Rockall评分系统在急性非静脉曲张性上消化道出血患者中的应用

Application of Rockall risk scoring system in patients with acute non-variceal upper gastrointestinal bleeding

目的探讨Rockall危险积分在急性非静脉曲张性上消化道出血患者中的应用，评估其对死亡及再出血的预测能力准确性。方法回顾性分析上海浦东医院消化科ANVUGIB患者474例，按年龄段分为〈40岁组、40～59岁组、60～79岁组和／〉80岁组，应用Rockall评分系统进行评分，采用受试者工作特征曲线（ROC）下面积（AUC）评估其对ANVUGIB再出血及死亡的预测能力。结果474例ANVUGIB患者中男性与女性之比约为2．36：1，死亡22例（4．64％），再出血54例（11．39％）。Rockalli~分系统预测死亡的AUC=0．849（P〈0．05），预测再出血的AUC=0．675（P〉0．05）。各组再出血率分别为10％、7．53％、12．58％、19．58％。Rockall评分系统评估各组再出血率AUC分别为0．610、0．740、0．632、0．727。各组死亡率分别为0％、5．48％、2．65％、10．3％。结论Rockall评分系统对ANVUGIB死亡的预测能力良好。Rockall评分系统对40～59岁组、≥80岁组ANVUGIB患者再出血预测价值较高。

Objective To explore the application of Rockall risk scoring system in patients with acute non-variceal upper gastrointestinal bleeding and to evaluate the predictive effect of Rockall risk scoring system on rebleeding and mortality. Methods Clinical materials of 474 inpatients were analyzed retrospectively. All patients were divided into 4 groups according to ages. Rockall risk sco- ring system was used. The area under receiver operating characteristic curve was calculated to assess its effect on rebleeding rate and mortality. Results In 474 cases of ANVUGIB patients, the ratio of maleto female was2.3 6 ： 1 , and 2 2 patients died （ 4.6 4 % ） , 5 4 patients had rebleeding （ 1 1.3 9 % ）. AUC = 0.849 （P 〈 0.05 ） for predicting the mortality AUC = 0. 849 （ P 〈 0.05 ）, and AUC = 0.675 （ P 〉 0.05 ） for predicating re-bleeding in Rockall scoring system. The rate of rebleeding in each group was 10% , 7.53% , 12.58% and 19.58% respectively. AUC for assessing the rate of rebleeding was 0.6 1 0 , 0. 7 4 0 , 0. 6 3 2 and 0. 7 2 7 respectively , while mortality was （ 0 / 8 0 , 0 % ） , （ 8 / 1 4 6 , 5.48% ）, （4/151, 2.65% ） and （10/97, 10.3% ） respectively in Rockall risk scoring system. Conclusion Rockall risk scoring system shows a good accuracy for the prediction of ANVUGIB mor- tality. In the groups with 40 - 59 years and ~〉 80 years, Rockall risk scoring system plays a higher val- ue in predicting the rate of rebleeding.