慢性肝衰竭食管静脉曲张破裂出血预测模型的建立及临床应用
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摘要
研究背景和目的肝衰竭是多种因素引起的严重肝脏损害，导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿，出现以凝血机制障碍和黄疸、肝性脑病、腹水等为主要表现的一组临床症候群。不同类型肝病患者血浆D-dimer水平均有不同程度的升高表明各类肝病均呈现不同程度的纤溶亢进现象，因此，动态观察血浆D-dimer水平对肝病患者肝功能的评价、病情的预后及治疗具有重要的临床应用价值。出血是严重肝病常见的临床症状，也是终末期肝病患者死亡的主要原因之一。研究慢性肝衰竭上消化道大出血患者内镜止血后血浆D-dimer水平的动态变化规律，根据CTP分级和MELD评分进行分组，观察感染与纤溶亢进间、感染与死亡间以及影响死亡的诸因素间的联系以指导临床治疗并辅助判断预后。同时在实践中判断自行设计的出血分级评分对出血的判断效果。通过综合分析MELD评分、出血时血浆D-dimer水平和出血评分，尝试寻找能有效预测慢性肝衰竭门静脉高压伴食管静脉曲张患者出血的潜在联系，建立可能的评估模型并应用于临床进行实践操作，以有效减少该类高危患者上消化道大出血的风险并及时给予对症治疗改善预后。
方法1．通过内镜检查诊断食管静脉曲张伴／不伴出血的慢性肝衰竭患者各50例，出血组在出血时和血流动力学稳定后的第3，8，15天分别测定D-Dimer水平。非出血病人仅测定D-Dimer水平一次。所有食管静脉曲张伴／不伴破裂出血均在急诊内镜下诊断和进行必要治疗。全部患者均计算入院时CTP分级、MELD评分和出血评分，评估患者感染情况并予以相应治疗。应用SPSS16．0和SAS8．0统计软件包对血浆D-dimer水平的动态变化及相关临床因素进行统计学分析。通过综合分析MELD评分、出血时血浆D-dimer水平和出血评分间联系，建立慢性肝衰竭食管静脉曲张患者出血评估模型。
2．MELD评分在26分以上的慢性肝衰竭伴食管静脉曲张患者共48例，在模型应用组30例患者中根据“MELD≥26分伴出血评分≥10分和／或血浆D-Dimer＞700ug／L”筛选高危患者，建议行内镜检查并予套扎和／或硬化治疗，与对照组18例进行统计学比较，观察模型应用的临床效果。
结果1．100例慢性肝衰竭生存组和死亡组的感染优势比为9．438，感染是死亡的危险因素之一。出血组和非出血组临床病死率有统计学差异，出血是死亡的危险因素之一。出血组和非出血组病例间MELD和出血评分有统计学差异，提示和出血有关。在出血组，死亡与生存患者间的MELD、CTP、内毒素和出血评分均存在显著差异。而在非出血组，死亡与生存患者间的MELD、CTP存在统计学差异，但内毒素和出血评分未见显著差异。全部死亡和生存患者间的MELD、CTP、内毒素和出血评分均存在显著差异。出血组和非出血组内再按死亡分组时，发现MELD分值差距明显，提示MELD有助于评估患者预后。ROC曲线确定出血评分的分值对预测出血的最佳临界值为10分，ROC曲线确定出血患者首次血浆D-Dimer水平预测死亡的最佳临界值为首次D-Dimer＞700ug／L。ROC曲线确定出血患者MELD分值预测死亡的最佳临界值为26。慢性肝衰竭食管静脉曲张患者大出血后血浆D-Dimer的变化为高阶非线性变化。合并出血并最终死亡的慢性肝衰竭患者血浆D-Dimer水平持续异常。logistic多重回归死亡预测显示对死亡有影响的变量(P＜0．05)为MELD，CTP。趋势分析显示慢性肝衰竭患者伴食管静脉曲张破裂出血时血浆D-Dimer水平将在出血后第三天达高峰，而后逐渐下降并在出血后2周左右恢复到出血前状态。
2．模型应用组生存与死亡患者CTP和血浆D-dimer水平间存在显著性差异。考虑临床终点不同患者体内凝血和纤溶状态显著不同所致。应用组与对照组间死亡比例存在显著性差异。优势比为2．94，95％可信区间(1．23，7．04)，说明经积极动员高危患者内镜检查并预防性医疗操作行内镜下套扎和／或硬化治疗使MELD≥26的慢性肝衰竭合并门静脉高压食管静脉曲张患者死亡比例明显下降。由于临床医疗干预措施的实施，临床多项指标均不能作为本组患者的死亡预测因子。
结论1．感染和内毒素水平在慢性肝衰竭食管静脉曲张伴出血患者相关，并与死亡有关，对患者体内的凝血和纤溶活性有很大的影响。2．ROC判定MELD对慢性肝衰竭食管静脉曲张破裂出血患者死亡预测的最佳临界值为26。3．ROC判定慢性肝衰竭伴食管静脉曲张破裂出血患者出血时体内纤溶状态影响预后并与死亡相关，出血时血浆D-Dimer水平预测死亡的最佳临界值为700ug／L，其增高可增加该组患者再出血和死亡风险。4．慢性肝衰竭伴食管静脉曲张破裂出血患者血浆D-Dimer水平均值的动态变化趋势为：出血发生后血浆D-Dimer水平迅速升高，并在止血后第三天达高峰，而后逐渐下降并在出血后2周左右恢复到出血前状态。5．出血评分可用于慢性肝衰竭患者的自我评估和临床辅助预测食管静脉曲张出血的可能，出血评分预测出血的最佳临界值为10分。6．慢性肝衰竭门静脉高压伴食管静脉曲张患者上消化道出血临床评估模型为：以MELD≥26分为基础，伴出血评分≥10分和／或血浆D-Dimer＞700ug／L。7．慢性肝衰竭食管静脉曲张患者出血评估模型的临床应用有助于降低高危出血患者的死亡发生比例，对于改善慢性肝衰竭食管静脉曲张患者的短期预后价值很大。
Background and Aims Liver failure is the inability of the liver to perform its normalsynthetic and metabolic function as part of normal physiology when large parts of theliver become damaged beyond repair.It is a life-threatening condition that sometimesdemands urgent medical care.Most often liver failure occurs gradually and overmany years.Chronic liver failure usually occurs in the context of cirrhosis,itselfpotentially the result of many possible causes.Variceal bleeding carries a highmortality rate in patients with liver cirrhosis.Bleeding from esophageal varices is aleading cause of death in chronic liver failure.Severity of the bleeding episode,failure to control bleeding and early recurrence are indicators of poor outcome.Allthese factors depending on the severity of the underlying liver dysfunction.Increasedfrequency of hyperfibrinolytic activity was reported in patients with cirrhosis.However,the incidence,clinical presentation and the parameters related tohyperfibrinolysis remain largely unknown in these patients.Accelerated intravascularcoagulation with secondary hyperfibrinolysis has been reported in patients with liverfailure.Hyperfibrinolysis may delay primary hemostasis,thereby aggravating varicealbleeding and facilitating recurrence.
This study try to find the value of the dynamic changes of plasma D-dimer,which may have correlations with variceal bleeding in cirrhotic patients.Toinvestigate the relationship between Model for End stage Liver Disease (MELD) orCTP and plasma D-dimer in the patients with chronic liver failure.Also,thecorrelation among infection,endotoxaemia and hypertibrinolysis should be found ifexists.One of the aims of this study was to ascertain whether or not the dynamicchanges of plasma D-dimer evaluated serially are independent factor relate to theclinical outcome of patients with chronic liver failure,no matter complicate varicealhaemorrhage or not.Some factors,include MELD,plasma D-dimer and the bleedinggrading score combined to predict the risk of massive hemorrhage of esophagealvarices in cirrhosis patients especially with chronic liver failure.Then,the patientwith chronic liver failure who has a high risk of massive hemorrhage of esophagealvarices would be suggested to take the therapeutic endoscopy.The death rate observed to assess the prognostic significance of using the model in high risk patientswith massive hemorrhage of esophageal varices in chronic liver failure.
Methods 1.Patients with chronic liver failure was divided into two groups:bleedinggroup (group A,n=50) and non-bleeding group (Group B,n=50).Plasma D-dimerwas compared between two groups.In the group A,serial D-dimer measurementswere performed in cirrhotics bleeding from esophageal varices at baseline and duringfollow-up(3 days,8 days,15 days after the bleeding onset) and in 50 non-bleedingcirrhotic patients at baseline only.Both MELD score and CTP score were computedfor each patient according to the original formula on admission day.Area under thereceiver operating characteristic curve (ROC) and cutoff value were used to assess thevalue of MELD score for predicting the prognosis and so as the value of bleedinggrading score for predicting the bleeding from esophageal varices.Some factors likeMELD,plasma D-dimer and the bleeding grading score were integrated into a modelfor predicting the risk of massive hemorrhage of esophageal varices in patients withchronic liver failure.
2.Forty-eight patients with chronic liver failure were studied and observed indifferent groups according to using the model which include MELD,plasma D-dimerand bleeding grading score.The death rate was observed within 2 weeks in differentgroups.The predictive of the model and effect of endoscopic therapy was evaluatedby the odd ratio of death.The predictive accuracy of MELD was evaluated by ROCcurve.
