• 四川大學(xué)華西醫(yī)院肝移植中心（成都610041）;;
  • 通訊作者： 嚴(yán)律南;

【摘要】目的 討論終末期肝病模型（MELD）的產(chǎn)生與發(fā)展，評價(jià)對肝移植的影響。
方法 回顧性分析MELD在肝移植應(yīng)用中的有關(guān)文獻(xiàn)。
結(jié)果 MELD廣泛應(yīng)用于預(yù)測和評定終末期肝病的嚴(yán)重程度及患者等待肝移植期間死亡危險(xiǎn)度，以決定器官分配的優(yōu)先順序。
結(jié)論 MELD為新的評分系統(tǒng)，可減少患者等待肝移植的時(shí)間，客觀地、精確地預(yù)測終末期肝病患者的短期生存率和死亡危險(xiǎn)度，是較為理想的器官分配評分系統(tǒng)。

引用本文： 謝建國,嚴(yán)律南. MELD評分系統(tǒng)在肝移植中的應(yīng)用和意義. 中國普外基礎(chǔ)與臨床雜志, 2005, 12(6): 634-636. doi: 復(fù)制

1. Testa R, Valente U, Risso D, et al. Can the MEGX test and serum bile acids improve the prognostic ability of ChildPugh’s score in liver cirrhosis? [J]. Eur J Gastroenterol Hepatol, 1999; 11(5)559.
2. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts [J]. Hepatology, 2000; 31(4)864.
3. Chalasani N, Kahi CJ, Francois F, et al. Mayo clinic endstage liver disease model (MELD) for predicting patient outcomes following acute variceal bleeding [J]. Hepatology, 2001； 34∶345A.
4. Carithers RL Jr. Liver transplantation. American Association for the Study of Liver Diseases [J]. Liver Transpl, 2000; 6(1)122.
5. Abouassi SG, Mihas AA, Williams LM, et al. MELD and CTP scores are equivalent predictors of mortality in cirrhotic veterans referred for orthotopic liver transplantation (OLT) [J]. Hepatology, 2001; 34207A.
6. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with endstage liver disease [J]. Hepatology, 2001; 33(2)464.
7. Bambha K, Kim WR, Kremers WK, et al. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements [J]. Am J Transplant, 2004; 4(11)1798.
8. Wiesner RH, McDiarmid SV, Kamath PS, et al. MELD and PELD: application of survival models to liver allocation [J]. Liver Transpl, 2001; 7(7)567.
9. Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study [J]. Gut, 2003; 52(1)134.
10. Freeman RB Jr, Wiesner RH, Roberts JP, et al. Improving liver allocation: MELD and PELD [J]. Am J Transplant, 2004; 4(Suppl 9)114.
11. Freeman RB, Wiesner RH, Edwards E, et al. Results of the first year of the new liver allocation plan [J]. Liver Transpl, 2004; 10(1)7.
12. Jacob M, Copley LP, Lewsey JD, et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland [J]. Liver Transpl, 2004; 10(7)903.
13. Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation [J]. Liver Transpl, 2003; 9(2)117.
14. Bambha K, Kim WR, Kremers WK, et al. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements [J]. Am J Transplant, 2004; 4(11)1798.
15. Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy [J]. Gastroenterology, 2004; 127(5 Suppl 1)S261.
16. Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact [J]. Liver Transpl, 2004; 10(1)36.
17. Yao FY, Bass NM, Ascher NL, et al. Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of EndStage Liver Disease (MELD) organ allocation policy [J]. Liver Transpl, 2004; 10(5)621.
18. Olthoff KM, Brown RS Jr, Delmonico FL, et al. Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA [J]. Liver Transpl, 2004; 10(10 Suppl 2)A6.
19. Wang VS, Saab S. Liver transplantation in the era of model for endstage liver disease [J]. Liver Int, 2004; 24(1)1.
20. Trotter JF, Brimhall B, Arjal R, et al. Specific laboratory methodologies achieve higher model for endstage liver disease (MELD) scores for patients listed for liver transplantation [J]. Liver Transpl, 2004; 10(8)995.
21. McCaughan GW, Strasser SI. To MELD or not to MELD? [J]. Hepatology， 2001; 34(1)215.
22. Heuman DM, AbouAssi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death [J]. Hepatology， 2004; 40(4)802.
