r)] 美 [ˈlɪvɚ]
释义 n. 肝脏；生活者，居民
例句 They also found particles in the liver cells of patients with hepatitis.他们在肝炎病人的肝细胞也发现了这种微粒。
disease 英 [dɪˈzi:z] 美 [dɪˈziz]
释义 n. 病，[医] 疾病；弊病
vt. 传染；使…有病
例句 Your doctor will be the one to ascertain if you do in fact have the disease.您的医生将是一个以确定如果你确实有这种疾病。
概述
概述
终末期肝病一直以来都没有一个较完善的评分指标来评价其严重程度。自终末期肝病模型(model for end-stage liver disease，MELD)标准制定以来，因其可对终末期肝病短期、中期死亡率进行有效的预测，并因其评价指标获得简单、客观、易于计算而在肝病诊治中广为应用。
由来及计算公式
2000年Malinchoc等首先应用MELD来预测终末期肝病行经颈静脉肝内门-体分流术后患者的死亡率，并证实MELD可以预测终末期肝病的死亡率及术后的生存时间。其计算公式为：R=0.378ln[胆红素(mg/dl)]+1.12ln(INR)+0.95ln[肌酐(mg/dl)]+0.64(病因：胆汁性或酒精性0，其他1)。其R值越高，其风险越大，生存率越低。后为计算方便，Kamath等将公式改良为 R=3.8ln[胆红素(mg/dl)]+11.2ln(INR)+9.6ln [肌酐(mg/dl)]+6.4(病因：胆汁性或酒精性0，其他1)。
临床应用
（1）在非移植患者预测肝病死亡率中的应用；
（2）在肝移植中的应用；
（3）在重型肝炎及人工肝中的应用。
缺陷性
（1）MELD分级中使用的血清肌酐、胆红素、INR等指标，容易受非肝病因素的影响，这将直接影响判断真实的肝病病情；
（2）MELD评分尚须纳入更多的观察指标；
（3）人的疾病是错综复杂的，大多数情况下简单的线性回归并不能满足要求，疾病的各观察指标之间常常会有相关性，这就造成了变量间的共线性问题。
复制标题手握力量为终末期肝病评分模型增加了比基于成像的肝硬化男性肌肉质量测量更多的预后价值
发表时间：2019-07-08
影响指数：4.2
作者： Marie Sinclair
期刊：Liver Transplantation
Sarcopenia is associated with mortality in cirrhosis, but there is no gold standard for its diagnosis. The comparative utility of different diagnostic methods is unknown. This single-center observational cohort study followed 145 men referred for liver transplant evaluation between 2005 and 2012. Muscle mass was estimated by handgrip strength, dual energy X-ray absorptiometry (DEXA) lean mass, and single-slice computed tomography (CT) scan at the fourth lumbar vertebra. Recorded outcomes included time to death or liver transplantation. The median (interquartile range [IQR]) age was 54 years (47-59 years), and Model for End-Stage Liver Disease (MELD) score was 17 (14-23). Of 145 men, 56 died with a median (IQR) time to death of 7.44 months (3.48-14.16 months). In total, 79 men underwent transplantation with median (IQR) time to transplant of 7.20 months (3.96-12.84 months). The prevalence of sarcopenia differed between diagnostic modalities with 70.3% using CT muscle mass, 45.9% using handgrip strength, and 38.7% using DEXA. Muscle mass was inversely associated with wait-list mortality for measured CT muscle mass (hazard ratio [HR], 0.94; 95% confidence interval (CI), 0.90-0.98; P = 0.002), DEXA muscle mass (HR, 0.99; 95% CI, 0.99-0.99; P = 0.003), and handgrip strength (HR, 0.94; 95% CI, 0.91-0.98; P = 0.002). These results retained significance independent of the MELD score. In predicting mortality, the MELD-handgrip strength bivariate Cox model was superior to a MELD-CT muscle Cox model (P < 0.001). In conclusion, handgrip strength combined with MELD score was the superior predictive model in this novel study examining 3 commonly employed techniques to diagnose sarcopenia in cirrhosis. Handgrip strength has additional potential clinical benefits because it can be performed serially without the radiation dose, cost, and access issues attributable to CT and DEXA.
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