Results 1.Patients with chronic liver failure and high levels of plasma D-dimer are athigh risk of bleeding.The clinical and biochemical parameters didn't show significantdifferences in both groups.Baseline measurements of coagulation activation andfibrinolysis were more impaired in bleeders.Average level of plasma D-dimer in thegroup A(the first one) were significantly higher than the group B.In bleeders,levelsof plasma D-dimer were persistently more abnormal in patients who died ultimately.CTP and MELD were the significant predictors of death.High levels of plasmad-dimer at the time of bleeding and infection are the dangerous factors of death.CTPand MELD were independent predictors of death when multivariate analyses wasused to assess the independent prognostic value of these variables.The cutoff value of MELD to predict death is 26.The cutoff value of D-dimer to predict death is 700ug/L.The cutoff value of bleeding grading score to predict bleeding is 10..The trendanalysis shows the changing tendency of the average level of plasma D-dimer inbleeders:the plasma D-dimer will reach high peak on the third day after bleeding andthen descend gradually until back to the original state around 2 weeks after bleeding.The model for predicting the risk of massive hemorrhage of esophageal varices inpatients with chronic liver failure is:MELD≥26 and bleeding grading score≥10and/or plasma d-dimer＞700ug/L
2.CTP and plasma D-dimer showed significant differences between twogroups while the other parameters of clinical and biochemical didn't.The odd ratio ofdeath is 2.94,95% CI(1.23,7.04).Multivariate analysis disclosed no markerpredictive of death after endoscopic therapy.
Conclusions Among the patients with chronic liver failure:1.Infection andendotoxin level may correlated with death.The higher fibrinolytic activity,the higherrisk of bleeding which may affected by infection.2.Cutoff value of MELD forpredicting the death is 26.3.Cutoff value of plasma D-dimer(first time from bleedingonset) for predicting the death is 700ug/L.4.The average value of plasma D-dimerreach the peak 3 days after bleeding onset,then descend gradually until back to theoriginal state around 2 weeks after bleeding.5.Cutoff value of bleeding grading scorefor predicting the variceal bleeding is 10.6.The model for predicting the risk ofmassive hemorrhage of esophageal varices in patient is:MELD≥26 and bleedinggrading score≥10 and/or plasma D-dimer＞700ug/L.7.The model which includeMELD score combined with bleeding grading score and/or plasma D-dimer shouldsucceed in predicting the prognosis of chronic liver failure as an useful predictor ofesophageal variceal bleeding.Moreover,high risk population with massivehemorrhage of esophageal varices in chronic liver failure could be predicted anddiscovered by using the model.Endoscopic therapy would be suggested and may playan important role to improve the prognosis of these patients then.
方法1．通过内镜检查诊断食管静脉曲张伴／不伴出血的慢性肝衰竭患者各50例，出血组在出血时和血流动力学稳定后的第3，8，15天分别测定D-Dimer水平。非出血病人仅测定D-Dimer水平一次。所有食管静脉曲张伴／不伴破裂出血均在急诊内镜下诊断和进行必要治疗。全部患者均计算入院时CTP分级、MELD评分和出血评分，评估患者感染情况并予以相应治疗。应用SPSS16．0和SAS8．0统计软件包对血浆D-dimer水平的动态变化及相关临床因素进行统计学分析。通过综合分析MELD评分、出血时血浆D-dimer水平和出血评分间联系，建立慢性肝衰竭食管静脉曲张患者出血评估模型。
2．MELD评分在26分以上的慢性肝衰竭伴食管静脉曲张患者共48例，在模型应用组30例患者中根据“MELD≥26分伴出血评分≥10分和／或血浆D-Dimer＞700ug／L”筛选高危患者，建议行内镜检查并予套扎和／或硬化治疗，与对照组18例进行统计学比较，观察模型应用的临床效果。
结果1．100例慢性肝衰竭生存组和死亡组的感染优势比为9．438，感染是死亡的危险因素之一。出血组和非出血组临床病死率有统计学差异，出血是死亡的危险因素之一。出血组和非出血组病例间MELD和出血评分有统计学差异，提示和出血有关。在出血组，死亡与生存患者间的MELD、CTP、内毒素和出血评分均存在显著差异。而在非出血组，死亡与生存患者间的MELD、CTP存在统计学差异，但内毒素和出血评分未见显著差异。全部死亡和生存患者间的MELD、CTP、内毒素和出血评分均存在显著差异。出血组和非出血组内再按死亡分组时，发现MELD分值差距明显，提示MELD有助于评估患者预后。ROC曲线确定出血评分的分值对预测出血的最佳临界值为10分，ROC曲线确定出血患者首次血浆D-Dimer水平预测死亡的最佳临界值为首次D-Dimer＞700ug／L。ROC曲线确定出血患者MELD分值预测死亡的最佳临界值为26。慢性肝衰竭食管静脉曲张患者大出血后血浆D-Dimer的变化为高阶非线性变化。合并出血并最终死亡的慢性肝衰竭患者血浆D-Dimer水平持续异常。logistic多重回归死亡预测显示对死亡有影响的变量(P＜0．05)为MELD，CTP。趋势分析显示慢性肝衰竭患者伴食管静脉曲张破裂出血时血浆D-Dimer水平将在出血后第三天达高峰，而后逐渐下降并在出血后2周左右恢复到出血前状态。
2．模型应用组生存与死亡患者CTP和血浆D-dimer水平间存在显著性差异。考虑临床终点不同患者体内凝血和纤溶状态显著不同所致。应用组与对照组间死亡比例存在显著性差异。优势比为2．94，95％可信区间(1．23，7．04)，说明经积极动员高危患者内镜检查并预防性医疗操作行内镜下套扎和／或硬化治疗使MELD≥26的慢性肝衰竭合并门静脉高压食管静脉曲张患者死亡比例明显下降。由于临床医疗干预措施的实施，临床多项指标均不能作为本组患者的死亡预测因子。
结论1．感染和内毒素水平在慢性肝衰竭食管静脉曲张伴出血患者相关，并与死亡有关，对患者体内的凝血和纤溶活性有很大的影响。2．ROC判定MELD对慢性肝衰竭食管静脉曲张破裂出血患者死亡预测的最佳临界值为26。3．ROC判定慢性肝衰竭伴食管静脉曲张破裂出血患者出血时体内纤溶状态影响预后并与死亡相关，出血时血浆D-Dimer水平预测死亡的最佳临界值为700ug／L，其增高可增加该组患者再出血和死亡风险。4．慢性肝衰竭伴食管静脉曲张破裂出血患者血浆D-Dimer水平均值的动态变化趋势为：出血发生后血浆D-Dimer水平迅速升高，并在止血后第三天达高峰，而后逐渐下降并在出血后2周左右恢复到出血前状态。5．出血评分可用于慢性肝衰竭患者的自我评估和临床辅助预测食管静脉曲张出血的可能，出血评分预测出血的最佳临界值为10分。6．慢性肝衰竭门静脉高压伴食管静脉曲张患者上消化道出血临床评估模型为：以MELD≥26分为基础，伴出血评分≥10分和／或血浆D-Dimer＞700ug／L。7．慢性肝衰竭食管静脉曲张患者出血评估模型的临床应用有助于降低高危出血患者的死亡发生比例，对于改善慢性肝衰竭食管静脉曲张患者的短期预后价值很大。
Background and Aims Liver failure is the inability of the liver to perform its normalsynthetic and metabolic function as part of normal physiology when large parts of theliver become damaged beyond repair.It is a life-threatening condition that sometimesdemands urgent medical care.Most often liver failure occurs gradually and overmany years.Chronic liver failure usually occurs in the context of cirrhosis,itselfpotentially the result of many possible causes.Variceal bleeding carries a highmortality rate in patients with liver cirrhosis.Bleeding from esophageal varices is aleading cause of death in chronic liver failure.Severity of the bleeding episode,failure to control bleeding and early recurrence are indicators of poor outcome.Allthese factors depending on the severity of the underlying liver dysfunction.Increasedfrequency of hyperfibrinolytic activity was reported in patients with cirrhosis.However,the incidence,clinical presentation and the parameters related tohyperfibrinolysis remain largely unknown in these patients.Accelerated intravascularcoagulation with secondary hyperfibrinolysis has been reported in patients with liverfailure.Hyperfibrinolysis may delay primary hemostasis,thereby aggravating varicealbleeding and facilitating recurrence.
This study try to find the value of the dynamic changes of plasma D-dimer,which may have correlations with variceal bleeding in cirrhotic patients.Toinvestigate the relationship between Model for End stage Liver Disease (MELD) orCTP and plasma D-dimer in the patients with chronic liver failure.Also,thecorrelation among infection,endotoxaemia and hypertibrinolysis should be found ifexists.One of the aims of this study was to ascertain whether or not the dynamicchanges of plasma D-dimer evaluated serially are independent factor relate to theclinical outcome of patients with chronic liver failure,no matter complicate varicealhaemorrhage or not.Some factors,include MELD,plasma D-dimer and the bleedinggrading score combined to predict the risk of massive hemorrhage of esophagealvarices in cirrhosis patients especially with chronic liver failure.Then,the patientwith chronic liver failure who has a high risk of massive hemorrhage of esophagealvarices would be suggested to take the therapeutic endoscopy.The death rate observed to assess the prognostic significance of using the model in high risk patientswith massive hemorrhage of esophageal varices in chronic liver failure.
