PATE评分用于评价痔严重程度和指导临床治疗的可行性及有效性分析

The feasibility and efficacy of the Position Acute Tone External system score in evaluating hemorrhoid severity and guiding clinical treatment

目的分析PATE评分用于评价痔严重程度和指导临床治疗的可行性及有效性。方法本研究为横断面研究,自2021年11月至2022年11月在6家肛肠中心门诊/病房对痔患者开展问卷调查。问卷由本课题组自行设计,其中包括患者人口学资料,PATE评分,患者(采用视觉模拟评分法)自我评价痔严重程度评分,患者(采用视觉模拟评分法)自我评价痔症状(脱垂、便血、肛门疼痛、肛周瘙痒、肛门潮湿感、污裤)严重程度评分,以及患者的生命质量评分(采用痔和肛裂患者生命质量量表汉化版评价)等方面的内容。分析PATE评分的评价实施情况,比较不同Goligher分类和不同治疗方案(药物治疗或手术治疗)的患者的PATE评分,分析PATE评分与患者自我评价痔严重程度评分的相关性。借助受试者工作特征曲线分析PATE评分预测需要接受手术治疗的效能并得出PATE评分的最佳截断值,根据该最佳截断值将患者分组并比较不同PATE评分组别之间的患者自我评价痔症状严重程度评分、生命质量评分和接受药物治疗与手术治疗的患者比例。结果本研究回收符合研究要求的问卷为623份(回收率为88.1%)。共有615例患者具备完整的Goligher分类数据,Goligher分类为Ⅰ~Ⅳ度的患者的PATE评分总体比较差异有统计学意义(P<0.05)。接受手术治疗的患者的PATE评分高于接受药物治疗的患者,差异有统计学意义(P<0.05)。PATE评分与患者自我评价痔严重程度评分的相关系数为0.736(P<0.001)。根据患者接受的治疗方案及其相应的PATE评分绘制的受试者工作特征曲线的曲线下面积为0.755(95%CI为0.716~0.793),PATE评分的最佳截断值为18.45分,敏感性为0.644,特异性为0.794。根据临床实际的评分,将患者分为低分组(PATE评分≤18分)和高分组(PATE评分≥19分);两组之间的患者自我评价痔症状严重程度评分,痔和肛裂患者生命质量量表汉化版各维度评分及总分,以及接受药物治疗与手术治疗的患者比例比较差异有统计学意义(P<0.05)。结论PATE评分反映痔严重程度的价值较高,可以给临床治疗方案的制定提供参考信息,当PATE评分≥19分可优先考虑手术治疗。

Objectives To analyze the feasibility and efficacy of the Position Acute Tone External(PATE)system score in evaluating hemorrhoid severity and guiding clinical treatment.Methods This cross-sectional study conducted a questionnaire survey among patients with hemorrhoids in outpatient/ward settings at six anorectal centers from November 2021 to November 2022.The questionnaire,designed by our research team,included demographic information,PATE system score,patient self-evaluation of hemorrhoid severity using the Visual Analog Scale(VAS),patient self-evaluation of hemorrhoid symptoms(prolapse,hematochezia,anal pain,perianal pruritus,anal dampness,and soiling of pants)severity using the VAS,and patient quality of life score using the Chinese version of the HEMO-FISS-Quality of Life Questionnaire.The implementation of the PATE system score was analyzed,and comparisons of the PATE system score were made among/between with different Goligher grades and treatments(medication or surgery).The correlation between the PATE system score and patient self-evaluation of hemorrhoid severity score was also analyzed.The efficacy of the PATE system score in predicting the need for surgery was analyzed using the Receiver Operating Characteristic(ROC)curve,and the optimal cut-off value for the PATE system score was determined.Patients were grouped based on this optimal cut-off value,and comparisons were made between different PATE system score groups regarding patient self-evaluation of hemorrhoid symptoms severity,patient quality of life score,and the proportion of patients receiving medication or surgery.Results A total of 623 questionnaires were collected(response rate:88.1%).Complete Goligher grades data were available for 615 patients.There was a statistically significant difference in PATE system score of overall comparison among patients with Goligher grades I-IV(P<0.05).Patients undergoing surgery had higher PATE system score than those receiving medication,with a statistically significant difference(P<0.05).The correlation coefficient between the PATE system score and patient self-evaluation of hemorrhoid severity score was 0.736(P<0.001).The area under the ROC curve in predicting the need for surgery based on the PATE system score was 0.755(95%CI:0.716-0.793),with an optimal cut-off value of 18.45,sensitivity of 0.644,and specificity of 0.794.Based on clinical scoring,patients were divided into a low-score group(PATE system score≤18)and a high-score group(PATE system score≥19).There were statistically significant differences between the two groups regarding patient self-evaluation of hemorrhoid symptoms severity,all dimensions and total score of the Chinese version of the HEMO-FISS-Quality of Life Questionnaire,and the proportion of patients receiving medication or surgery(P<0.05).Conclusion The PATE system score effectively reflects hemorrhoid severity and could provide reference information for clinical treatment planning.Patients with a PATE system score of 19 or higher should be considered for upfront surgery.