23. Freeman RB. Mathematical models and behavior: assessing delta MELD for liver allocation [J]. Am J Transplant， 2004; 4(11)1735.
  1. 1. Testa R, Valente U, Risso D, et al. Can the MEGX test and serum bile acids improve the prognostic ability of ChildPugh’s score in liver cirrhosis? [J]. Eur J Gastroenterol Hepatol, 1999; 11(5)559.
  2. 2. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts [J]. Hepatology, 2000; 31(4)864.
  3. 3. Chalasani N, Kahi CJ, Francois F, et al. Mayo clinic endstage liver disease model (MELD) for predicting patient outcomes following acute variceal bleeding [J]. Hepatology, 2001； 34∶345A.
  4. 4. Carithers RL Jr. Liver transplantation. American Association for the Study of Liver Diseases [J]. Liver Transpl, 2000; 6(1)122.
  5. 5. Abouassi SG, Mihas AA, Williams LM, et al. MELD and CTP scores are equivalent predictors of mortality in cirrhotic veterans referred for orthotopic liver transplantation (OLT) [J]. Hepatology, 2001; 34207A.
  6. 6. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with endstage liver disease [J]. Hepatology, 2001; 33(2)464.
  7. 7. Bambha K, Kim WR, Kremers WK, et al. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements [J]. Am J Transplant, 2004; 4(11)1798.
  8. 8. Wiesner RH, McDiarmid SV, Kamath PS, et al. MELD and PELD: application of survival models to liver allocation [J]. Liver Transpl, 2001; 7(7)567.
  9. 9. Botta F, Giannini E, Romagnoli P, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study [J]. Gut, 2003; 52(1)134.
  10. 10. Freeman RB Jr, Wiesner RH, Roberts JP, et al. Improving liver allocation: MELD and PELD [J]. Am J Transplant, 2004; 4(Suppl 9)114.
  11. 11. Freeman RB, Wiesner RH, Edwards E, et al. Results of the first year of the new liver allocation plan [J]. Liver Transpl, 2004; 10(1)7.
  12. 12. Jacob M, Copley LP, Lewsey JD, et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland [J]. Liver Transpl, 2004; 10(7)903.
  13. 13. Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation [J]. Liver Transpl, 2003; 9(2)117.
  14. 14. Bambha K, Kim WR, Kremers WK, et al. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements [J]. Am J Transplant, 2004; 4(11)1798.
  15. 15. Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy [J]. Gastroenterology, 2004; 127(5 Suppl 1)S261.
  16. 16. Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact [J]. Liver Transpl, 2004; 10(1)36.
  17. 17. Yao FY, Bass NM, Ascher NL, et al. Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of EndStage Liver Disease (MELD) organ allocation policy [J]. Liver Transpl, 2004; 10(5)621.
  18. 18. Olthoff KM, Brown RS Jr, Delmonico FL, et al. Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA [J]. Liver Transpl, 2004; 10(10 Suppl 2)A6.
  19. 19. Wang VS, Saab S. Liver transplantation in the era of model for endstage liver disease [J]. Liver Int, 2004; 24(1)1.
  20. 20. Trotter JF, Brimhall B, Arjal R, et al. Specific laboratory methodologies achieve higher model for endstage liver disease (MELD) scores for patients listed for liver transplantation [J]. Liver Transpl, 2004; 10(8)995.
  21. 21. McCaughan GW, Strasser SI. To MELD or not to MELD? [J]. Hepatology， 2001; 34(1)215.
  22. 22. Heuman DM, AbouAssi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death [J]. Hepatology， 2004; 40(4)802.
  23. 23. Freeman RB. Mathematical models and behavior: assessing delta MELD for liver allocation [J]. Am J Transplant， 2004; 4(11)1735.