Methods 1.Patients with chronic liver failure was divided into two groups:bleedinggroup (group A,n=50) and non-bleeding group (Group B,n=50).Plasma D-dimerwas compared between two groups.In the group A,serial D-dimer measurementswere performed in cirrhotics bleeding from esophageal varices at baseline and duringfollow-up(3 days,8 days,15 days after the bleeding onset) and in 50 non-bleedingcirrhotic patients at baseline only.Both MELD score and CTP score were computedfor each patient according to the original formula on admission day.Area under thereceiver operating characteristic curve (ROC) and cutoff value were used to assess thevalue of MELD score for predicting the prognosis and so as the value of bleedinggrading score for predicting the bleeding from esophageal varices.Some factors likeMELD,plasma D-dimer and the bleeding grading score were integrated into a modelfor predicting the risk of massive hemorrhage of esophageal varices in patients withchronic liver failure.
2.Forty-eight patients with chronic liver failure were studied and observed indifferent groups according to using the model which include MELD,plasma D-dimerand bleeding grading score.The death rate was observed within 2 weeks in differentgroups.The predictive of the model and effect of endoscopic therapy was evaluatedby the odd ratio of death.The predictive accuracy of MELD was evaluated by ROCcurve.
Results 1.Patients with chronic liver failure and high levels of plasma D-dimer are athigh risk of bleeding.The clinical and biochemical parameters didn't show significantdifferences in both groups.Baseline measurements of coagulation activation andfibrinolysis were more impaired in bleeders.Average level of plasma D-dimer in thegroup A(the first one) were significantly higher than the group B.In bleeders,levelsof plasma D-dimer were persistently more abnormal in patients who died ultimately.CTP and MELD were the significant predictors of death.High levels of plasmad-dimer at the time of bleeding and infection are the dangerous factors of death.CTPand MELD were independent predictors of death when multivariate analyses wasused to assess the independent prognostic value of these variables.The cutoff value of MELD to predict death is 26.The cutoff value of D-dimer to predict death is 700ug/L.The cutoff value of bleeding grading score to predict bleeding is 10..The trendanalysis shows the changing tendency of the average level of plasma D-dimer inbleeders:the plasma D-dimer will reach high peak on the third day after bleeding andthen descend gradually until back to the original state around 2 weeks after bleeding.The model for predicting the risk of massive hemorrhage of esophageal varices inpatients with chronic liver failure is:MELD≥26 and bleeding grading score≥10and/or plasma d-dimer＞700ug/L
2.CTP and plasma D-dimer showed significant differences between twogroups while the other parameters of clinical and biochemical didn't.The odd ratio ofdeath is 2.94,95% CI(1.23,7.04).Multivariate analysis disclosed no markerpredictive of death after endoscopic therapy.
Conclusions Among the patients with chronic liver failure:1.Infection andendotoxin level may correlated with death.The higher fibrinolytic activity,the higherrisk of bleeding which may affected by infection.2.Cutoff value of MELD forpredicting the death is 26.3.Cutoff value of plasma D-dimer(first time from bleedingonset) for predicting the death is 700ug/L.4.The average value of plasma D-dimerreach the peak 3 days after bleeding onset,then descend gradually until back to theoriginal state around 2 weeks after bleeding.5.Cutoff value of bleeding grading scorefor predicting the variceal bleeding is 10.6.The model for predicting the risk ofmassive hemorrhage of esophageal varices in patient is:MELD≥26 and bleedinggrading score≥10 and/or plasma D-dimer＞700ug/L.7.The model which includeMELD score combined with bleeding grading score and/or plasma D-dimer shouldsucceed in predicting the prognosis of chronic liver failure as an useful predictor ofesophageal variceal bleeding.Moreover,high risk population with massivehemorrhage of esophageal varices in chronic liver failure could be predicted anddiscovered by using the model.Endoscopic therapy would be suggested and may playan important role to improve the prognosis of these patients then.
引文
[1]田德安．肝硬化[A]．见：陆再英．内科学(第7版)[M]．北京：人民卫生出版社，2008：446．
[2]田德安，梁扩寰．门静脉高压症的病因学[A]．见：梁扩寰，李绍白．门静脉高压症[M]．北京：人民军医出版社，1999：17．
[3]李晓华，王炼，方友文，等．彩色多普勒超声监测肝硬变门脉高压症的血流动力学改变[J]．世界华人消化杂志，1999,7(5)：453-454．
[4]陈佳玮，许晓萍．肝硬化食管静脉曲张破裂出血的预测与防治[J]．中华医学研究杂志，2005，5(1)：38-39．
[5]Graham DY,Smith JL.The course of patients after variceal hemorrhage[J].Gastroenterology,1981,80(4):800-809.
[6]Pinto HC,Abrantes A,Esteves AV,et al.Long-term prognosis of patients with cirrhosis of the liver and upper gastrointestinal bleeding[J].Am J Gastroenterol,1989,84(10):1239-1243.
[7]中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华内科杂志，2006，45(12)：1053-1056．
[8]胡万峰，周亚珍．全身炎症反应综合征对慢性重型肝炎预后的影响[J]．中西医结合肝病杂志，2007，17(1)：51-52．
[9]Kamath PS，Wiesner RH，Malinchoc M，et al．A modal to predict survival in patients with end-stage liver disease[J]．Hepatology,2001，33(2)：464-470．
[10]蒋雪花，孙永年，黄祝青，等．干扰素治疗对慢性乙肝患者细胞因子和抗病前疗效的影响分析[J]．中国现代医学杂志，2004，14(24)：21-25．
[11]王英杰．肝衰竭：定义、诊断与治疗[J]．中华肝脏病杂志，2008，16(10)：725-727
[12]Dunn W,Jamil LH,Brown LS,et al.MELD accurately predicts mortality in patients with alcoholic hepatitis[J].Hepatology,2005,41(2):353-358.
[13]Coobes JM,Trotter JF.Development of allocation system for deceased donor liver transplantation[J].Clin Med Res,2005,3(2):87-92.
[14]严德辉，雷俊阳，陶涛，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．
[15]Malinchoc M,Kamath PS,Gordon FD,et al.Amodel to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology,2000,31(4):864-871.
[16]吴阶平，裘法祖．黄家驷外科学[M]．北京：人民卫生出版社，1999：1244-1245
[17]O'Grady JG,Alexander GJM,Haynar KM,et al.Early indicators of prognosis in fulminant hepatic failure[J].Gastroenterology,1989,97(2):439-445.
[18]Wiesner R,Edwards E,Freeman R,et al.Model for end-stage liver disease (MELD)and allocation of donor livers[J].Gastroenterology,2003,124(1):91-96.
[19]刘青，刘铮，王泰龄，等．应用MELD系统预测慢性重型肝炎的预后及其治疗效果[J]．中华医学杂志，2005，85(25)：1771-1777．
[20]张铁英，赵金满，施贵静．肝硬化患者肝储备功能对TIPSS术后近期疗效的影响[J]．世界华人消化杂志，2005，13(3)：415-418．
[21]Salerno F，Merli M，Cazzaniga M，et al．MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugnlar intrahepatic portosystemie shunt[J]．J Hepatol，2002，36(4)：494-500．
[22]翁志宏，蔡淑清．重型病毒性肝炎的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(4)：249-251．
[23]吴巍，顾掌生．MELD评分联合血清胆红素水平预测肝硬化预后[J]．胃肠病与肝病学杂志，2005，14(5)：504-506．
[24]Paramo JA,Rocha E.Hemostasis in advanced liver disease[J].Semin Thromb Hemost,1993,19(3):184-190.
[25]Hu KQ,Yu AS,Tiyyagura L,et al.Hyperfibrinolytic activity in hospitalized cirrhotic patients in a referral liver unit[J].Am J Gastroenterol,2001,96(5):1581.
[26]刘志国，毛远丽．D-二聚体在肝病中的应用价值[J]．中国医学检验杂志，2007，5(4)：382．
[27]谭杰雄，柏桂英，张艳，等．肝硬化合并感染的临床与危险因素分析[J]．中国感染控制杂志，2008，7(3)：182-183．
[28]茹清静，施维群．慢性肝病肠源性内毒素血症病理生理及治疗进展[J]．中国中西医结合急救杂志，2003，10(6)：388-390．
[29]王锦，于锦辉，孙光裕．肝硬化患者小肠细菌过度生长与内毒素血症[J]．中华内科杂志，2002，41(7)：461．
[30]黄艳．肠源性内毒素血症与肝功能衰竭[J]．临床肝胆病杂志，2006．22(4)：309-311．
[31]李筠．内毒素对肝脏的二次打击及中医药治疗[J]．北京中医药，2008，27(2)：94-95．
[32]马优钢，李晓松，赵军，等．改良Sugiurg手术治疗门静脉高压症的回顾[J]．中华消化外科杂志，2002，1(6)：418-420．
[33]D'Amico G,Pietrosi G,Tarantino I,et al.Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis:a Cochrane meta-analysis[J].Gastroenterology,2003,124(5):1277-1279.
