白蛋白-胆红素评分联合Glasgow-Blatchford量表对危险性上消化道出血患者短期预后的预测价值

Predictive value of albumin-bilirubin score combined with Glasgow-Blatchfordscale in the short-term prognosis of patients with acute upper gastrointestinal hemorrhage

目的:探讨白蛋白-胆红素(ALBI)评分联合Glasgow-Blatchford量表(GBS)对危险性上消化道出血患者短期预后的预测价值。方法:将2020年5月至2022年5月长江大学附属荆州医院收治的81例危险性上消化道出血患者作为研究对象,根据30 d内患者的预后情况分为预后不良组(35例)和预后尚可组(46例)。收集两组患者的临床资料,比较两组白蛋白(ALB)、肌酐(Cr)、血红蛋白(Hb)、总胆红素(TBIL)、尿素氮(BUN)和ALBI、GBS评分的差异;采用Logistic多因素回归分析危险性上消化道出血患者短期预后的独立危险因素,并评估ALBI评分、GBS评分对危险性上消化道出血患者短期预后的预测价值;绘制受试者工作特征(ROC)曲线,计算并比较曲线下面积。结果:两组患者在性别构成、心率、收缩压、吸烟史、饮酒史、用药情况、晕厥、神志改变、合并疾病方面比较差异无统计学意义(P>0.05);而预后不良组年龄高于预后尚可组[(65.60±7.90)岁比(62.60±7.50)岁],差异有统计学意义(P<0.05)。预后不良组BUN、TBIL、GBS评分高于预后尚可组[(9.86±2.94)mmol/L比(8.56±2.66)mmol/L、(20.70±12.31)μmol/L比(11.71±8.11)μmol/L、(10.77±1.59)分比(7.91±1.91)分],而Hb、Cr、ALB、ALBI评分低于预后尚可组[(74.97±16.47)g/L比(84.01±19.44)g/L、(65.72±12.08)μmol/L比(70.37±11.52)μmol/L、(25.67±4.30)g/L比(32.62±5.07)g/L、(0.75±0.47)分比(1.37±0.43)分],差异有统计学意义(P<0.05)。Logistic回归分析结果显示,ALB、TBIL、ALBI评分、GSB评分是影响危险性上消化道出血患者30 d内预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,ALBI评分、GBS评分预测危险性上消化道出血患者短期预后不良的曲线下面积分别为0.922、0.875,而二者联合预测曲线下面积为0.958,灵敏度为94.29%,特异度为84.78%,均显著高于单独预测(Z=1.87、2.44,P<0.05)。结论:ALBI评分联合GBS评分对危险性上消化道出血患者短期预后具有良好的预测价值。

Objective To investigate the predictive value of albumin-bilirubin score combined with Glasgow-Blatchfordscale(GBS)in the short-term prognosis of patients with acute upper gastrointestinal hemorrhage.Methods Eighty-one patients with acute upper gastrointestinal hemorrhage who were treated in JingzhouHospital Affiliated to Yangtze University from May 2020 to May 2022 were selected as the research subjects,according to the prognosis of patients within 30 d,they were divided into poor prognosis group(35 cases)and fair prognosis group(46 cases).Clinical data were collected and the levels of albumin(ALB),creatinine(Cr),hemoglobin(Hb),total bilirubin(TBIL),urea nitrogen(BUN)and the scores of ALBI,GBS were compared between the two groups.The independent risk factors of short-term prognosis in patients with acute upper gastrointestinal hemorrhage were analyzed by Logistic multivariate regression analysis.The predictive value of ALBI score and GBS score for short-term prognosis of acute upper gastrointestinal hemorrhage was evaluated.Receiver operating characteristic(ROC)curve were drawn,and the area under the curve was calculated and compared.Results There were no significant differences in baseline data such as gender,heart rate,systolic blood pressure,smoking history,drinking history,drug use,syncope,mental changesand comorbidities between the two groups(P>0.05).The age in the poor prognosis group was higher than that in the fair prognosis group:(65.60±7.90)years vs.(62.60±7.50)years,there was statistical difference(P<0.05).The levels of BUN,TBIL and GBS scores in the poor prognosis group were higher than those in the fair prognosis group:(9.86±2.94)mmol/L vs.(8.56±2.66)mmol/L,(20.70±12.31)μmol/L vs.(11.71±8.11)μmol/L,(10.77±1.59)scores vs.(7.91±1.91)scores;the levels of Hb,Cr,ALB and ALBI scores were lower than those in the fair prognosis group:(74.97±16.47)g/L vs.(84.01±19.44)g/L,(65.72±12.08)μmol/L vs.(70.37±11.52)μmol/L,(25.67±4.30)g/L vs.(32.62±5.07)g/L,(0.75±0.47)scores vs.(1.37±0.43)scores,there were statistical differences(P<0.05).Logistic regression analysis showed that ALB,TBIL and ALBI,GSB scores were independent risk factors for death within 30 din patients with acute upper gastrointestinal hemorrhage(P<0.05).ROC curve analysis showed that the area under the curve of ALBI score and GBS score were 0.922 and 0.875,while the area under the curve of combined was 0.958,the sensitivity was 94.29%,and the specificity was 84.78%,which were significantly higher than predicted alone(Z=1.87,2.44;P<0.05).Conclusions ALBI score combined with GBS has good predictive value for short-term prognosis in patients with acute upper gastrointestinal hemorrhage.