Blatchford评分在预测460例急诊上消化道出血病因中的价值研究

The value of Blatchford score in predicting etiology of upper gastrointestinal bleeding in 460 patients

目的:探讨Blatchford评分在预测急诊上消化道出血病因中的价值。方法:选取2017-01-2019-12期间我院急诊科收治的急性上消化道出血患者460例,根据出血病因分为肝硬化静脉曲张破裂出血组193例和非静脉曲张性出血组267例,分析两组患者临床特征,绘制受试者工作曲线(ROC),评价Blatchford评分预测肝硬化静脉曲张破裂出血的能力。结果:两组患者中男性居多,肝硬化静脉曲张破裂出血组平均动脉压(MAP)、白细胞计数(WBC)、血红蛋白浓度(Hb)、血小板计数(PLT)、凝血酶原活动度(PTA)、纤维蛋白原(FIB)、白蛋白(ALB)及白/球比值(A/G)显著降低,部分凝血活酶时间(APTT)、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、球蛋白(GLB)增高,差异均有统计学意义(P<0.05)。肝硬化静脉曲张破裂出血组Blatchford评分较高,Blatchford评分预测肝硬化静脉曲张破裂出血的ROC曲线下面积为0.66。结论:Blatchford评分在预测急诊上消化道出血病因方面仍需进一步研究来证实。

Objective:To explore the value of Blatchford score in predicting the etiology of upper gastrointestinal bleeding in emergency department. Method:From January 2017 to December 2019, 460 patients with acute upper gastrointestinal hemorrhage treated in our emergency department were selected.The clinical characteristics of the two groups of patients were analyzed, and the receiver operating curve(ROC) was plotted to evaluate the Blatchford score for predicting the ability of cirrhotic varicose veins to rupture and bleeding. Result:The majority of patients in the two groups were men. The mean arterial pressure(MAP), white blood cell count(WBC), hemoglobin concentration(Hb), platelet count(PLT), prothrombin activity(PTA), Fibrinogen(FIB), albumin(ALB), and white/globular ratio(A/G) in gastroesophageal varices and variceal hemorrhage group were significantly reduced when comapred with non-gastroesophageal varices and variceal hemorrhage group. Partial thromboplastin time(APTT), total bilirubin(TBIL), alanine aminotransferase(ALT), asparagus Transaminase(AST) and globin(GLB) increased in astroesophageal varices and variceal hemorrhage group, and the differences were statistically significant(P<0.05)between two groups. The blunt varicose vein rupture and bleeding group had a higher Blatchford score, and the Blatchford score predicted the area under the ROC curve for cirrhotic varicose vein rupture and bleeding was 0.66. Conclusion:The Blatchford score needs to be further confirmed to predict the etiology of emergency upper gastrointestinal bleeding.