血尿素氮/白蛋白比值在急性非静脉曲张性上消化道出血患者预后中的价值  

The prognostic value of blood urea nitrogen/albumin ratio in patients with acute non-variceal upper gastrointestinal bleeding

作　　者：赵香梅[1] 徐雅欣[1] 王泽华 秦历杰[1] 杨蕾[1] 陈龙 朱娟[1] Zhao Xiangmei;Xu Yaxin;Wang Zehua;Qin Lijie;Yang Lei;Chen Long;Zhu Juan(Emergency Department of Henan Provincial People’s Hospital(People's Hospital of Henan University),Zhengzhou,450003,China)

机构地区：[1]河南省人民医院(河南大学人民医院)急诊部,郑州450003

出　　处：《中华急诊医学杂志》2022年第8期1102-1109,共8页Chinese Journal of Emergency Medicine

基　　金：河南省卫健委医学教育研究项目(Wjlx2020044);河南省人民医院23456人才工程项目。

摘　　要：目的探讨血尿素氮(Blood urea nitrogen,BUN)与白蛋白(Albumin)(B/A)比值在急性非静脉曲张性上消化道出血(acute non-variceal upper gastrointestinal bleeding,ANVUGIB)患者预后中的价值。方法前瞻性收集2019年1月至2021年12月急诊入院的上消化道出血(upper gastrointestinal bleeding,UGIB)患者1120例,最终入选449例符合条件的ANVUGIB患者,记录患者的临床资料、实验室检查及内镜结果,比较30 d存活组和死亡组的数据。结果存活组和死亡组在年龄、平均动脉压、脉率、白蛋白、总蛋白、血尿素氮、血糖水平、GBS、Rockall、AIMS65评分及血尿素氮/白蛋白(B/A)比值方面差异有统计学意义(P均<0.05),死亡组B/A比值明显高于存活组[(24.9±16.4)vs.(9.0±8.6)mg/g,P<0.001]。ROC曲线分析显示B/A比值预测30 d死亡的最佳临界值为32.08 mg/g(敏感度0.776,特异度0.823),B/A比值≥32.08 mg/g者与B/A<32.08 mg/g者30 d预后的Kaplan-Meier生存曲线差异有统计学意义(Log Rank 32.229,P<0.001)。多因素回归分析显示,B/A比值(≥32.08 mg/g)是ANVUGIB患者30 d死亡的独立预测因素(OR 4.87,95%CI 1.94~6.85,P<0.001)。B/A比值、GBS、Rockall和AIMS65评分预测30 d死亡的受试者工作曲线下面积(AUC)分别为0.855(95%CI 0.807~0.902),0.849(95%CI 0.796~0.901)、0.657(95%CI 0.576~0.737)、0.828(95%CI 0.774~0.883)。结论B/A比值可作为ANVUGIB患者30天死亡预测的简单有效的预后预测指标。Objective To determine whether the blood urea nitrogen to serum albumin(B/A)ratio was a useful prognostic factor of mortality in the patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods Totally 1120 patients with acute upper gastrointestinal bleeding(VUGIB)admitted to the Emergency Department from January 2019 to December 2021 were prospectively and continuously collected and 449 eligible patients with acute non-varicose upper gastrointestinal tract were finally enrolled.The clinical data,laboratory tests and endoscopic results of the patients were recorded,and the data from the 30-day survival group and the non-survival group were compared and analyzed.Results Significant differences were observed in age,mean arterial pressure,pulse rate,albumin levels,total protein levels,blood urea nitrogen levels,glucose,Glasgow-Blatchford score(GBS),Rockall,and AIMS65 scores between the survival and non-survival groups(all P<0.05).The B/A ratio in the non-survival group was significantly higher than that in the survival group[(24.9±16.4)vs.(9.0±8.6)mg/g,P<0.001].Receiver operating characteristic(ROC)curve showed that the best cutoff value of B/A ratio for predicting 30-day death was 32.08 mg/g,with a sensitivity of 0.776 and specificity of 0.823.There was a significant difference in the 30-day Kaplan-Meier survival curve between patients with B/A ratio≥32.08 mg/g and those with B/A ratio<32.08 mg/g(Log Rank 32.229,P<0.001).Multivariate logistic regression analysis revealed that the B/A ratio(≥32.08 mg/g)was associated with 30-day mortality(OR=4.87,95%CI:1.94-6.85,P<0.001).Area under the ROC curve(AUC)for B/A ratio,GBS,Rockall and AIMS65 scores for predicting 30-day mortality were 0.855(95%CI:0.807-0.902),0.849(95%CI:0.796-0.901),0.657(95%CI:0.576-0.737),and 0.828(95%CI:0.774-0.883),respectively.Conclusions The B/A ratio is a simple but potentially useful prognostic factor of mortality in the ANVUGIB patients.

关 键 词：血尿素氮 白蛋白 血尿素氮/白蛋白比值 上消化道出血 非静脉曲张性上消化道出血 胃肠镜 预后 急诊 

分 类 号：R573.2[医药卫生—消化系统]