Blatchford和Rockall评分系统对急性非静脉曲张性上消化道出血预后评估的比较  

Comparative study on the evaluation of the prognosis for patients suffered acute nonvariceal upper gastrointestinal bleeding by using Blatchford and Rockall scoring system

作　　者：陶莉[1] 胡祥鹏[1] 宋莎莎[1] 章礼久[1] TAO Li(Department of gastroenterology,the second affiliated hospital of Anhui Medical University,Hefei,Anhui,230001,China)

机构地区：[1]安徽医科大学第二附属医院消化内科,安徽合肥230001

出　　处：《齐齐哈尔医学院学报》2019年第17期2136-2139,共4页Journal of Qiqihar Medical University

基　　金：安徽省自然科学基金(1708085QH192)。

摘　　要：目的探讨Blatchford和Rockall两种评分系统对于急性非静脉曲张性上消化道出血(ANVUGIB)患者输血、内镜止血、外科手术和死亡的预测价值。方法收集2017年6月-2018年9月在本院消化内科治疗的210例ANVUGIB住院患者进行回顾性分析,采用Blatchford和Rockall评分系统对其进行危险程度分级评分,应用受试者工作特征(ROC)曲线下面积(AUC)评估两个评分系统对输血、内镜止血、外科手术和死亡的预测价值。结果输血、内镜止血、外科手术及死亡的ANVUGIB患者Blatchford和Rockall评分均显著高于相应未输血、未行内镜止血、未手术及未死亡的患者,差异具有统计学意义(P<0.01)。Blatchford和Rockall评分预测输血的AUC分别为0.870、0.772,Blatchford在预测输血方面优于Rockall评分,差异具有统计学意义(P<0.05);两种评分预测外科手术的AUC分别为0.975、0.951,Blatchford评分优于Rockall评分,差异具有统计学意义(P<0.05);两种评分系统预测内镜止血的AUC分别为0.729、0.809,预测死亡的AUC分别为0. 977、0. 987,两种评分间差异无统计学意义(P> 0. 05)。结论 Blatchford和Rockall评分系统在评价ANVUGIB患者临床干预和死亡方面均具有良好价值;Blatchford评分对于输血及外科手术预测能力较好,优于Rockall评分;两者对于内镜止血及死亡的预测能力相当。Objective To investigate the predictive values of Blatchford and Rockall scoring system for assessing the risk of blood transfusion,endoscopic intervention,surgical intervention and mortality in patients with acute nonvariceal upper gastrointestinal bleeding( ANVUGIB). Methods The clinical data of 210 cases of patients with ANVUGIB,who were treated in the second affiliated hospital of Anhui Medical University from June 2017 to September 2018,were retrospectively analyzed.The 210 cases of patients with ANVUGIB were scored by Blatchford and Rockall scoring system,respectively.Predictive values of these two scoring systems for assessing the risk of blood transfusion,endoscopic intervention,surgical intervention and mortality were assessed by area under the curve( AUC) of receiver operating characteristic curve( ROC). Results Blatchford and Rockall scores in patients those received blood transfusion, endoscopic intervention,surgical intervention and mortality were significantly higher than those in patients without blood transfusion,endoscopic intervention,surgical intervention and survived( P<0.01).The AUC of Blatchford and Rockall scores in predicting blood transfusion were 0.870 and 0.772.Blatchford was superior to Rockall scores in predicting blood transfusion( P < 0. 05). The AUC of the two kinds of scoring system in predicting surgical intervention was 0.975 and 0.951. Blatchford had higher predictive value than Rockall scoring( P<0.05).The AUC of Blatchford and Rockall scores in endoscopic intervention was 0.729 and 0.809,and the AUC in predicting mortality was 0. 977 and 0. 987. There was no significant difference between the two scoring systems in predicting endoscopic intervention and mortality( P > 0. 05). Conclusions Blatchford and Rockall scoring system present high predictive value for clinical intervention and mortality in patients with ANVUGIB. Blatchford scoring system is better for predicting blood transfusion and surgical intervention than Rockall scoring system. The predictive value of endoscopic

关 键 词：Blatchford评分系统 Rockall评分系统 急性非静脉曲张性上消化道出血 临床干预 死亡 

分 类 号：R573[医药卫生—消化系统]