入院首次血小板及血清总胆红素判别首次上消化道出血类型

Determination of the type of first-time upper gastrointestinal bleeding by initial platelet count and serum total bilirubin on admission

目的:回顾性分析首次静脉曲张性上消化道出血(variceal upper gastrointestinal bleeding,VUGB)及非静脉曲张性上消化道出血(non-variceal upper gastrointestinal bleeding,NVUGB)病例,筛选首次上消化道出血中的VUGB。方法:收集首次VUGB 63例,NVUGB 383例,记录出院诊断、入院首次血红蛋白(hemoglobin,HGB)、血小板计数(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、血清总胆红素(total bilirubin,TB)及血白蛋白(albumin,ALB),建立多因素Logistic回归模型,绘制受试者工作特征曲线(ROC),确定最佳预测界值(Cut-Off),分析最佳预测界值对上消化道出血类型判别效果。结果:14.13%首次上消化道出血为VUGB;消化道出血量、ALB、PT无助于消化道出血类型判别;相对于NVUGB患者,VUGB患者PLT、ALB降低,PT延长及TB增高;当入院首次PLT<140.5×10~9/L、TB≥14.55μmol/L、判别函数P值(P=EXP(0.033×PLT-0.158×TB)/1+EXP(0.033×PLT-0.158×TB))<0.92时出血类型多为VUGB,而PLT≥140.5×10~9/L时出血类型多为NVUGB。结论:入院首次血小板及血清总胆红素可判别首次上消化道出血类型。

Objective： To retrospectively analyse the data of the patients with variceal upper gastrointestinal bleeding （VUGB） and nonvariceal upper gastrointestinal bleeding （NVUGB）, and to screen out those with first- time VUGB. Methods： A total of 63 first-time VUGB patients and 383 first-time NVUGB patients were included in this study. The initial hemoglobin count （HGB）, platelet count （PLT）, prothrombin time （PT）, serum total bilirubin （TB）, and serum albumin （ALB） on admission, as well as the diagnosis at time of discharge of the patients were recorded. Based on these data, a multivariate logistic regression model and receiver operating characteristic （ROC） curve were established in order to determine the optimal Cut-Off value and to evaluate its accuracy in determining the type of UGB. Results： Among patients with first-time upper gastrointestinal bleeding （UGB）, 14.13% were identified as having VUGB. UGB volume, ALB, and PT were not useful for determining UGB type. Compared with NVUGB patients, VUGB patients had reduced PLT and ALB, prolonged PT, and elevated TB. It was found that VUGB predominates in ease of initial PLT 〈 140.5 × 10^9/L, TB I〉 14.55 μmol/L, and discriminant function P value （P=EXP（0.033×PLT-0.158×TB）/1＋EXP（0.033×PLT-0.158×TB））〈 0.92, and NVUGB predominates in caseof PLT ≥ 140.5 × 10^9/L on admission. Conclusions： Initial platelet count and serum total bilirubin can determine the type of first-time UGB on admission.