[34]刘吉奎，蔡景修，董家鸿．门脉高压症的外科治疗：争论及治疗方法的合理选择[J]．中国实用外科杂志，2001，21(1)：33-34．
[35]中华医学会传染病与寄生虫学分会、肝病学分会．病毒性肝炎防治方案[J]．中华传染病杂志，2000，18(8)：324-329．
[36]中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食 管胃静脉曲张出血的防治共识[J]．中华肝脏病杂志，2008，16(8)：564-570．
[37]中华医学会．临床诊疗指南(消化系统疾病分册)[M]．北京：人民卫生出版社，2005：3．
[38]中华消化内镜学会．食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J]．中华消化内镜杂志，2000，17(4)：198-199．
[39]中华医学会，中华医院管理学会，药事管理专业委员会，等．抗菌药物临床应用指导原则[J]．中华医学杂志，2004，84(22)：1857-1862．
[40]王晓燕，李晶晶，陈振萍，等．出血分级在特发性血小板减少性紫癜患者中的临床意义[J]．山东医药，2008，48(10)：11-13．
[41]何振平．门脉高压症手术治疗的选择[J]．肝胆外科杂志，2004，12(5)：324-326．
[42]汪丽蕙，许广润，张树基．现代内科诊疗手册[M]．北京：北京大学医学出版社，2001：1066．
[43]Triantos CK,Goulis J,Patch D,et al.An evaluation of emergency sclerotherapy of varices in randomized trials:looking the needle inthe eye Endoscopy,2006,38(8):797-807.
[44]曹毅，赵芳，李鸿林，等．严重肝病维生素K纠正试验后凝血酶原活动度变化的意义[J]．中国误诊学杂志，2006，10(6)：1896-1897．
[45]张春荣．肝硬化患者凝血功能四项指标的改变[J]．广西医学，2006，28(6)：1064-1065．
[46]丛玉隆，魏玉香，张立文，等．肝硬化患者凝血、抗凝及纤溶指标的变化与Child-Pugh分级的关系[J]．中华肝脏病杂志，2005，13(1)：312．
[47]Yu M,Nardella A,Pechet L.Screening tests of disseminated intravascular coagulation:Guidelines for rapid and Specific laboratory diagnosis.Crit Care Med,2000,28(6):1777-1780.
[48]Amitrano L,Guardascione MA,Brancaccio V,et al.Coagulation disorders in liver disease[J].Semin Liver Dis,2002,22(1):83-96.
[49]de Mattos AA,Coral GP,Menti E,et al.Bacterial infections in cirrhotic patients[J].Arq Gastroenterol,2003,40(1):11-15.
[50]郑树森，徐骁．积极推进中国肝移植的发展[J]．中华肝胆外科杂志，2005，11(7)：437-439．
[51]单晶，徐瑞平，丁小君，等．重型病毒性肝炎患者预后模型的临床应用分析[J]．中国危重病急救医学，2005，17(10)：586-588．
[52]Forman LM,Lucey MR.Predicting the prognosis of chronic liver disease:an evolution from child to MELD.Mayo End-stage Liver Disease[J].Hepatology,2001,33(2):473-475.
[53]毛德文，邱华，胡振武．终末期肝病模型评分在肝功能衰竭中应用的研究进展[J]．中国危重病急救医学，2006，18(7)：441-443．
[54]梁扩寰．肝脏病学[M]．北京：人民卫生出版社，1995：203．
[55]邱德凯．慢性肝病临床并发症[M]．上海：上海科学技术出版社，2001：319．
[56]熊伍军，刘菲，赵中辛，等．终末期肝病模型在评估肝硬化患者预后中的价值[J]．世界华人消化杂志，2004，12(5)：1159-1162．
[57]Schepke M,Roth F,Fimmers R,et al.Comparison of MELD,Child-Pugh,and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting.Am J Gastroenterol,2003,98(5):1167-1174.
[58]马慧，王豪，孙焱，等．失代偿期肝硬化患者的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(6)：407-409．
[59]张桂珍．终末期肝病模型评分对肝硬化患者食管曲张静脉套扎术预后分析[J]．职业与健康，2008，24(7)：698．
[60]颜虹．医学统计学[M]．北京：人民卫生出版社，2005：220．
[61]蒋忠胜，江建宁．CTP和MELD评分预测慢性重型肝炎预后的临床价值[J]．中国危重病急救医学，2007，19(7)：412-415．
[62]贾继东．进一步重视肝硬化临床诊治工作的系统性和规范性[J]．中华肝脏病杂志，2005，13(6)：401-402．
[63]Runyon BA,Practice Guidelines Committee,American Association for the Study of Liver Diseases(AASLD).Management of adult patients with ascites due to cirrhosis[J].Hepatology,2004,39(3):841-856.
[64]Blei AT,Cordoba J,Practice Parameters Committee of the American College of Gastroenterology.Hepatic Encephalopathy[J].Am J Gastroenterol,2001,96(7):1968-1976.
[65]de Franchis R.Evolving consensus in portal hypertension.Report of the Baveno Ⅳ consensus workshop on methodology of diagnosis and therapy in portal hypertension[J].J Hepatol,2005,43(1):167-176.
[66]de Franchis R,Dell'Era A,Iannuzzi F.Diagnosis and treatment of portal hypertension[J].Dig Liver Dis,2004,36(12):787-798.
[67]中华医学会肝病学分会，感染病学分会．慢性乙型肝炎防治指南[J]．中华肝脏病杂志，2005，13(12)：881-891．
[68]中华医学会肝病学分会，传染病与寄生虫病学分会．丙型肝炎防治指南[J]．中华肝脏病杂志，2004，12(4)：194-198．
[69]Groszmann R J,Garcia-Tsao G,Bosch J,et al.Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis[J].N Engl J Med,2005,353(21):2254-2261.
[70]Garcia-Tsao G,Sanyal A J,Grace ND,et al.Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J].Hepatology,2007,46(3):922-938.
[71]Lay CS,Tsai YT,Lee FY,et al.Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis[J].J Gastroenterol Hepatol,2006,21(2):413-419.
[72]Eisen GM,Eliakim R,Zaman A,et al.The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices:a prospective three-center pilot study[J].Endoscopy,2006,38(1):31-35.
[73]中华医学会消化内镜分会．食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年)[J]．中华消化内镜杂志，2004，21(3)：149-151．
[74]袁伟建，张桂英，邹益友，等．肝硬化患者治疗前后血浆内毒素的变化[J]．中国现代医学杂志，2003，13(1)：65．
[75]张影，张福奎，王宝恩．细菌感染和／或内毒素血症对肝硬化患者预后的影响[J]．肝脏，2007，12(4)：310-312．
[76]Hou MC,Lin HC,Liu TT,et al.Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage:a randomized trial[J].Hepatology,2004,39(3):746-753.
[77]霍丽霞，岳锦生，王彦民．肝硬变合并上消化道出血患者血浆内毒素水平测定[J]．哈尔滨医科大学学报，2002，36(3)：246．
[78]周和龙，杨小铭，何生松，等．内毒素及h-EGF检测与重型病毒性肝炎预后的临床研究[J]．临床消化病杂志，2004，16(5)：198．
[79]王冬梅，张振宇，黄永存．重症肝炎患者血浆内毒素测定及临床意义[J]．牡丹江医学院学报，2008，29(2)：51-52．
[80]Hua J,Qiu de K,Li JQ,et al.Expression of Toll-like receptor 4 in rat liver during the course of carbon tetrachloride-induced liver injury[J].J Gastroenterol Hepatol,2007,22(6):862-869.
[81]沈镭，陆伦根．肠道微生态与肝硬化[J]．肝脏，2006，11(4)：278-280．
[82]Liaw YF,Leung N,Guan R,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2005 update[J].Liver Int,2005,25(3):472-489.
[83]Lok AS,McMahon BJ.Chronic hepatitis B[J].Hepatology,2007,45(2):507-539.
[84]Angermayr B,Cejna M,Karnel F,et al.Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt[J].Gut,2003,52(6):879-885.
[85]Giannini E,Botta F,Fumaqalli A,et al.Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?[J].Liver Int,2004,24(5):465-470.
[86]林栋栋，李铎，孙家邦．一种终末期肝病的危险度评分模型[J]．中华肝脏病杂志，2004，12(4)：253-254．
[87]张俊勇，王宝恩，贾继东．终末期肝病模型评分与肝移植[J]．中华肝脏病杂志，2005，13(3)：235-237．
[88]Kamath PS,Kim WR,Advanced Liver Disease Study Group.The model for end-stage liver disease(MELD)[J].Hepatology,2007,45(3):797-805.
[89] Llad(?) L, Figueras J, Memba R, et al. Is MELD really the definitive score for liver allocation? [J]. Liver Transpl, 2002, 8(9): 795-798.
[1]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):464-470.
[2]中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华内科杂志，2006，45(12)：1053-1056．
[3]Diehl AM.Acute and chronic liver failure and hepatic encephalopaphy[A].In:Goldman L,Bennett JC,eds.Cecil textbook of medicine[M].Philadelphia:Sauaders,2000:813-816.
[4]中华医学会传染病与寄生虫学分会、肝病学分会．病毒性肝炎防治方案[J]．中华传染病杂志，2000，18(8)：324-329．
[5]Ostapowicz G,Fontana RJ,Schiodt FV,et al.Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States[J].Ann Intern Med,2002,137(12):947-954.
[6]蒋雪花，孙永年，黄祝青，等．干扰素治疗对慢性乙肝患者细胞因子和抗病前疗效的影响分析[J]．中国现代医学杂志，2004，14(24)：21-25．
[7]胡万峰，周亚珍．全身炎症反应综合征对慢性重型肝炎预后的影响[J]．中西医结合肝病杂志，2007，17(1)：51-52．
[8]王英杰．肝衰竭：定义、诊断与治疗[J]．中华肝脏病杂志，2008，16(10)：725-727．
[9]张晶，韩大康，孔明，等．肝衰竭诊断及预后判断现状与展望[J]．传染病信息，2005，18(2)：72-74．
[10]李琴，王宝恩，贾继东．肝功能分级的演变及特点：从Child到MELD[J]．中华肝脏病杂志，2004，12(5)：319-320．
[11]熊伍军，刘菲，赵中辛，等．终末期肝病模型在评估肝硬化患者预后中的价值[J]．世界华人消化杂志，2004，12(5)：1159-1162．
[12]Poison J,Lee WM.American association for the study of the liver disease[J].Hepatology,2005,41(5):1179-1187.
