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41卷第7期
不同评分系统对溃疡性消化道出血内镜治疗后预后的预测价值
The predictive value of different scoring systems for patients with peptic ulcer bleeding after endoscopic therapy
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DOI:
作者:
董智瑀,王珺文,展婷婷,陈莹,边海鹏,许树长
Zhiyu Dong, Junwen Wang, Tingting Zhan, Ying Chen,Haipeng Bian, Shuchang Xu
作者单位:
上海市同济医院
Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
关键词:
溃疡性消化道出血;内镜治疗;评分系统
peptic ulcer bleeding; endoscopic hemostasis; scoring system
摘要:
目的:探讨Rockall Score(RS)、Glasgow-Blatchford Score(GBS)以及modified Glasgow-Blatchford Score(mGBS)评分系统对溃疡性消化道出血内镜治疗术后再出血、需要输血等的预测价值。方法:收集我院2012-2017年经内镜治疗的溃疡性消化道出血病例,通过受试者工作特征曲线和曲线下面积和趋势性检验,探寻三种评分系统对内镜治疗术后再出血、需要输血的预测能力。结果:共159例病例纳入研究。在再出血的预测能力方面,RS、GBS和mGBS评分系统的曲线下面积分别为0.682 (95%CI 0.57-0.79)、0.697 (95%CI 0.6-0.8)和0.712 (95%CI 0.62-0.81),而术后需要输血的预测方面,RS、GBS和mGBS评分系统的曲线下面积分别为0.674 (95%CI 0.56-0.78)、0.776 (95%CI 0.68-0.87)和0.786 (95%CI 0.7-0.87)。其中,mGBS预测术后需要输血的能力显著优于RS(P=0.042)。亚组分析中,无论是不同溃疡创面大小(>1cm或<=1cm)和不同溃疡发生部位(胃溃疡或十二指肠球部溃疡)患者,GBS和mGBS的预测能力与全体PUB患者相当,而RS对于溃疡创面大小>1cm和十二指肠球部溃疡患者的再出血发生有着较好的预测能力(0.754(95%CI 0.57-0.94); 0.791(0.67-0.92))。结论:在预测术后再出血方面,RS和GBS评分系统表现不佳,而mGBS评分系统有较为良好的预测能力。在预测术后需要输血方面,RS评分系统预测能力不理想,而GBS和mGBS评分系统具备良好的预测能力。然而,对于溃疡创面较大或是十二指肠球部溃疡所引起的上消化道出血患者,RS对于术后再出血有着较好的预测能力。
Objective To explore the value of Rockall Score(RS), Glasgow-Blatchford Score(GBS) and modified Glasgow-Blatchford Score(mGBS) for predicting rebleeding and requirement of blood transfusion in peptic ulcer bleeding patients after endoscopic hemostasis. Method A retrospective single-center study was conducted from 2012 to 2017. Accuracy of these 3 scoring systems for predicting rebleeding and requirement of blood transfusion after endoscopic hemostasis was performed using receiver operating characteristics- curve and trend test. Results 159 patients were included. In predicting rebleeding, the area under curve of RS, GBS and mGBS was 0.682 (95%CI 0.57-0.79), 0.697 (95%CI 0.6-0.8) and 0.712 (95%CI 0.62-0.81) respectively. In predicting requirement of blood transfusion, the area under curve of RS, GBS and mGBS was 0.674 (95%CI 0.56-0.78), 0.776 (95%CI 0.68-0.87) and 0.786 (95%CI 0.7-0.87) respectively. Additionally, mGBS outperformed RS in predicting requirement of blood transfusion significantly(P=0.042). In subgroup analysis, GBS and mGBS performed as well as before in all subgroup splited by the size or site of ulcer. However, RS performed better in the ulcerative size>1cm or duodenum ulcer groups (0.754(95%CI 0.57-0.94); 0.791(0.67-0.92)). Conclusion In predicting rebleeding after endoscopic hemostasis, mGBS performed well but RS and GBS were barely satisfactory. GBS and mGBS performed well in predicting requirement of blood transfusion but RS had poor efficiency. However, as for the patients with duodenum ulcer or ulcer of which size>1cm, RS performed well in rebleeding after endoscopic hemostasis.
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