天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (4): 423-427.doi: 10.11958/20161472

• 诊断技术与方法 • 上一篇    下一篇

Rockall、 Blatchford 和 AIMS65 评分系统在急性 上消化道出血诊治中的价值

刘会领 1， 罗雁 1△， 李长平 2， 梅玫 1， 陈静 1， 苏芳 1， 张砚 1， 陈延丽 1   

  1. 1 天津市海河医院消化内科 （邮编 300350）； 2 天津医科大学公共卫生学院
  • 收稿日期:2016-12-06 修回日期:2017-03-07 出版日期:2017-04-15 发布日期:2017-04-15
  • 通讯作者: △通讯作者 E-mail: tjhhnk@163.com E-mail:tjhhnk@163.com
  • 作者简介:刘会领 （1977）， 女， 副主任医师， 硕士， 主要从事消化道出血及脂肪肝诊治研究

The values of Rockall, Blatchford and AIMS65 scoring systems in the diagnosis and treatment of patients with acute upper gastrointestinal bleeding

LIU Hui-ling1, LUO Yan1△, LI Chang-ping2, MEI Mei1, CHEN Jing1, SU Fang1, ZHANG Yan1, CHEN Yan-li1   

  1. 1 Department of Gastroenterology, Tianjin Haihe Hospital, Tianjin 300350, China; 2 School of Public Health, Tianjin Medical University
  • Received:2016-12-06 Revised:2017-03-07 Published:2017-04-15 Online:2017-04-15
  • Contact: Corresponding Author E-mail：tjhhnk@163.com E-mail:tjhhnk@163.com

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摘要： 目的 比较 Rockall、 Blatchford 和 AIMS65 这 3 种评分系统对急性上消化道出血（AUGIB）预后的预测价值。方法 选取我院 2014 年 8 月—2016 年 8 月收治的 130 例 AUGIB 患者为研究对象， 采用 Rockall、 Blatchford 和 AIMS65 这 3 种评分系统分别对患者危险程度进行评分， 观察患者入院确诊后 2 个月内的再出血及死亡情况。比较 3 种评分系统对 AUGIB 患者的危险程度分级及再出血、 死亡的预测价值。结果 根据 Rockall 评分系统和 Blatchford 评分系统分组的各危险组之间再出血率及病死率差异均无统计学意义（P＞0.05）； AIMS65 评分系统分组的低危组再出血率低于高危组 （1.45% vs. 13.11%， P<0.05）， 而病死率差异无统计学意义 （P＞0.05）。以 Rockall 评分系统、 Blatchford 评分系统和 AIMS65 评分系统评分为检验变量进行受试者工作特征曲线 （ROC） 分析， 结果显示 3 种系统预测再出血率的 ROC 曲线下面积 （AUC） 依次为 0.625 8、 0.691 0 和 0.724 1， 预测病死率的 AUC 依次为 0.703 1、 0.796 9 和 0.703 1， 但差异均无统计学意义（P＞0.05）。以 3 种评分系统评估的危险程度分级为检验变量进行 ROC 分析， 结果显示 3 种系统预测再出血率的 AUC 依次为 0.618 9、 0.613 9 和 0.725 4（χ2=1.99， P＞0.05）； 预测病死率的 AUC 依次为 0.621 1、 0.664 1 和 0.769 5（χ2=29.67， P＜0.01）。结论 AIMS65 评分系统操作简单方便， 适用人群范围广。在对再出血、 死亡等进行预测时， 具有较高的预测精准度和稳定性， 值得在临床推广应用。

关键词: 胃肠出血, 预后, 诊断技术, 消化系统, 方案评价, Rockall 评分, Blatchford 评分, AIMS65 评分

Abstract: Objective To compare the predictive values of Rockall, Blatchford and AIMS65 scoring systems in the prognosis of patients with acute upper gastrointestinal bleeding (AUGIB). Methods A total of 130 patients with AUGIB in our hospital were enrolled in this study from August 2014 to August 2016 . Three kinds of scoring systems including Rockall, Blatchford and AIMS65 were used to evaluate the risk classification of the patients. Patients were followed up for 2 months. The incidence rates of re-bleeding and death within 2 months after admission were observed. Data of prognosis in patients with AUGIB were compared between the three scoring systems in the prognosis of patients with AUGIB, including the risk classification and the prediction accuracy of re-bleeding and death. Results There were no significant differences in the re- bleeding rate and fatality rate between the groups divided by Rockall and Blatchford scoring systems (P＞0.05). According to the grouping results of AIMS65 scoring system, the re-bleeding rate of low-risk group was lower than that in high risk group (1.45% vs. 13.11%, P=0.01), but there was no significant difference in fatality rate between the two groups (P＞0.05). The values of area under the curve (AUC) of predicting re- bleeding rates by using Rockall, Blatchford and AIMS65 scoring systems were 0.625 8, 0.691 0, and 0.724 1, and the values of AUC of predicting fatality rates were 0.703 1, 0.796 9, and 0.703 1 by using receiver operating characteristic curve (ROC) analysis. There were no significant differences between them (P＞0.05). The values of AUC of predicting re-bleeding rates by using the risk grading calculation by Rockall, Blatchford and AIMS65 scoring systems were 0.618 9, 0.613 9 and 0.725 4 (P＞0.05). But the values of AUC of predicting fatality rates were 0.621 1, 0.664 1 and 0.769 5 (P＜0.01). Conclusion The operation method of AIMS65 scoring system is simple and convenient, which is applicable to a wide range of patients with AUGIB. In the prediction of re-bleeding and mortality, AIMS65 scoring system has high accuracy and stability, which is worthy of promoting in clinical application.

Key words: gastrointestinal hemorrhage, prognosis, diagnostic techniques, digestive system, program evaluation, Rockall scoring, Blatchford scoring, AIMS65 scoring