阿司匹林风险评分对服用肠溶阿司匹林患者非静脉曲张上消化道出血的预测  

Aspirin risk score for the prediction of nonvariceal upper gastrointestinal bleeding in patients taking enteric-coated aspirin

作　　者：尤嘉璐 徐佳颖 唐琛 廖湘粤 高峰 YOU Jialu;XU JiaYing;TANG Chen;LIAO XiangYue;GAO Feng(Department of Gastroenterology,Beijing Anzhen Hospital,Capital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029)

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所消化内科,100029 [2]首都医科大学第六床医学院

出　　处：《心肺血管病杂志》2024年第6期605-609,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医科大学“本科生科研创新项目”(XSKY2024278)。

摘　　要：目的:探讨阿司匹林风险评分(acetylsalicylic acid risk score,ASA)对服用肠溶阿司匹林患者非静脉曲张上消化道出血的预测价值。方法:纳入2022年1月至2022年8月,就诊于首都医科大学附属北京安贞医院正在服用肠溶阿司匹林患者172例,应用ASA风险评分进行评分及分组(0~2分为低危组,得分>2分为高危组)。观察的主要指标为1年内上消化道出血的发生率,每3个月对患者进行电话随访,如患者发生黑便或呕血,实验室检查大便潜血阳性,即判定为上消化道出血。结果:入选患者172例,其中男109例,女63例,共160例患者完成随访,失访率为7.0%。随访3个月低危组(n=78)无上消化道出血发生,高危组(n=82)为5例,发生率为6.1%,采取矫正的确切概率法,高危组3个月内上消化道出血率高于低危组(P=0.033)。随访12个月低危组无上消化道出血的患者,高危组(n=82)为6例,发生率为7.3%,采取矫正的确切概率法,高危组12个月内上消化道出血率高于低危组(P=0.017)。ROC曲线分析结果显示,ASA风险评分预测3个月内上消化道出血的ROC曲线下面积为0.856(95%CI:0.730~0.982,P=0.007),最佳截断值为3.5分,敏感度为80.0%,特异度为75.5%。ASA评分预测12个月内上消化道出血的ROC曲线下面积为0.876(95%CI:0.766~0.985,P=0.002),最佳截断值为3.5分,敏感度为83.3%,特异度为76.0%。结论:ASA风险评分对服用肠溶阿司匹林患者非静脉曲张上消化出血具有一定的预测价值,值得临床推广应用。Objective:To investigate the predictive value of the acetylsalicylic acid risk score(ASA risk score)for non-varicose upper gastrointestinal bleeding in patients taking enteric-coated aspirin.Methods:A total of 172 patients who were taking enteric-coated aspirin from January 2022 to August 2022 in Beijing Anzhen Hospital of Capital Medical University were enrolled.ASA risk score was used to score and group them(lowrisk group with a score of 0-2,high-risk group with a score>2).The primary outcome was the incidence of upper gastrointestinal bleeding within 1 year.Every 3 months for patients with telephone follow-up,such as patients with melena or hematemesis,laboratory examination of fecal occult blood positive,that is,determined to be upper gastrointestinal bleeding.Results:A total of 172 patients(109 males and 63 females)were enrolled.A total of 160 patients were followed up,with a loss to follow-up rate of 7.0%.During the 3-month follow-up,no gastrointestinal bleeding occurred in the low-risk group(n=78)and 5 cases in the high-risk group(n=82),with an incidence of 6.1%.The incidence of upper gastrointestinal bleeding in the high-risk group was higher than that in the low-risk group(P=0.033).During the 12-month follow-up,no gastrointestinal bleeding occurred in the low-risk group(n=78)and 6 cases in the high-risk group(n=82),,with an incidence of 7.3%.The incidence of upper gastrointestinal bleeding in the high-risk group was higher than that in the low-risk group(P=0.017).ROC curve analysis showed that the ASA score predicted upper gastrointestinal bleeding at 3 months with The area under curve is 0.856(95%CI:0.730-0.982,P=0.007),an optimal cut-off of 3.5 points,a sensitivity of 80.0%,a specificity of 75.5%.Conclusion ASA risk score has a certain value in the prediction of non-varicose upper gastrointestinal bleeding in patients taking enteric Asprin and is worthy of clinical application.

关 键 词：阿司匹林 上消化道出血 风险预测 

分 类 号：R54[医药卫生—心血管疾病]