[13]中华医学会感染病学分会，肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华肝脏病杂志，2006， 14(9)：643-646．
[14]郑欢伟，贾继东．肝衰竭的诊断和治疗现状．传染病信息，2007，20(3)：139．
[15]Acharya SK,Panda SK,Saxena A,et al.Acute liver failure in India:a perspective from the East[J].J Gastroenterol Hepatol,2000,15(5):473-479.
[16]王泰龄，刘青，郑丽虹，等．结合病理学改变探讨重型肝炎的分类和时限划分[J]．中日友好医院学报，2002，16(1)：3-7．
[17]孙艳玲，赵景民，周光德，等．重型肝炎发病时相及临床病理特征的研究[J]．中华实验与临床病毒学杂志，2003，17(3)：270-273．
[18]于乐成．慢加急性肝衰竭[J]．肝脏，2007，12(2)：135-137．
[19]曾珍，韩玉坤，耿华，等．慢性重型肝炎分类的研究[J]．中华实验和临床病毒学杂志，2006，20(2)：53-55．
[20]王宇明，陈耀凯．肝衰竭／重型肝炎的研究进展[J]．临床内科杂志，2002，19(4)：247-250．
[21]Hanau C,Munoz SJ,Rubin.R.Histopathological heterogeneity in fulminant hepatic failure[J].Hepatology,1995,21(2):345-351.
[22]崇雨田，林国莉，赵志新，等．肝衰竭39例患者的离体肝组织的病理特点[J]．中华传染病杂志，2006，24(3)：172-174．
[23]张立洁，王泰龄，刘旭华，等．慢性重型乙型肝炎病理形态学表现及诊断[J]．中华肝脏病杂志，2007，15(5)：323-327．
[24]王宇明，陈耀凯，顾长海，等．重型肝炎命名和诊断分型的再认识附477例临床分析[J]．中华肝脏病杂志，2000，8(5)：261-263．
[25]Ferenci P,Lockwood A,Mullen K,et al.Hepatic encephalopathy-definition,nomenclature,diagnosis,and quantification:final report of the working party at the 11th World Congresses of Gastroenterology,Vienna,1998[J].Hepatology,2002,35(3):716-721.
[26]Bernuau J.Acute liver failure:avoidance of deleterious cofactors and early specific medical therapy for the liver are better than late intensive care for the brain[J].J Hepatology,2004,41(1):152-155.
[27]Sen S,Williams R,Jalan R,et al.The pathophysiology basis of acute-on-chronic liver failure[J].Liver,2002,22(Suppl 2):5-13.
[28]Wasmuth HE,Kunz D,Yagmur E,et al.Patients with acute on chronic liver failure display"sepsis-like"immune paralysis[J].J Hepatology,2005,42(2):195-201.
[29]陈黎明，叶文华，王陆军，等．慢加急性肝衰竭与慢性肝衰竭的临床分析[J]．传染病信息，2007，20(4)：234-235．
[30]Forman LM,Lucey MR.Predicting the prognosis of chronic liver disease:an evolution from child to MELD.Mayo End-stage Liver Disease[J].Hepatology,2001,33(2):473-475.
[31]Kamath PS,Kim WR;Advanced Liver Disease Study Group.The model for end-stage liver disease(MELD)[J].Hepatology,2007,45(3):797-805.
[32]马慧，王豪，孙焱，等．失代偿期肝硬化患者的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(6)：407-409．
[33]刘青，刘铮，王泰龄，等．应用MELD系统预测慢性重型肝炎的预后及其治疗效果[J]．中华医学杂志，2005，85(25)：1771-1777．
[34]Malinehoe M,Kamath PS,Gordon FD,et al.A model to predict poor survival in patients undergoing transjugular intrahepatie to systemic shunts[J].Hepatology,2000,31(4):864-871.
[35]张铁英，赵金满，施贵静．肝硬化患者肝储备功能对TIPSS术后近期疗效的影响[J]．世界华人消化杂志，2005，13(3)：415-418．
[36]毛德文，邱华，胡振武．终末期肝病模型评分在肝功能衰竭中应用的研究进展[J]．中国危重病急救医学，2006，18(7)：441-443．
[37]Freeman RB,Wiensner RH,Harper A,et al.The new liver allocation system:moving toward evidence-based transplantation policy[J].Liver Transpl,2002,8(9):851-858.
[38]Robert A,Chazouilleres O.Prothrombin time in liver failure:time,ratio,activity percentage,or international normalized ratio[J]?Hepatology,1996,24(6):1392-1394.
[39]Dickson ER,Grambsch PM,Flerming TR,et al.A Prognosis in primary biliary cirrhosis:a model for decision making[J].Hepatology,1989,10(1):1-7.
[40]Coobes JM,Trotter JF.Development of allocation system for deceased donor liver transplantation[J].Clin Med Res,2005,3(2):87-92.
[41]Paqliaro L.MELD:the End of Child-Pugh Classification?[J].Hepatology,2002,36(1):141-142.
[42]蒋忠胜，江建宁．CTP和MELD评分预测慢性重型肝炎预后的临床价值[J]．中国危重病急救医学，2007，19(7)：412-415．
[43]Wiesner R,Edwards E,Freeman R,et al.Model for end-stage liver disease(MELD)and allocation of donor livers[J].Gastroenterology,2003,24(1):91-96.
[44]Bae WK,Lee JS.Usefulness ofDeltaMELD/month for Prediction of the Mortality in t he First Episode of Variceal Bleeding Patients with Liver Cirrhosis:Comparison with CTP,MELD Score and DeltaCTP/month[J].Korean J Hepatol,2007,13(1):51-60.
[45]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):134-139.
[46]Said A,Williams J,Holden J,et al.Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease[J].J Hepatol,2004,40(6):897-903.
[47]Giannini E,Botta F,Fumagalli A,et al.Can inclusion of serum creatinine values improve the child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?[J].Liver Int,2004,24(5):465-470
[48]Saab S,Landaverde C,Ibrahim AB,et al.The MELD score in advanced liver disease:association with clinical portal hypertension and mortality[J].Exp Clin Transplant,2006,4(1):395-399.
[49]Papatheodoridis GV,Cholongitas E,Dimitriadou E,et al.MELD vs child-pugh and creatine-modified child-pugh score for predicting survival in patients with decompensated cirrhosis[J].World J Gastroenterol,2005,11(20):3099-3104.
[50]Merion RM,Wolfe RA,Dykstra DM,Leichtman AB,Gillespie B,Held PJ.Longitudinal assessment of mortality risk among candidates for liver transplantation[J].Liver Transpl,2003,9(1):12-18.
[51]Zhang JY,Zhang FK,Wang BE,et al.The prognostic value of end-stage liver disease model in liver cirrhosis[J].Zhonghua Nei Ke Za Zhi,2005,44(11):822-824.
[52]Huo TI,Lin HC,Wu JC,et al.Different model for end-stage liver disease score block distributions may have a variable ability for outcome prediction[J].Transplantation,2005,80(10):1414-1418.
[53]Dhiman RK,Jain S,Maheshwari U,et al.Early indicators of prognosis in fulminant hepatic failure:an assessment of the model for end-stage liver disease(MELD)and King's college hospital criteria[J].Liver Transpl,2007,13(6):814-821.
[54]赵燕芹，胡肖兵，李粤平，等．慢性重型肝炎MELD评分分析[J]．现代临床医学生物工程学杂志，2004，10(5)：396-397．
[55]Angermayr B,Cejna M,Karnel F,et al.Child-Pugh Versus MELD Score in Predicting Survival in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt[J].Gut,2003,52(6):879-885.
[56]Ferral H,Gamboa P,Postoak DW,et al.Survival after Elective Transjugular Intrahepatic Portosystemic Shunt Creation:Prediction With Model for End-Stage Liver Disease Score[J].Radiology,2004,231(1):231-236.
[57]Salerno F,Merli M,Cazzaniga M,et al.MELD score is better than Child:Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt[J].J Hepatol,2002,36(4):494-500.
[58]Wiesner RH,McDiarmid SV,Kamath PS,et al.MELD and PELD:application of survival models to liver allocation[J].Liver Transpl,2001,7(7):567-580.
[59]Stell DA,McAlister VC,Thorbum D.A comparison of disease severity and survival rates after liver transplantation in the United Kingdom,Canada and the United States[J].Liver Transpl,2004,10(7):898-902.
[60]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[J].Liver Transpl,2004,10(10 suppl 2):A6-A22.
[61] Habib S, Berk B, Chang CC, et al. MELD and prediction of post liver transplantation survival[J]. Liver Transplantation, 2006, 12(3): 440-447.
[62] Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation[J]. Liver Transpl, 2003, 9(2): 117-123.
[63] Ravaioli M, Grazi GL, Ercolani G, et al. Efficacy of MELD score in predicting survival after liver retransplantation[J].Transplant Proc,2004,36(9): 2748-2749.
[64] Merion RM, Schaubel DE, Dykstra DM, et al. The survival benefit of liver transplantation[J]. Am J Transplant, 2005, 5(2): 307-313.
[65] Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy[J]. Liver Transpl, 2003, 9(7): 684-692.
