3种非胃镜评分系统对Mallory-Weiss综合征临床干预及预后的预测

Application of Three Non-Gastroscopic Scoring Systems in Clinical Intervention and Prognostic Evaluation of Mallory-Weiss Syndrome

目的评估AIMS65、Glasgow-Blatchford评分(GBS)、内镜前Rockall评分(PeRS)3种非胃镜评分系统对Mallory-Weiss综合征(MWS)患者临床干预及预后的预测价值。方法回顾性收集胃镜检查确诊的117例MWS患者的临床资料并进行AIMS65、GBS、PeRS评分,应用受试者工作特征(ROC)曲线比较3种评分系统对患者的临床干预(胃镜止血、输血、中心静脉置管、重症化、高剂量质子泵抑制剂/808方案)及预后(再出血、死亡)的预测价值。结果AIMS65、GBS、PeRS预测MWS患者死亡的AUC值分别为0.971、0.993、0.978(均P<0.05),但3者间预测能力比较,其差异无统计学意义(均P>0.05);GBS预测中心静脉置管、重症化、输血、高剂量质子泵抑制剂/808方案的AUC值分别为0.814、0.907、0.825、0.707(均P<0.05),而AIMS65及PeRS不能较好预测这些临床干预(均P>0.05);3种评分系统不能较好预测胃镜下止血及再出血(均P>0.05)。结论3种非胃镜评分系统对MWS患者死亡均具较好的预测价值;GBS对MWS患者输血、808方案、重症化、中心静脉置管等临床干预均具有较好的预测价值;GBS可能是MWS患者最优的非胃镜评分系统。

Objective To evaluate the values of AIMS65,Glasgow-Blatchford score(GBS)and pre-endoscopic Rockall score(PeRS)systems in clinical intervention and prognostic prediction in patients with Mallory-Weiss syndrome(MWS).Methods Clinical data of 117 patients with MWS diagnosed by endoscopy were retrospectively analyzed.The receiver operator characteristic(ROC)curve was used to compare the predictive values of AIMS65,GBS and PeRS systems in clinical interventions(endoscopic hemostasis,blood transfusion,central venous catheterization,ICU admission and high-dose esomeprazole/808 scheme)and outcomes(rebleeding and mortality).ResultsThe AUC values of AIMS65,GBS and PeRS were 0.971,0.993 and 0.978 for predicting mortality in MWS patients(P<0.05).However,there were no significant differences in the predictive power among the three systems(P>0.05).The AUC values of GBS were 0.814,0.907,0.825 and 0.707 for predicting central venous catheterization,ICU admission,blood transfusion and high-dose esomeprazole/808 scheme(P<0.05).Both AIMS65 and PeRS could not predict these clinical interventions(P>0.05).None of the three scoring systems could accurately predict endoscopic hemostasis and rebleeding(P>0.05).Conclusion All of the AIMS65,GBS and PeRS systems can accurately predict mortality in MWS patients.Moreover,the GBS has a good predictive value in blood transfusion,808 scheme,ICU admission,central venous catheterization and other clinical interventions.Therefore,the GBS may be the optimal non-gastroscopic scoring system for patients with MWS.