Rockall、Blatchford和AIMS65评分系统在急性上消化道出血诊治中的价值  

The values of Rockall, Blatchford and AIMS65 scoring systems in the diagnosis and treatment of patients with acute upper gastrointestinal bleeding

作　　者：刘会领[1] 罗雁[1] 李长平[2] 梅玫[1] 陈静[1] 苏芳[1] 张砚[1] 陈延丽[1] LIU Hui-ling;LUO Yan;LI Chang-ping;MEI Mei;SU Fang;ZHANG Yan;CHEN Yan-li(Department of Gastroenterology, Tianjin Haihe Hospital, Tianjin 300350, China;School of Public Health, Tianjin Medical University)

机构地区：[1]天津市海河医院消化内科,300350 [2]天津医科大学公共卫生学院

出　　处：《天津医药》2017年第4期423-427,共5页Tianjin Medical Journal

摘　　要：目的比较Rockall、Blatchford和AIMS65这3种评分系统对急性上消化道出血(AUGIB)预后的预测价值。方法选取我院2014年8月—2016年8月收治的130例AUGIB患者为研究对象,采用Rockall、Blatchford和AIMS65这3种评分系统分别对患者危险程度进行评分,观察患者入院确诊后2个月内的再出血及死亡情况。比较3种评分系统对AUGIB患者的危险程度分级及再出血、死亡的预测价值。结果根据Rockall评分系统和Blatchford评分系统分组的各危险组之间再出血率及病死率差异均无统计学意义(P>0.05);AIMS65评分系统分组的低危组再出血率低于高危组(1.45%vs.13.11%,P<0.05),而病死率差异无统计学意义(P>0.05)。以Rockall评分系统、Blatchford评分系统和AIMS65评分系统评分为检验变量进行受试者工作特征曲线(ROC)分析,结果显示3种系统预测再出血率的ROC曲线下面积(AUC)依次为0.6258、0.6910和0.7241,预测病死率的AUC依次为0.7031、0.7969和0.7031,但差异均无统计学意义(P>0.05)。以3种评分系统评估的危险程度分级为检验变量进行ROC分析,结果显示3种系统预测再出血率的AUC依次为0.6189、0.6139和0.7254(χ~2=1.99,P>0.05);预测病死率的AUC依次为0.6211、0.6641和0.7695(χ~2=29.67,P<0.01)。结论 AIMS65评分系统操作简单方便,适用人群范围广。在对再出血、死亡等进行预测时,具有较高的预测精准度和稳定性,值得在临床推广应用。Objective To compare the predictive values of Rockall,Blatchford and AIMS65scoring systems in the prognosis of patients with acute upper gastrointestinal bleeding(AUGIB).Methods A total of130patients with AUGIB inour hospital were enrolled in this study from August2014to August2016.Three kinds of scoring systems including Rockall,Blatchford and AIMS65were used to evaluate the risk classification of the patients.Patients were followed up for2months.The incidence rates of re-bleeding and death within2months after admission were observed.Data of prognosis in patients with AUGIB were compared between the three scoring systems in the prognosis of patients with AUGIB,including the risk classification and the prediction accuracy of re-bleeding and death.Results There were no significant differences in there-bleeding rate and fatality rate between the groups divided by Rockall and Blatchford scoring systems(P>0.05).According to the grouping results of AIMS65scoring system,the re-bleeding rate of low-risk group was lower than that inhigh risk group(1.45%vs.13.11%,P=0.01),but there was no significant difference in fatality rate between the two groups(P>0.05).The values of area under the curve(AUC)of predicting re-bleeding rates by using Rockall,Blatchford andAIMS65scoring systems were0.6258,0.6910,and0.7241,and the values of AUC of predicting fatality rates were0.7031,0.7969,and0.7031by using receiver operating characteristic curve(ROC)analysis.There were no significant differencesbetween them(P>0.05).The values of AUC of predicting re-bleeding rates by using the risk grading calculation by Rockall,Blatchford and AIMS65scoring systems were0.6189,0.6139and0.7254(P>0.05).But the values of AUC of predictingfatality rates were0.6211,0.6641and0.7695(P<0.01).Conclusion The operation method of AIMS65scoring system issimple and convenient,which is applicable to a wide range of patients with AUGIB.In the prediction of re-bleeding andmortality,AIMS65scoring system has high accuracy and stability,which is worthy of promoting in clini

关 键 词：胃肠出血 预后 诊断技术 消化系统 方案评价 Rockall评分 Blatchford评分 AIMS65评分 

分 类 号：R573.2[医药卫生—消化系统]