Oakland评分系统联合凝血功能指标对结肠息肉内镜切除术后下消化道出血的预测价值  

Value of Oakland score system combined with coagulation function index in predicting bleeding risk oflower digestive tract after endoscopic resection of colon polyps

作　　者：陈文静 赖敏 陈燕 徐泽艳 Chen Wenjing;Lai Min;Chen Yan(Department of Gastroenterology,Chengdu Pidu Didtrict People′s Hospital,Chengdu 611730,China)

机构地区：[1]成都郫都区人民医院消化内科,611730

出　　处：《中华保健医学杂志》2024年第3期319-322,共4页Chinese Journal of Health Care and Medicine

基　　金：成都市医学科研课题(2020156)。

摘　　要：目的 分析Oakland评分系统联合凝血功能指标对结肠息肉内镜切除术后下消化道出血的预测价值。方法 选取2020年1月~2023年5月于成都郫都区人民医院接受结肠息肉内镜切除术的患者337例,依据术后72 h内是否发生下消化道出血将其分为未出血组(308例)、出血组(29例)。比较两组患者基本资料,纤维蛋白原(FIB)、血小板(PLT)、凝血酶原时间(PT)、D-二聚体(D-D)、Oakland评分,分析Oakland评分、凝血指标对息肉切除术后下消化道出血风险的预测价值。结果 与未出血组对比,出血组的Oakland评分、D-D水平上升[(5.29±1.42)分vs.(9.13±1.78)分、(0.33±0.11)mg/L vs.(0.38±0.12)mg/L],PT时间延长[(12.42±1.30)s vs. 13.29±2.15)s],FIB、PLT水平降低[(3.42±1.10)g/L vs.(2.39±0.70)g/L、(255.34±43.19)×10^(9)/L vs.(178.51±32.45)×10^(9)/L],差异均有统计学意义(t=13.601、4.945、9.329、2.141、2.159,P<0.05)。多因素logistic回归分析发现,高血压、息肉直径、息肉是否有蒂、医师技术、Oakland评分、FIB、PLT、PT、D-D为患者术后发生下消化道出血的风险因素(P<0.05)。Oakland评分、FIB、PLT、PT、D-D与术后下消化道出血相关,相关系数分别为0.690、-0.618、-0.682、0.461、0.357。Oakland评分、FIB、PLT、PT、D-D五项联合预测患者术后下消化道出血的ROC曲线下面积最大,为0.853。结论 凝血指标、Oakland评分与结肠息肉患者术后出血密切相关,Oakland评分联合PLT、FIB、PT、D-D对预测息肉切除术后下消化道出血具有一定价值,对高出血风险患者,可制定针对性干预措施改善预后。Objective To assess the predictive capability of the Oakland scoring system combined with coagulation function indicators for lower gastrointestinal bleeding following endoscopic resection of colon polyps.Methods A total of 337 patients who underwent endoscopic resection of colon polyps at our hospital from January 2020 to May 2023 were included.Patients were categorized into two groups:non-bleeding(n=308)and bleeding(n=29)based on the occurrence of lower gastrointestinal bleeding occurred within 72 hours post-surgery.Compare the basic clinical data of two groups of patients,including fibrinogen(FIB),platelet count(PLT),Prothrombin time(PT),D-dimer(D-D)and Oakland score,and analyze the predictive value of Oakland score and coagulation indicators on the risk of lower gastrointestinal bleeding after polypectomy.Results Compared with the non bleeding group,the Oakland score and D-D levels in the bleeding group increased,PT time prolonged,FIB and PLT levels decreased,and there were statistically significant differences between the groups(t=13.601,4.945,9.329,2.141,2.159,P<0.05).Multivariate logistic regression analysis found that hypertension,polyp diameter,whether the polyp has a pedicle,physician skills,Oakland score,FIB,PLT,PT,and D-D were risk factors for postoperative lower gastrointestinal bleeding in patients.Oakland score,FIB,PLT,PT,D-D were correlated with postoperative lower gastrointestinal bleeding,with correlation coefficients of 0.690,-0.618,-0.682,0.461,and 0.357,respectively.The combined prediction of Oakland score,FIB,PLT,PT,and D-D has the largest area under the ROC curve for postoperative lower gastrointestinal bleeding in patients,which is 0.853.Conclusion Coagulation indicators and the Oakland score are closely associated with postoperative bleeding in patients with colon polyps.Combining the Oakland score with PLT,FIB,PT and D-D holds promise in predicting lower gastrointestinal bleeding after polypectomy.Tailored intervention strategies can be devised for patients at high risk of bleeding to im

关 键 词：结肠息肉内镜切除术 Oakland评分系统 凝血功能指标 下消化道出血 

分 类 号：R574[医药卫生—消化系统]