3种评分系统对肝硬化胃底食管静脉曲张出血患者预后的预测价值  

Prognostic evaluation of three scoring systems in patients with esophageal and gastricvarices bleeding

作　　者：余维微[1] 蔡宗宗 曾耀明[1] 叶影 朱小区[2] YU Weiwei;CAI Zongzong;ZENG Yaoming;YE Ying;ZHU Xiaoqu(Department of Gastroenterology,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou,Zhejiang 325000,China;Department of Hepatology,Wenzhou Hospital of Traditional Chinese Medicine,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江省温州市中医院消化科,325000 [2]浙江省温州市中医院肝病科,325000

出　　处：《重庆医学》2020年第10期1623-1626,1630,共5页Chongqing medicine

基　　金：浙江省温州市科技计划项目(Y20180868)。

摘　　要：目的评估Blatchford、MELD及BioCliM评分系统对肝硬化胃底食管静脉曲张出血(EGVB)患者预后的预测价值。方法选择该院2016年1月至2018年10月收治的因首次肝硬化EGVB的住院患者130例为研究对象,采用各评分系统对患者进行评分。以患者入院后6个月作为观察结点,记录出血患者死亡与存活情况,将其分为死亡组和存活组。采用ROC曲线下面积分析各评分系统对患者6个月内死亡的预测价值。结果两组患者Blatchford评分差异无统计学意义(P>0.05),死亡组患者MELD、BioCliM评分均高于生存组(P<0.05)。Blatchford、MELD、BioCliM评分评估预后的曲线下面积分别为0.656、0.757、0.916。BioCliM评分对预后结局的评估效力显著高于其余两种评分系统(P<0.05),MELD评分的评估效力高于Blatchford评分系统(P<0.05)。Blatchford、MELD、BioCliM评分评价患者预后的最佳截断值分别为9.3、46.9、-0.2,灵敏度分别为81.74%、86.36%、93.26%,特异度分别为73.33%、75.41%、88.85%。结论除Blatchford评分系统外,MELD、BioCliM评分系统对肝硬化EGVB的危险性和预后的评估,均具有较好的准确率,其中BioCliM评分系统最优。Objective To investigate the prognostic evaluation of Blatchford,MELD and BioCliM scoring system for cirrhosis patients with esophageal and gastricvarices bleeding(EGVB).Methods A total of130 patients with cirrhosis due to initial EGVB admitted to this hospital from January 2017 to October 2018 were selected as research objects,and the patients were evaluated by various scoring systems.Six months after admission,the death and survival of patients with EGVB were recorded and they were divided into the death group and the survival group.The area under ROC curve was used to analyze the predictive value of every scoring system in dying within 6 months.Results There was no significant difference between the two groups in Blatchford score(P>0.05),while MELD and BioCliM scores in the death group were all higher than those in the survival group(P<0.05).The area under curve of Blatchford,MELD and BioCliM scores for prognostic evaluation was 0.656,0.757 and 0.916,respectively.The BioCliM score was significantly more effective than the other two scoring systems(P<0.05),and the MELD scoring system was more effective than Blatchford scoring system(P<0.05).The best truncation values of Blatchford,MELD and BioCliM scores were 9.3,46.9,-0.2,respectively,with the sensitivity of 81.74%,86.36%,93.26%,respectively,and the specificity of73.33%,75.41%,88.85%,respectively.Conclusion In addition to Blatchford scoring system,MELD and BioCliM scoring system were all of relatively high accuracy in evaluating the risk and prognosis of cirrhosis EGVB.Among them,BioCliM scoring system is superior to other scoring systems.

关 键 词：肝硬化 食管和胃静脉曲张 评分系统 预后 

分 类 号：R575.2[医药卫生—消化系统]