Blatchford危险评分系统对老年人急性非静脉曲张上消化道出血的评估价值

Prognostic value of Blatchford score system in acute non-variceal upper gastrointestinal bleeding in elderly patients

目的 探讨Blatchford评分对老年急性非静脉曲张上消化道出血（ANUGIB）患者输血、再出血、干预和死亡的预测价值. 方法 采用Blatchford评分系统对我院270例老年ANUGIB患者进行危险程度分级,与同期311例非老年患者进行对比,应用受试者工作特征（ROC）曲线评估Blatchford评分系统对患者输血、再出血、干预和死亡的预测价值. 结果 老年组输血率显著高于非老年组（39.3％比25.1％,P=0.000）;老年组和非老年组再出血率分别为4.1％（11/270）比4.2％（13/311）,总干预率为27.0％（73/270）比28.3％（88/311）,病死率为2.2％ （6/270）比1.0％（3/311）,差异均无统计学意义（P＞0.05）.以6分为分界点,Blatchford评分诊断老年和非老年ANUGIB的敏感性分别为94.9％和84.5％;以9分为分界点,特异性分别为73.1％和83.5％.Blatchford评分评估老年和非老年患者ROC曲线下面积（AUC）分别为,输血0.72比0.87,死亡0.74比0.95,Blatchford评分系统对老年和非老年患者输血和死亡均有较好的预测价值（均P＜0.01）;再出血0.60比0.70,对非老年组再出血具有较好的预测价值（P=0.015）,但对老年组再出血无预测价值;内镜为0.65比0.55,介入0.84比0.65,手术干预0.49比0.66;Blatchford评分系统对老年组进行内镜和介入干预具有较好的预测价值（均P＜0.01）,对手术干预无预测价值（P＞0.05）;对非老年组手术干预具有较好的预测价值（P＜0.01）,对内镜和介入治疗无预测价值（P＞0.05）. 结论 Blatchford评分系统对于老年ANUGIB患者输血、内镜/介入干预和死亡具有较好的预测价值,对手术干预和再出血无预测价值;对于老年患者,可将6分作为分界点判断高低危人群.

Objective To investigate the predictive value of Blatchford score system in the blood transfusion,rebleeding,intervention and death in elderly patients with acute non-variceal upper gastrointestinal bleeding （ANUGIB）.Methods 270 elderly patients with ANUGIB were graded by Blatchford score system,as compared with 311 non-elderly patients.The receiver operating characteristic （ROC） curve of Blatchford score was used to evaluate blood transfusion,rebleeding,intervention and death.Results The blood transfusion rate was higher in elderly patients than in non elderly patients （39％ vs.25.1％,P=0.000）.There were no significant differences in the rebleeding rate,operation/intervention/endoscopy therapy rate and mortality rate between the elderly and non-elderly groups [4.1％ （11/270） vs.4.2％ （13/311）,27.0％ （73/270） vs.28.3％ （88/311）,and 2.2％ （6/270） vs.1.0％ （3/311）,respectively,all P＞0.05].The sensitivity of Blatchford scoring system in prediction of ANUGIB in elderly and non-elderly patients was 94.9％ and 84.5％ respectively with score 6 as the cut-off point,and the specificity was 73.1％ and 83.5％ respectively with score 9 as the cut-off point.The area under the ROC curve （AUC） of Blatchford score for the assessment of blood transfusion and death in elderly and non-elderly patients was 0.72 （P1=0.000）,0.87 （P=0.000）,0.74 （P=0.006）and 0.95 （P=0.007） respectively,which showed that Blatchford score had better prognostic value on blood transfusion and death in the two groups.The AUC of Blatchford score for rebleeding was 0.70 （P=0.015） in non-elderly group and 0.6 （P＞0.05） in elderly group,which showed that Blatchford score had better prognostic value on rebleeding in non-elderly group,but not in the elderly group.The AUC of Blatchford score for endoscopy,intervention and operation therapy inelderly and non-elderly group were 0.65 （P=0.001）,0.55 （P＞0.05）,0.84（P＞0.05）,0.65 （P＞0.05）,0.49 （P＞0.05）,0.66 （P=0.019） respectively,which showed that Blatchford score had better prognostic value on endoscopy,intervention treatment in elderly group and operation therapy in non-elderly group,but had noprognostic value on operation therapy in elderly group and endoscopy,intervention treatment in non-elderly group.Conclusions Blatchford score system has better prognostic value on blood transfusion,endoscopy/intervention therapy and death,but has no value for prediction of rebleeding and operation therapy in the elderly patients with ANUGIB.Score 6 can be regarded as the cut-off point to judge the high or low risk in the elderly patients with ANUGIB.