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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
陈金,张伟,郑松柏,姚健凤.四种评分系统对老年人急性非静脉曲张性上消化道出血干预及预后的预测价值[J].中华老年多器官疾病杂志,2020,19(8):561~565
四种评分系统对老年人急性非静脉曲张性上消化道出血干预及预后的预测价值
Predictive value of four scoring systems for intervention and prognosis of elderly patients with acute non-varicose upper gastrointestinal bleeding
投稿时间:2019-09-24  
DOI:10.11915/j.issn.1671-5403.2020.08.132
中文关键词:  老年人;急性非静脉曲张性上消化道出血;评分系统
英文关键词:aged; acute non-varicose upper gastrointestinal bleeding; scoring system This work was supported by the 13th Five-Year Key Research and Development Plan
基金项目:十三五重点研发计划 (2018YFC2000300)
作者单位E-mail
陈金 复旦大学附属华东医院消化内科,上海 200040 yjf1966@126.compredictive 
张伟 复旦大学附属华东医院消化内科,上海 200040 yjf1966@126.compredictive 
郑松柏 复旦大学附属华东医院消化内科,上海 200040 yjf1966@126.compredictive 
姚健凤 复旦大学附属华东医院消化内科,上海 200040 yjf1966@126.compredictive 
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中文摘要:
      目的 评价内镜检查前Rockall评分(pRS)、完整Rockall评分(fRS)、Glasgow-Blatchford评分(GBS)、AIMS65评分系统对老年人急性非静脉曲张性上消化道出血(ANVUGIB)输血、内镜或手术治疗、死亡及再出血的预测价值。方法 收集2013年1月至2018年12月,复旦大学附属华东医院消化内科老年(≥65岁)ANVUGIB患者284例。按照是否输血、内镜或手术治疗,将患者分为输血组和非输血组、内镜或手术治疗组和药物治疗组。使用上述4种评分系统分别对每位患者评分,使用ROC曲线下面积(AUC)比较4种评分系统对老年人ANVUGIB输血、内镜或手术治疗、死亡、再出血的预测价值。采用SPSS 19.0统计软件对数据进行分析。结果 输血组pRS、fRS、GBS及AIMS65的分值分别为(2.73±1.39)、(4.77±1.44)、(8.17±1.62)和(1.60±0.69)分,与非输血组(1.96±1.08)、(3.37±1.55)、(4.68±3.29)和(1.12±0.32)分比较,差异均有统计学意义(均P<0.05)。内镜或手术治疗组fRS和GBS的分值分别为(6.69±1.75)分和(7.69±2.39)分,与药物治疗组[(3.58±1.60)、(5.20±3.34)分]比较,差异均有统计学意义(均P<0.05);但内镜或手术治疗组pRS、AIMS65分值分别为(2.46±1.39)分和(1.31±0.48)分,与药物治疗组[(2.08±1.17)、(1.20±0.45)分]比较,差异均无统计学意义(均P>0.05)。GBS对输血治疗的预测价值优于pRS、fRS、AIMS65(0.817和0.668、0.749、0.689;P<0.05);GBS对内镜或手术治疗的预测价值优于pRS、fRS、AIMS65(0.717和0.577、0.680、0.562;P<0.05);GBS与fRS对死亡的预测价值相当(0.785和0.774;P>0.05);pRS、fRS、GBS、AIMS65对再出血的预测价值无明显差异(0.551、0.545、0.542和0.551;P>0.05)。结论 GBS对老年人ANVUGIB的输血、内镜或手术治疗、死亡有较好的预测价值,值得临床推广。
英文摘要:
      Objective To evaluate the predictive value of pre-endoscopy Rockall score (pRS), Full-Rockall score (fRS), Glasgow-Blatchford score (GBS) and AIMS65 scoring system for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly patients with acute non-varicose upper gastrointestinal bleeding (ANVUGIB). Methods The data were collected of 284 elderly patients (≥ 65 years old) with ANVUGIB in Huadong Hospital Affiliated to Fudan University from January 2013 to December 2018. The patients were divided into blood-transfusion (BT) group, non-blood-transfusion (NBT) group, endoscopic-or-surgical (EoS) group, and drug therapy (DT) group. Each patient was scored using the above-mentioned four scoring systems. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scoring systems for blood transfusion, endoscopic or surgical treatment, death and rebleeding in the elderly ANVUGIB patients. SPSS statistics 19.0 was used for data analysis. Results The scores of pRS, fRS, GBS and AIMS65 were (2.73±1.39), (4.77±1.44), (8.17±1.62) and (1.60±0.69) points in transfusion group, and (1.96±1.08), (3.37±1.55), (4.68±3.29) and (1.12±0.32) points in non-transfusion group (all P<0.05). The scores of fRS and GBS were (6.69±1.75) and (7.69±2.39) points in endoscopic or surgical treatment group, and (3.58±1.60) and (5.20±3.34) points in drug-treated group (all P<0.05). The scores of pRS and AIMS65were (2.46±1.39) and (1.31±0.48) points in endoscopic or surgical treatment group, and (2.08±1.17) and (1.20±0.45) points in drug-treated group (all P>0.05). The predictive value of GBS for blood transfusion therapy was better than that of pRS, fRS, AIMS65 (0.817 vs 0.668,0.749,0.689; P<0.05). The predictive value of GBS for endoscopic or surgical treatment is better than that of pRS, fRS, AIMS65(0.717 vs 0.577,0.680,0.562; P<0.05). The predictive value of GBS for death was the same as that of fRS (0.785 vs 0.774; P>0.05). There was no significant difference in the predictive value of pRS, fRS, GBS, AIMS65 for rebleeding (0.551 vs 0.545 vs 0.542 vs 0.551; P>0.05). Conclusion The GBS has good predictive value for the blood transfusion, endoscopic or surgical treatment and death of ANVUGIB in the elderly, and it is worthy of clinical promotion.
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