Blatchford,Rockall,MELD评分在肝硬化食管胃底静脉曲张出血患者预后评价中的应用  

Analysis of prognostic evaluation of Blatchford,Rockall,and MELD score systems in cirrhosis patients with upper esophageal gastric varices bleeding

作　　者：金怒云 施建平 王凯 李玉琴 魏双琴 

机构地区：[1]上海市浦东医院消化内科,上海201399

出　　处：《中国中西医结合消化杂志》2014年第9期489-493,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：上海市浦东新区卫生系统重点学科建设资助(No:PWZx2014-07)

摘　　要：[目的]评估Blatchford,Rockall,MELD评分系统对肝硬化胃底食管静脉曲张患者预后的预测价值.[方法]选择2009年2月-2013年2月我院收治的肝硬化胃底食管静脉曲张出血患者146例,采用Blatchford,Rockall,MELD评分系统对患者进行评分和危险度分级,计算各个危险度患者的再出血率、病死率.采用ROC曲线下面积分析3种评分系统对患者6个月内死亡的预测价值.[结果]生存组和死亡组患者Blatchford评分差异均无统计学意义.而生存组患者Rockall和MELD评分均小于死亡组（P＜0.05）.随着Blatchford,Rockall,MELD评分的增加,肝硬化胃底食管静脉曲张出血患者再出血率和病死率均逐渐增加.Blatchford评分低危组再出血比率高于其余2种评分系统,而Rockall评分高危组患者再出血比率显著高于其余2种评分组（P＜0.05）.在病死率方面,Rockall高危组患者病死率高达94.1％,显著高于其余2种评分系统（P＜0.05）.Blatchford,Rockall,MELD评分系统评价患者6个月内病死率的ROC曲线下面积分别为0.56、0.61、0.85（P＜0.05）.[结论]Blatchford,Rockall,MELD评分系统可作为肝硬化胃底食管静脉曲张出血患者危险性和预后的评估指标,而MELD评分系统对患者死亡的预测价值优于其余2种评分系统.[Objective]To investigate the prognostic predictive value of Blatchford, Rockall, and MELD scoring systems for assessing the risk of cirrhosis patients with gastric esophageal varices. [Methods]One hundred and forty-six cirrhosis patients with gastric variceal bleeding were selected from February 2009 to February 2013 in our hospital. Score and risk classification were assessed using Blatchford, Rockall, and MELD scoring systems,calculating each patient＇s risk of re-hemorrhage and mortality. Predictive value of patient death within six months was conducted using ROC curve according three scoring systems. [Results] Blatchford score between survival group and death group had no significant difference. Rockall and MELD scores of survival group were lower than that of death group（P〈0.05）. With the increase of Blatchford, Rockall, and MELD scores, rebleeding and mortality rates in patients with esophageal gastric varices bleeding also increased. Rebleeding rate was higher in low risk group based on Blatchford scoring than the other two rating systems. Rebleeding rate was also significantly higher in high risk group based on Rockall sco- ring system than the other two scoring groups（P〈0.05）. In terms of mortality, the mortality rate was ashigh as 94. 1% in Rockall high-risk group, which was significantly higher than the other two scoring sys- tems（P〈0.05）. Areas under the ROC curve using Blatchford, Rockall, and MELD scoring system in the e- valuation of mortality within 6-months were 0.56,0.61, and 0.85 （P〈0.05）. [Conclusion] Blatchford, Rockall,and MELD scoring systems can be used to assess the risk of hemorrhage and prognosis of liver cir-hosis patients with gastric variceal bleeding. MELD scoring system is better than the other two rating systems in predicting death in these patients.

关 键 词：Blatchford评分系统 Rockall评分系统 MELD评分系统 预后 

分 类 号：R575.2[医药卫生—消化系统]