[66] Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact[J]. Liver Transpl, 2004, 10(1): 36-41.
[67] 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- S267.
[68] Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis[J]. Liver Transpl, 2006, 12(6): 966-971
[69] Huo TI, Lee PC, Huang YH, et al. The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy[J]. J Clin Gastroenterol, 2006, 40(6): 543-550.
[70] Reuben A. Child comes of age[J]. Hepatology, 2002, 35(1): 244 -245.
[71] Giannini E, Botta F, Testa E, et al. The 1-year and 3-month prognostic utility of the AST/AST ratio and model for end-stage liver disease score in patients with viral liver cirrhosis[J]. Am J Gastroenterol, 2002, 97(11): 2855-2860.
[72] Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone[J]. Liver Transpl, 2005,11(3): 336-343.
[73] Biggins SW, Rodriguez HJ, Bacehetti P, et al. Serum sodium predicts mortality in patients listed for liver transplantation[J]. Hepatology, 2005, 41(1): 32-39.
[74] Saab S, Ibrahim AB, Shpaner A, et al. MELD fails to measure quality of life in hver transplant candidates[J]. Liver Transpl, 2005, 11(2): 218-223.
[75] Freeman RB. MELD: the holy grail of organ allocation ? [J]. J Hepatol ,2005 , 42 (1): 16-20.
[76] Everson GT. MELD: the answer or just more questions? [J]. Gastroenterology, 2003, 124(1): 251-254.
[77] Llad(?) L, Figueras J, Memba R, et al. Is MELD really the definitive score for liver allocation? [J]. Liver Transpl, 2002, 8(9): 795-798.
[78] McCaughan GW, Strasser SI. To MELD or not to MELD?[J]. Hepatology, 2001, 34(1): 215-216.
[2]田德安，梁扩寰．门静脉高压症的病因学[A]．见：梁扩寰，李绍白．门静脉高压症[M]．北京：人民军医出版社，1999：17．
[3]李晓华，王炼，方友文，等．彩色多普勒超声监测肝硬变门脉高压症的血流动力学改变[J]．世界华人消化杂志，1999,7(5)：453-454．
[4]陈佳玮，许晓萍．肝硬化食管静脉曲张破裂出血的预测与防治[J]．中华医学研究杂志，2005，5(1)：38-39．
[5]Graham DY,Smith JL.The course of patients after variceal hemorrhage[J].Gastroenterology,1981,80(4):800-809.
[6]Pinto HC,Abrantes A,Esteves AV,et al.Long-term prognosis of patients with cirrhosis of the liver and upper gastrointestinal bleeding[J].Am J Gastroenterol,1989,84(10):1239-1243.
[7]中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华内科杂志，2006，45(12)：1053-1056．
[8]胡万峰，周亚珍．全身炎症反应综合征对慢性重型肝炎预后的影响[J]．中西医结合肝病杂志，2007，17(1)：51-52．
[9]Kamath PS，Wiesner RH，Malinchoc M，et al．A modal to predict survival in patients with end-stage liver disease[J]．Hepatology,2001，33(2)：464-470．
[10]蒋雪花，孙永年，黄祝青，等．干扰素治疗对慢性乙肝患者细胞因子和抗病前疗效的影响分析[J]．中国现代医学杂志，2004，14(24)：21-25．
[11]王英杰．肝衰竭：定义、诊断与治疗[J]．中华肝脏病杂志，2008，16(10)：725-727
[12]Dunn W,Jamil LH,Brown LS,et al.MELD accurately predicts mortality in patients with alcoholic hepatitis[J].Hepatology,2005,41(2):353-358.
[13]Coobes JM,Trotter JF.Development of allocation system for deceased donor liver transplantation[J].Clin Med Res,2005,3(2):87-92.
[14]严德辉，雷俊阳，陶涛，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．
[15]Malinchoc M,Kamath PS,Gordon FD,et al.Amodel to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J].Hepatology,2000,31(4):864-871.
[16]吴阶平，裘法祖．黄家驷外科学[M]．北京：人民卫生出版社，1999：1244-1245
[17]O'Grady JG,Alexander GJM,Haynar KM,et al.Early indicators of prognosis in fulminant hepatic failure[J].Gastroenterology,1989,97(2):439-445.
[18]Wiesner R,Edwards E,Freeman R,et al.Model for end-stage liver disease (MELD)and allocation of donor livers[J].Gastroenterology,2003,124(1):91-96.
[19]刘青，刘铮，王泰龄，等．应用MELD系统预测慢性重型肝炎的预后及其治疗效果[J]．中华医学杂志，2005，85(25)：1771-1777．
[20]张铁英，赵金满，施贵静．肝硬化患者肝储备功能对TIPSS术后近期疗效的影响[J]．世界华人消化杂志，2005，13(3)：415-418．
[21]Salerno F，Merli M，Cazzaniga M，et al．MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugnlar intrahepatic portosystemie shunt[J]．J Hepatol，2002，36(4)：494-500．
[22]翁志宏，蔡淑清．重型病毒性肝炎的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(4)：249-251．
[23]吴巍，顾掌生．MELD评分联合血清胆红素水平预测肝硬化预后[J]．胃肠病与肝病学杂志，2005，14(5)：504-506．
[24]Paramo JA,Rocha E.Hemostasis in advanced liver disease[J].Semin Thromb Hemost,1993,19(3):184-190.
[25]Hu KQ,Yu AS,Tiyyagura L,et al.Hyperfibrinolytic activity in hospitalized cirrhotic patients in a referral liver unit[J].Am J Gastroenterol,2001,96(5):1581.
[26]刘志国，毛远丽．D-二聚体在肝病中的应用价值[J]．中国医学检验杂志，2007，5(4)：382．
[27]谭杰雄，柏桂英，张艳，等．肝硬化合并感染的临床与危险因素分析[J]．中国感染控制杂志，2008，7(3)：182-183．
[28]茹清静，施维群．慢性肝病肠源性内毒素血症病理生理及治疗进展[J]．中国中西医结合急救杂志，2003，10(6)：388-390．
[29]王锦，于锦辉，孙光裕．肝硬化患者小肠细菌过度生长与内毒素血症[J]．中华内科杂志，2002，41(7)：461．
[30]黄艳．肠源性内毒素血症与肝功能衰竭[J]．临床肝胆病杂志，2006．22(4)：309-311．
[31]李筠．内毒素对肝脏的二次打击及中医药治疗[J]．北京中医药，2008，27(2)：94-95．
[32]马优钢，李晓松，赵军，等．改良Sugiurg手术治疗门静脉高压症的回顾[J]．中华消化外科杂志，2002，1(6)：418-420．
[33]D'Amico G,Pietrosi G,Tarantino I,et al.Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis:a Cochrane meta-analysis[J].Gastroenterology,2003,124(5):1277-1279.
[34]刘吉奎，蔡景修，董家鸿．门脉高压症的外科治疗：争论及治疗方法的合理选择[J]．中国实用外科杂志，2001，21(1)：33-34．
[35]中华医学会传染病与寄生虫学分会、肝病学分会．病毒性肝炎防治方案[J]．中华传染病杂志，2000，18(8)：324-329．
[36]中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食 管胃静脉曲张出血的防治共识[J]．中华肝脏病杂志，2008，16(8)：564-570．
[37]中华医学会．临床诊疗指南(消化系统疾病分册)[M]．北京：人民卫生出版社，2005：3．
[38]中华消化内镜学会．食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J]．中华消化内镜杂志，2000，17(4)：198-199．
[39]中华医学会，中华医院管理学会，药事管理专业委员会，等．抗菌药物临床应用指导原则[J]．中华医学杂志，2004，84(22)：1857-1862．
[40]王晓燕，李晶晶，陈振萍，等．出血分级在特发性血小板减少性紫癜患者中的临床意义[J]．山东医药，2008，48(10)：11-13．
[41]何振平．门脉高压症手术治疗的选择[J]．肝胆外科杂志，2004，12(5)：324-326．
[42]汪丽蕙，许广润，张树基．现代内科诊疗手册[M]．北京：北京大学医学出版社，2001：1066．
[43]Triantos CK,Goulis J,Patch D,et al.An evaluation of emergency sclerotherapy of varices in randomized trials:looking the needle inthe eye Endoscopy,2006,38(8):797-807.
[44]曹毅，赵芳，李鸿林，等．严重肝病维生素K纠正试验后凝血酶原活动度变化的意义[J]．中国误诊学杂志，2006，10(6)：1896-1897．
[45]张春荣．肝硬化患者凝血功能四项指标的改变[J]．广西医学，2006，28(6)：1064-1065．
[46]丛玉隆，魏玉香，张立文，等．肝硬化患者凝血、抗凝及纤溶指标的变化与Child-Pugh分级的关系[J]．中华肝脏病杂志，2005，13(1)：312．
[47]Yu M,Nardella A,Pechet L.Screening tests of disseminated intravascular coagulation:Guidelines for rapid and Specific laboratory diagnosis.Crit Care Med,2000,28(6):1777-1780.
[48]Amitrano L,Guardascione MA,Brancaccio V,et al.Coagulation disorders in liver disease[J].Semin Liver Dis,2002,22(1):83-96.
[49]de Mattos AA,Coral GP,Menti E,et al.Bacterial infections in cirrhotic patients[J].Arq Gastroenterol,2003,40(1):11-15.
