Rockall与Blatchford评分系统评估急性上消化道出血的比较研究

Comparative Study of Rockall and Blatchford Risk Scoring Systems in Assessment of Acute Upper Gastrointestinal Bleeding

背景:急性上消化道出血(AUGIB)是临床常见危重症之一,一些整合临床和内镜指标的评分系统近年相继问世。目的:评估Rockall与B1atchford评分系统对AUGIB患者再出血、手术和死亡的预测价值。方法:纳入仁济医院急诊科2008年1月～2010年12月AUGIB患者320例,分别采用Rockall和Blatchford评分系统对患者行危险度分级,计算各危险度患者的再出血率、手术率和死亡率。采用受试者工作特征(ROC)曲线下面积(AUC)评估两种评分系统对再出血、手术和死亡的预测价值。结果:随着Rockall评分和B1atchford评分的增加,AUGIB患者的再出血率、手术率和死亡率相应升高。Rockall评分高危组再出血率、手术率和死亡率显著高于中危组和低危组,中危组显著高于低危组(P<0.01)。BIatchford评分中高危组再出血率、手术率和死亡率显著高于低危组(P<0.01)。Rockall评分系统评估再出血率、手术率和死亡率的AUC分别为0.682(95%CI:0.601～0.764,P<0.01)、0.735(95%CI:0.614～0.856,P<0.01)和0.815(95%CI:0.716～0.914,P<0.01),Blatchford评分系统分别为0.734(95%CI:0.656～0.811,P<0.01)、0.855(95%CI:0.789～0.920,P<0.01)和0.731(95%CI:0.607～0.855,P<0.01)。结论:Rockall与Blatchford评分系统可作为AUGIB的危险性和预后评估指标,预测再出血、手术和死亡的准确性较高。Rockall评分系统对死亡的预测价值优于Blatchford评分系统,Blatchford评分系统对再出血和手术的预测价值优于Rockall评分系统。

Background： Acute upper gastrointestinal bleeding （AUGIB） is one of the commonly seen critically severe diseases in clinic. In recent years, several risk scoring systems integrating clinical and endoscopic parameters have been developed. Aims： To investigate the predictive value of Rockall and Blatchford risk scoring systems for assessing the risk of rebleeding, surgery and mortality in patients with AUGIB. Methods： Three hundred and twenty patients with AUGIB admitted between Jan. 2008 and Dec. 2010 in Department of Emergency of Renji Hospital were enrolled in this study. Rockall and Blatchford risk scoring systems were used respectively to identify patients at risk, and the rates of rebleeding, surgery and mortality were calculated. The area under the receiver operating characteristic （ROC） curve （AUC） was calculated to verify the efficiency of these two risk scoring systems for assessing rebleeding, surgery and mortality. Results： With the increase of Rockall risk score and Blatchford risk score, the rates of rebleeding, surgery and mortality increased accordingly in AUGIB patients. According to Rockall risk scoring, rates of rebleeding, surgery and mortality in high risk group were much higher than those in intermediate risk group and low risk group, and those in intermediate risk group were much higher than those in low risk group （P〈0.01）. According to Blatchford risk scoring, rates of rebleeding, surgery and mortality in high-intermediate risk group were much higher than those in low risk group （P〈0.01）. The AUC of Rockall risk scoring for assessing the rates of rebleeding, surgery and mortality was 0.682 （95% CI： 0.601-0.764, P〈0.01）, 0.735 （95% Ch 0.614-0.856, P〈0.01） and 0.815 （95% CI： 0.716-0.914, P〈0.01）, respectively. The AUC of Blatchford risk scoring was 0.734 （95% CI： 0.656-0.811, P〈0.01）, 0.855 （95% CI： 0.789-0.920, P〈0.01） and 0.731 （95% Ch 0.607-0.855, P〈0.01）, respectively. Conclusions： Both Rockall and Blatchford risk scoring systems can be used to indicate the risk and assess the prognosis of AUGIB, and have good accuracy on predicting rebleeding, surgery and mortality. Rockall risk scoring system is better for predicting mortality, while Blatchford scoring system is better for predicting rebleeding and surgery.