不同评分系统对急性非静脉曲张性上消化道出血患者的预测价值

Predictive value of different scoring systems for patients with acute non-variceal upper gastrointestinal bleeding

目的探讨4种评分系统[Glasgow-Blatchford风险评分(GBS)、内镜前Rockall评分(PRS)、内镜后完整Rockall评分(RS)和AIMS65评分系统]在急性非静脉曲张性上消化道出血(ANVUGIB)患者的临床干预和预后等事件的预测能力,以指导临床实践。方法选取2021年1月至2022年12月该院消化内科和重症监护病房(ICU)收治的ANVUGIB患者77例作为研究对象,收集患者的临床资料、临床干预措施和预后情况,计算4种评分系统的分值。根据是否接受输血分为输血组(34例)和非输血组(43例)。根据是否进行手术操作分为手术操作组(11例)和非手术操作组(66例)。根据住院期间是否发生分为再出血再出血组(23例)和非再出血组(54例)。分析各组患者各评分系统的差异。使用受试者工作特征曲线下面积评估各评分系统对输血、手术操作、再出血和入住ICU的预测能力。结果输血组患者除GBS与非输血组比较,差异有统计学意义(P<0.05)外,其他评分系统与非输血组比较,差异均无统计学意义(P>0.05)。手术操作组患者PRS、RS与非手术操作组比较,差异均有统计学意义(P<0.05);GBS、AIMS65评分系统与非手术操作组比较,差异均无统计学意义(P>0.05)。再出血组患者PRS、RS、GBS与非再出血组比较,差异均有统计学意义(P<0.05),AIMS65评分系统与非再出血组比较,差异无统计学意义(P>0.05)。GBS对输血的预测价值均优于PRS、RS、AIMS65评分系统,差异均有统计学意义(P<0.05),最佳阈值为10分;RS对手术操作的预测价值均优于PRS、GBS、AIMS65评分系统,差异均有统计学意义(P<0.05),最佳阈值为4分;RS对再出血的预测价值均优于PRS、GBS、AIMS65AIMS65评分系统,差异均有统计学意义(P<0.05),最佳阈值为3分;4种评分系统对入住ICU的预测价值比较,差异无统计学意义(P>0.05)。结论在ANVUGIB患者的分层治疗中应使用GBS或RS。胃镜检查前如GBS>10分则判断患者需输血;胃镜检查后如RS>4分则判断患者需进行手术操作;如RS>3分则判断患者会发生再出血。

Objective To explore the predictive ability of four scoring systems[Glasgow-Blatchford risk score(GBS),pre-endoscopic Rockall score(PRS),post-endoscopic complete Rockall score(RS)and AIMS65 scoring system]in clinical intervention and prognosis of patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB),so as to guide clinical practice.Methods A total of 77 patients with ANVUGIB admitted to the Department of Gastroenterology and Intensive Care Unit(ICU)of the hospital from January 2021 to December 2022 were selected as the research objects.The clinical data,clinical intervention measures and prognosis of the patients were collected,and the scores of the four scoring systems were calculated.According to whether they received blood transfusion,they were divided into the blood transfusion group(34 cases)and the non-blood transfusion group(43 cases).According to whether the operation was performed,the surgical operation group(11 cases)and the non-surgical operation group(66 cases).According to whether rebleeding occurred during hospitalization,the rebleeding group(23 cases)and the non-rebleeding group(54 cases).The differences of each scoring system in each group were analyzed.The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each scoring system for blood transfusion,surgical procedure,rebleeding and ICU admission.Results There was statistically significant difference between the blood transfusion group and the non-blood transfusion group except GBS(P<0.05).There were significant differences in PRS and RS between the surgical operation group and the non-surgical operation group(P<0.05).There was no significant difference in GBS and AIMS65 scoring system between the non-surgical operation group and the non-surgical operation group(P>0.05).There were significant differences in PRS,RS and GBS between the rebleeding group and the non-rebleeding group(P<0.05).There was no significant difference in AIMS65 scoring system between the non-rebleeding group and the non-rebleeding group(P>0.05).The predictive value of GBS for blood transfusion was better than that of PRS,RS and AIMS65 scoring systems,and the difference was statistically significant(P<0.05).The optimal threshold was 10 points.The predictive value of RS for surgical operation was better than that of PRS,GBS and AIMS65 scoring systems,and the differences were statistically significant(P<0.05).The optimal threshold was four points.The predictive value of RS for rebleeding was better than that of PRS,GBS and AIMS65AIMS65 scoring systems,and the difference was statistically significant(P<0.05).The optimal threshold was three points.There was no significant difference in the predictive value of the four scoring systems for ICU admission(P>0.05).Conclusion GBS or RS should be used in the stratified treatment of ANVUGIB patients.If GBS>10 points before gastroscopy,it is judged that the patient needs blood transfusion.After gastroscopy,if RS>4 points,the patient was judged to need surgical operation.If RS>3 points,the patient will be judged to have rebleeding.