[50]郑树森，徐骁．积极推进中国肝移植的发展[J]．中华肝胆外科杂志，2005，11(7)：437-439．
[51]单晶，徐瑞平，丁小君，等．重型病毒性肝炎患者预后模型的临床应用分析[J]．中国危重病急救医学，2005，17(10)：586-588．
[52]Forman LM,Lucey MR.Predicting the prognosis of chronic liver disease:an evolution from child to MELD.Mayo End-stage Liver Disease[J].Hepatology,2001,33(2):473-475.
[53]毛德文，邱华，胡振武．终末期肝病模型评分在肝功能衰竭中应用的研究进展[J]．中国危重病急救医学，2006，18(7)：441-443．
[54]梁扩寰．肝脏病学[M]．北京：人民卫生出版社，1995：203．
[55]邱德凯．慢性肝病临床并发症[M]．上海：上海科学技术出版社，2001：319．
[56]熊伍军，刘菲，赵中辛，等．终末期肝病模型在评估肝硬化患者预后中的价值[J]．世界华人消化杂志，2004，12(5)：1159-1162．
[57]Schepke M,Roth F,Fimmers R,et al.Comparison of MELD,Child-Pugh,and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting.Am J Gastroenterol,2003,98(5):1167-1174.
[58]马慧，王豪，孙焱，等．失代偿期肝硬化患者的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(6)：407-409．
[59]张桂珍．终末期肝病模型评分对肝硬化患者食管曲张静脉套扎术预后分析[J]．职业与健康，2008，24(7)：698．
[60]颜虹．医学统计学[M]．北京：人民卫生出版社，2005：220．
[61]蒋忠胜，江建宁．CTP和MELD评分预测慢性重型肝炎预后的临床价值[J]．中国危重病急救医学，2007，19(7)：412-415．
[62]贾继东．进一步重视肝硬化临床诊治工作的系统性和规范性[J]．中华肝脏病杂志，2005，13(6)：401-402．
[63]Runyon BA,Practice Guidelines Committee,American Association for the Study of Liver Diseases(AASLD).Management of adult patients with ascites due to cirrhosis[J].Hepatology,2004,39(3):841-856.
[64]Blei AT,Cordoba J,Practice Parameters Committee of the American College of Gastroenterology.Hepatic Encephalopathy[J].Am J Gastroenterol,2001,96(7):1968-1976.
[65]de Franchis R.Evolving consensus in portal hypertension.Report of the Baveno Ⅳ consensus workshop on methodology of diagnosis and therapy in portal hypertension[J].J Hepatol,2005,43(1):167-176.
[66]de Franchis R,Dell'Era A,Iannuzzi F.Diagnosis and treatment of portal hypertension[J].Dig Liver Dis,2004,36(12):787-798.
[67]中华医学会肝病学分会，感染病学分会．慢性乙型肝炎防治指南[J]．中华肝脏病杂志，2005，13(12)：881-891．
[68]中华医学会肝病学分会，传染病与寄生虫病学分会．丙型肝炎防治指南[J]．中华肝脏病杂志，2004，12(4)：194-198．
[69]Groszmann R J,Garcia-Tsao G,Bosch J,et al.Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis[J].N Engl J Med,2005,353(21):2254-2261.
[70]Garcia-Tsao G,Sanyal A J,Grace ND,et al.Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis[J].Hepatology,2007,46(3):922-938.
[71]Lay CS,Tsai YT,Lee FY,et al.Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis[J].J Gastroenterol Hepatol,2006,21(2):413-419.
[72]Eisen GM,Eliakim R,Zaman A,et al.The accuracy of PillCam ESO capsule endoscopy versus conventional upper endoscopy for the diagnosis of esophageal varices:a prospective three-center pilot study[J].Endoscopy,2006,38(1):31-35.
[73]中华医学会消化内镜分会．食管胃静脉曲张内镜下诊断和治疗规范试行方案(2003年)[J]．中华消化内镜杂志，2004，21(3)：149-151．
[74]袁伟建，张桂英，邹益友，等．肝硬化患者治疗前后血浆内毒素的变化[J]．中国现代医学杂志，2003，13(1)：65．
[75]张影，张福奎，王宝恩．细菌感染和／或内毒素血症对肝硬化患者预后的影响[J]．肝脏，2007，12(4)：310-312．
[76]Hou MC,Lin HC,Liu TT,et al.Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage:a randomized trial[J].Hepatology,2004,39(3):746-753.
[77]霍丽霞，岳锦生，王彦民．肝硬变合并上消化道出血患者血浆内毒素水平测定[J]．哈尔滨医科大学学报，2002，36(3)：246．
[78]周和龙，杨小铭，何生松，等．内毒素及h-EGF检测与重型病毒性肝炎预后的临床研究[J]．临床消化病杂志，2004，16(5)：198．
[79]王冬梅，张振宇，黄永存．重症肝炎患者血浆内毒素测定及临床意义[J]．牡丹江医学院学报，2008，29(2)：51-52．
[80]Hua J,Qiu de K,Li JQ,et al.Expression of Toll-like receptor 4 in rat liver during the course of carbon tetrachloride-induced liver injury[J].J Gastroenterol Hepatol,2007,22(6):862-869.
[81]沈镭，陆伦根．肠道微生态与肝硬化[J]．肝脏，2006，11(4)：278-280．
[82]Liaw YF,Leung N,Guan R,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2005 update[J].Liver Int,2005,25(3):472-489.
[83]Lok AS,McMahon BJ.Chronic hepatitis B[J].Hepatology,2007,45(2):507-539.
[84]Angermayr B,Cejna M,Karnel F,et al.Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt[J].Gut,2003,52(6):879-885.
[85]Giannini E,Botta F,Fumaqalli A,et al.Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?[J].Liver Int,2004,24(5):465-470.
[86]林栋栋，李铎，孙家邦．一种终末期肝病的危险度评分模型[J]．中华肝脏病杂志，2004，12(4)：253-254．
[87]张俊勇，王宝恩，贾继东．终末期肝病模型评分与肝移植[J]．中华肝脏病杂志，2005，13(3)：235-237．
[88]Kamath PS,Kim WR,Advanced Liver Disease Study Group.The model for end-stage liver disease(MELD)[J].Hepatology,2007,45(3):797-805.
[89] Llad(?) L, Figueras J, Memba R, et al. Is MELD really the definitive score for liver allocation? [J]. Liver Transpl, 2002, 8(9): 795-798.
[1]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):464-470.
[2]中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华内科杂志，2006，45(12)：1053-1056．
[3]Diehl AM.Acute and chronic liver failure and hepatic encephalopaphy[A].In:Goldman L,Bennett JC,eds.Cecil textbook of medicine[M].Philadelphia:Sauaders,2000:813-816.
[4]中华医学会传染病与寄生虫学分会、肝病学分会．病毒性肝炎防治方案[J]．中华传染病杂志，2000，18(8)：324-329．
[5]Ostapowicz G,Fontana RJ,Schiodt FV,et al.Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States[J].Ann Intern Med,2002,137(12):947-954.
[6]蒋雪花，孙永年，黄祝青，等．干扰素治疗对慢性乙肝患者细胞因子和抗病前疗效的影响分析[J]．中国现代医学杂志，2004，14(24)：21-25．
[7]胡万峰，周亚珍．全身炎症反应综合征对慢性重型肝炎预后的影响[J]．中西医结合肝病杂志，2007，17(1)：51-52．
[8]王英杰．肝衰竭：定义、诊断与治疗[J]．中华肝脏病杂志，2008，16(10)：725-727．
[9]张晶，韩大康，孔明，等．肝衰竭诊断及预后判断现状与展望[J]．传染病信息，2005，18(2)：72-74．
[10]李琴，王宝恩，贾继东．肝功能分级的演变及特点：从Child到MELD[J]．中华肝脏病杂志，2004，12(5)：319-320．
[11]熊伍军，刘菲，赵中辛，等．终末期肝病模型在评估肝硬化患者预后中的价值[J]．世界华人消化杂志，2004，12(5)：1159-1162．
[12]Poison J,Lee WM.American association for the study of the liver disease[J].Hepatology,2005,41(5):1179-1187.
[13]中华医学会感染病学分会，肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊疗指南[J]．中华肝脏病杂志，2006， 14(9)：643-646．
[14]郑欢伟，贾继东．肝衰竭的诊断和治疗现状．传染病信息，2007，20(3)：139．
[15]Acharya SK,Panda SK,Saxena A,et al.Acute liver failure in India:a perspective from the East[J].J Gastroenterol Hepatol,2000,15(5):473-479.
[16]王泰龄，刘青，郑丽虹，等．结合病理学改变探讨重型肝炎的分类和时限划分[J]．中日友好医院学报，2002，16(1)：3-7．
[17]孙艳玲，赵景民，周光德，等．重型肝炎发病时相及临床病理特征的研究[J]．中华实验与临床病毒学杂志，2003，17(3)：270-273．
[18]于乐成．慢加急性肝衰竭[J]．肝脏，2007，12(2)：135-137．
[19]曾珍，韩玉坤，耿华，等．慢性重型肝炎分类的研究[J]．中华实验和临床病毒学杂志，2006，20(2)：53-55．
[20]王宇明，陈耀凯．肝衰竭／重型肝炎的研究进展[J]．临床内科杂志，2002，19(4)：247-250．
[21]Hanau C,Munoz SJ,Rubin.R.Histopathological heterogeneity in fulminant hepatic failure[J].Hepatology,1995,21(2):345-351.
