摘要
目的研究急性非静脉曲张性上消化道出血(ANVUGIB)死亡相关危险因素及不同评分系统对其死亡风险的预测价值。方法选取2016年1月至2018年10月广元市中心医院收治的115例ANVUGIB患者,根据预后不同分为病死组(12例,治疗失败病死者)和存活组(103例,治疗成功安全出院者),收集并比较两组临床资料,以Logistic多元回归方程分析死亡相关危险因素,绘制ROC曲线,比较Glasgow Blatch ford Score评分(GBS)、AIMS65评分系统、Full Rockall Score评分(FRS)对死亡的预测价值。结果病死组年龄≥65岁、血红蛋白<90g/L、血细胞比容<25%、血小板计数≤10×10^9L^-1、再出血、内镜下喷射样出血、合并脏器疾病、休克占比均高于存活组,且血尿素氮水平、GBS、AIMS65、FRS评分均高于存活组(P<0.05);经多元回归分析显示,血红蛋白<90g/L、血细胞比容<25%、血小板计数≤10×10^9L^-1、再出血、内镜下喷射样出血、合并脏器疾病、高血尿素氮水平、高GBS评分、高AIMS65评分、高FRS评分、休克是导致病死的独立危险因素(P<0.05);GBS、AIMS65、FRS评分对死亡预测价值的曲线下面积分别为0.645(95%CI:0.494~0.795)、0.648(95%CI:0.516~0.778)、0.670(95%CI:0.524~0.805),FRS评分对死亡风险的预测价值高于GBS、AIMS65评分(P<0.05),且其预测死亡的最佳值为5.5分。结论低血红蛋白、低血细胞比容、低血小板计数、再出血、内镜下喷射样出血、合并脏器疾病、高血尿素氮水平、高GBS评分、高AIMS65评分、高FRS评分、休克是ANVUGIB死亡的独立危险因素,FRS评分预测ANVUGIB患者死亡价值最高,预测最佳值为5.5分。
Objective To investigate the risk factors associated with death from acute non-variceal upper gastrointestinal bleeding (ANVUGIB) and the predictive value of different scoring systems for their mortality risk.Methods A total of 115 patients with ANVUGIB admitted to Guangyuan Central Hospital from Jan.2016 to Oct.2018 were enrolled.According to the prognosis,patients were divided into death group (12 cases,treatment failure patients) and survival group (103 cases,successful treatment and safe discharge).Clinical data were compared between two groups,Logistic multiple regression equations were used to analyze risk factors related to death,and ROC curves were drawn.The predictive value of Glasgow Blatchford Score (GBS),AIMS65 scoring system,Full Rockall Score (FRS) for death were compared.Results The age of the death group was ≥65 years old,hemoglobin<90 g/L,hematocrit<25%,platelet count ≤10×10^9 L^-1,rebleeding,endoscopic jet-like hemorrhage,combined organ disease,shock ratio were higher than the survival group,and blood urea nitrogen level,GBS,AIMS65,FRS score were higher than the survival group ( P <0.05).Logistic multiple regression analysis showed that hemoglobin<90 g/L,hematocrit <25%,platelet count ≤10×10^9 L^-1,rebleeding,endoscopic jet-like hemorrhage,combined organ disease,high blood urea nitrogen level,high GBS score,high AIMS65 score,high FRS score,shock were independent risk factors for death ( P <0.05);The area under the curve of predictive value of GBS,AIMS65,FRS score for death were 0.645 (95% CI :0.494- 0.795 ),0.648 (95% CI :0.516-0.778),and 0.670 (95% CI :0.524-0.805),respectively.The predicted value of FRS score for death risk was higher than the GBS and AIMS65 scores ( P <0.05),and the best value for predicting death was 5.5.Conclusion Low hemoglobin,low hematocrit,low platelet count,rebleeding,endoscopic jet-like bleeding,combined organ disease,high blood urea nitrogen level,high GBS score,high AIMS65 score,high FRS score,and shock are independent risk factors for ANVUGIB death.FRS score predicts the highest mortality value of patients with ANVUGIB,and the best predictive value is 5.5.
作者
董桂君
巨森
赵平
黄刚
谢吉良
龙小英
DONG Guijun;JU Sen;ZHAO Ping;HUANG Gang;XIE Jiliang;LONG Xiaoying(Department of Gastroenterology,Guangyuan Central Hospital,Guangyuan 628000;Intensive Care,Guangyuan Central Hospital,Guangyuan 628000;Department of Stomatology,the First People’s Hospital of Chongqing,China)
出处
《胃肠病学和肝病学杂志》
CAS
2019年第7期755-760,共6页
Chinese Journal of Gastroenterology and Hepatology
