三种评分系统对乙型肝炎肝硬化患者住院期间首次出血风险的预测价值  

Predictive value of three scoring systems for the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis

作　　者：林丽燕[1] 王碧芬[2] 肖烨 吴雅琴 刘水连 林燕[1] 黄玲玲[1] LIN Liyan;WANG Bifen;XIAO Ye;WU Yaqin;LIU Shuilian;LIN Yan;HUANG Lingling(Liver Disease Center Hepatology Department,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Nursing Department,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院肝病中心肝内科,福建福州350005 [2]福建医科大学附属第一医院护理部,福建福州350005

出　　处：《临床医学研究与实践》2025年第3期22-25,共4页Clinical Research and Practice

基　　金：福建医科大学附属第一医院护理专项创新研究项目(No.2022FY-HZ-42);福建省卫生健康青年科研课题(No.2021QNA032);福建医科大学启航基金项目(No.2020QH019)。

摘　　要：目的 分析三种评分系统对乙型肝炎肝硬化患者住院期间首次出血风险的预测价值,为临床护理风险评估提供参考。方法 采用回顾性分析法选取2017年1月1日至2022年12月30日福建省某三级甲等医院确诊为乙型肝炎肝硬化的患者,将住院期间首次出血患者作为出血组(70例),按照1∶2的比例随机抽取住院期间无出血患者作为未出血组(140例)。采用受试者工作特征(ROC)曲线比较Blatchford、内镜前Rockall、AIMS65评分对乙型肝炎肝硬化患者住院期间首次出血风险的预测效果。结果 出血组的Blatchford、内镜前Rockall及AIMS65评分均明显高于未出血组,差异具有统计学意义(P<0.05)。Blatchford、内镜前Rockall、AIMS65评分预测乙型肝炎肝硬化患者住院期间首次出血风险的曲线下面积(AUC)分别为0.765(95%CI0.702~0.821)、0.621(95%CI 0.552~0.687)、0.622(95%CI 0.553~0.688)。Blatchford评分预测乙型肝炎肝硬化患者住院期间首次出血风险的AUC明显优于内镜前Rockall、AIMS65评分(Z=3.324,P<0.001;Z=3.049,P=0.002);内镜前Rockall和AIMS65评分预测乙型肝炎肝硬化患者住院期间首次出血风险的AUC均较低,且差异无统计学意义(Z=0.026,P=0.980)。结论 Blatchford评分系统对乙型肝炎肝硬化患者住院期间首次出血风险的预测价值较好,值得临床推广与应用。Objective To analyze the predictive value of three scoring systems on the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis,and to provide reference for clinical nursing risk assessment.Methods A retrospective analysis method was used to select patients diagnosed with hepatitis B cirrhosis in a tertiary hospital in Fujian Province from January 1,2017 to December 30,2022.The patients with first bleeding during hospitalization were used as bleeding group(70 cases),and the patients without bleeding during hospitalization were randomly selected as non-bleeding group(140 cases)according to the ratio of 1∶2.The receiver operating characteristic(ROC)curve was used to compare the predictive effects of Blatchford,pre-endoscopic Rockall and AIMS65 scores on the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis.Results Blatchford,pre-endoscopic Rockall and AIMS65 scores in the bleeding group were significantly higher than those in the non-bleeding group,and the differences were statistically significant(P<0.05).The area under curve(AUC)of Blatchford,pre-endoscopic Rockall and AIMS65 scores in predicting the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis were 0.765(95%CI 0.702-0.821),0.621(95%CI 0.552-0.687)and 0.622(95%CI 0.553-0.688),respectively.The AUC of Blatchford score in predicting the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis was significantly better than that of pre-endoscopic Rockall and AIMS65 scores(Z=3.324,P<0.001;Z=3.049,P=0.002);the AUC of pre-endoscopic Rockall and AIMS65 scores in predicting the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis was low,and the difference was not statistically significant (Z=0.026, P=0.980). Conclusion The Blatchford score system has a good predictive value for the risk of first bleeding during hospitalization in patients with hepatitis B cirrhosis, which is worthy of clinical promotion and

关 键 词：肝硬化 乙型肝炎 出血风险 

分 类 号：R473.57[医药卫生—护理学]