[22]崇雨田，林国莉，赵志新，等．肝衰竭39例患者的离体肝组织的病理特点[J]．中华传染病杂志，2006，24(3)：172-174．
[23]张立洁，王泰龄，刘旭华，等．慢性重型乙型肝炎病理形态学表现及诊断[J]．中华肝脏病杂志，2007，15(5)：323-327．
[24]王宇明，陈耀凯，顾长海，等．重型肝炎命名和诊断分型的再认识附477例临床分析[J]．中华肝脏病杂志，2000，8(5)：261-263．
[25]Ferenci P,Lockwood A,Mullen K,et al.Hepatic encephalopathy-definition,nomenclature,diagnosis,and quantification:final report of the working party at the 11th World Congresses of Gastroenterology,Vienna,1998[J].Hepatology,2002,35(3):716-721.
[26]Bernuau J.Acute liver failure:avoidance of deleterious cofactors and early specific medical therapy for the liver are better than late intensive care for the brain[J].J Hepatology,2004,41(1):152-155.
[27]Sen S,Williams R,Jalan R,et al.The pathophysiology basis of acute-on-chronic liver failure[J].Liver,2002,22(Suppl 2):5-13.
[28]Wasmuth HE,Kunz D,Yagmur E,et al.Patients with acute on chronic liver failure display"sepsis-like"immune paralysis[J].J Hepatology,2005,42(2):195-201.
[29]陈黎明，叶文华，王陆军，等．慢加急性肝衰竭与慢性肝衰竭的临床分析[J]．传染病信息，2007，20(4)：234-235．
[30]Forman LM,Lucey MR.Predicting the prognosis of chronic liver disease:an evolution from child to MELD.Mayo End-stage Liver Disease[J].Hepatology,2001,33(2):473-475.
[31]Kamath PS,Kim WR;Advanced Liver Disease Study Group.The model for end-stage liver disease(MELD)[J].Hepatology,2007,45(3):797-805.
[32]马慧，王豪，孙焱，等．失代偿期肝硬化患者的终末期肝病模型预后分析[J]．中华肝脏病杂志，2005，13(6)：407-409．
[33]刘青，刘铮，王泰龄，等．应用MELD系统预测慢性重型肝炎的预后及其治疗效果[J]．中华医学杂志，2005，85(25)：1771-1777．
[34]Malinehoe M,Kamath PS,Gordon FD,et al.A model to predict poor survival in patients undergoing transjugular intrahepatie to systemic shunts[J].Hepatology,2000,31(4):864-871.
[35]张铁英，赵金满，施贵静．肝硬化患者肝储备功能对TIPSS术后近期疗效的影响[J]．世界华人消化杂志，2005，13(3)：415-418．
[36]毛德文，邱华，胡振武．终末期肝病模型评分在肝功能衰竭中应用的研究进展[J]．中国危重病急救医学，2006，18(7)：441-443．
[37]Freeman RB,Wiensner RH,Harper A,et al.The new liver allocation system:moving toward evidence-based transplantation policy[J].Liver Transpl,2002,8(9):851-858.
[38]Robert A,Chazouilleres O.Prothrombin time in liver failure:time,ratio,activity percentage,or international normalized ratio[J]?Hepatology,1996,24(6):1392-1394.
[39]Dickson ER,Grambsch PM,Flerming TR,et al.A Prognosis in primary biliary cirrhosis:a model for decision making[J].Hepatology,1989,10(1):1-7.
[40]Coobes JM,Trotter JF.Development of allocation system for deceased donor liver transplantation[J].Clin Med Res,2005,3(2):87-92.
[41]Paqliaro L.MELD:the End of Child-Pugh Classification?[J].Hepatology,2002,36(1):141-142.
[42]蒋忠胜，江建宁．CTP和MELD评分预测慢性重型肝炎预后的临床价值[J]．中国危重病急救医学，2007，19(7)：412-415．
[43]Wiesner R,Edwards E,Freeman R,et al.Model for end-stage liver disease(MELD)and allocation of donor livers[J].Gastroenterology,2003,24(1):91-96.
[44]Bae WK,Lee JS.Usefulness ofDeltaMELD/month for Prediction of the Mortality in t he First Episode of Variceal Bleeding Patients with Liver Cirrhosis:Comparison with CTP,MELD Score and DeltaCTP/month[J].Korean J Hepatol,2007,13(1):51-60.
[45]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):134-139.
[46]Said A,Williams J,Holden J,et al.Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease[J].J Hepatol,2004,40(6):897-903.
[47]Giannini E,Botta F,Fumagalli A,et al.Can inclusion of serum creatinine values improve the child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?[J].Liver Int,2004,24(5):465-470
[48]Saab S,Landaverde C,Ibrahim AB,et al.The MELD score in advanced liver disease:association with clinical portal hypertension and mortality[J].Exp Clin Transplant,2006,4(1):395-399.
[49]Papatheodoridis GV,Cholongitas E,Dimitriadou E,et al.MELD vs child-pugh and creatine-modified child-pugh score for predicting survival in patients with decompensated cirrhosis[J].World J Gastroenterol,2005,11(20):3099-3104.
[50]Merion RM,Wolfe RA,Dykstra DM,Leichtman AB,Gillespie B,Held PJ.Longitudinal assessment of mortality risk among candidates for liver transplantation[J].Liver Transpl,2003,9(1):12-18.
[51]Zhang JY,Zhang FK,Wang BE,et al.The prognostic value of end-stage liver disease model in liver cirrhosis[J].Zhonghua Nei Ke Za Zhi,2005,44(11):822-824.
[52]Huo TI,Lin HC,Wu JC,et al.Different model for end-stage liver disease score block distributions may have a variable ability for outcome prediction[J].Transplantation,2005,80(10):1414-1418.
[53]Dhiman RK,Jain S,Maheshwari U,et al.Early indicators of prognosis in fulminant hepatic failure:an assessment of the model for end-stage liver disease(MELD)and King's college hospital criteria[J].Liver Transpl,2007,13(6):814-821.
[54]赵燕芹，胡肖兵，李粤平，等．慢性重型肝炎MELD评分分析[J]．现代临床医学生物工程学杂志，2004，10(5)：396-397．
[55]Angermayr B,Cejna M,Karnel F,et al.Child-Pugh Versus MELD Score in Predicting Survival in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt[J].Gut,2003,52(6):879-885.
[56]Ferral H,Gamboa P,Postoak DW,et al.Survival after Elective Transjugular Intrahepatic Portosystemic Shunt Creation:Prediction With Model for End-Stage Liver Disease Score[J].Radiology,2004,231(1):231-236.
[57]Salerno F,Merli M,Cazzaniga M,et al.MELD score is better than Child:Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt[J].J Hepatol,2002,36(4):494-500.
[58]Wiesner RH,McDiarmid SV,Kamath PS,et al.MELD and PELD:application of survival models to liver allocation[J].Liver Transpl,2001,7(7):567-580.
[59]Stell DA,McAlister VC,Thorbum D.A comparison of disease severity and survival rates after liver transplantation in the United Kingdom,Canada and the United States[J].Liver Transpl,2004,10(7):898-902.
[60]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[J].Liver Transpl,2004,10(10 suppl 2):A6-A22.
[61] Habib S, Berk B, Chang CC, et al. MELD and prediction of post liver transplantation survival[J]. Liver Transplantation, 2006, 12(3): 440-447.
[62] Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation[J]. Liver Transpl, 2003, 9(2): 117-123.
[63] Ravaioli M, Grazi GL, Ercolani G, et al. Efficacy of MELD score in predicting survival after liver retransplantation[J].Transplant Proc,2004,36(9): 2748-2749.
[64] Merion RM, Schaubel DE, Dykstra DM, et al. The survival benefit of liver transplantation[J]. Am J Transplant, 2005, 5(2): 307-313.
[65] Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy[J]. Liver Transpl, 2003, 9(7): 684-692.
[66] Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact[J]. Liver Transpl, 2004, 10(1): 36-41.
[67] 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- S267.
[68] Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis[J]. Liver Transpl, 2006, 12(6): 966-971
[69] Huo TI, Lee PC, Huang YH, et al. The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy[J]. J Clin Gastroenterol, 2006, 40(6): 543-550.
[70] Reuben A. Child comes of age[J]. Hepatology, 2002, 35(1): 244 -245.
[71] Giannini E, Botta F, Testa E, et al. The 1-year and 3-month prognostic utility of the AST/AST ratio and model for end-stage liver disease score in patients with viral liver cirrhosis[J]. Am J Gastroenterol, 2002, 97(11): 2855-2860.
[72] Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone[J]. Liver Transpl, 2005,11(3): 336-343.
[73] Biggins SW, Rodriguez HJ, Bacehetti P, et al. Serum sodium predicts mortality in patients listed for liver transplantation[J]. Hepatology, 2005, 41(1): 32-39.
[74] Saab S, Ibrahim AB, Shpaner A, et al. MELD fails to measure quality of life in hver transplant candidates[J]. Liver Transpl, 2005, 11(2): 218-223.
[75] Freeman RB. MELD: the holy grail of organ allocation ? [J]. J Hepatol ,2005 , 42 (1): 16-20.
[76] Everson GT. MELD: the answer or just more questions? [J]. Gastroenterology, 2003, 124(1): 251-254.
[77] Llad(?) L, Figueras J, Memba R, et al. Is MELD really the definitive score for liver allocation? [J]. Liver Transpl, 2002, 8(9): 795-798.
[78] McCaughan GW, Strasser SI. To MELD or not to MELD?[J]. Hepatology, 2001, 34(1): 215-216.