AIMS65与Blatchford评分评估上消化道出血的比较研究

赵尚飞; 黄妮; 宋明全

doi:10.13201/j.issn.1009-5918.2021.02.003

AIMS65与Blatchford评分评估上消化道出血的比较研究

- 1. 青岛市第八人民医院消化内科(山东青岛, 266041);
- 2. 青岛大学附属医院消化内科

详细信息

通讯作者: 宋明全,E-mail:mingquansong@163.com

中图分类号: R573.2

收稿日期: 2020-12-11

Comparison of AIMS65 and Blatchford score in predicting the outcomes of upper gastrointestinal bleeding

- 1. Department of Gastroenterology, Qingdao Eighth People's Hospital, Qingdao, Shandong, 266041, China;
- 2. Department of Gastroenterology, the Affiliated Hospital of Qingdao University

More Information

Corresponding author: SONG Mingquan, E-mail: mingquansong@163.com

Received Date: 11 December 2020

摘要

摘要: 目的:比较AIMS65与Blatchford评分系统对于上消化道出血(UGIB)患者死亡、再出血、输血及内镜下治疗的预测价值。方法:选择青岛市第八人民医院消化内科2013年1月—2019年6月收治的486例UGIB患者,对其临床资料进行回顾性分析,分别采用AIMS65与Blatchford评分对患者进行评分,利用受试者工作特征(ROC)曲线下面积比较两种评分对于UGIB患者死亡、再出血、输血及内镜下治疗的预测价值。另外,采用AIMS65评分分别对非静脉曲张性和静脉曲张性UGIB患者进行评分,评估AIMS65评分对于两组患者预后的预测价值。结果:在486例UGIB患者中,死亡33例,再出血55例,输血268例,内镜下治疗91例。随着AIMS65、Blatchford评分的增加,UGIB患者的死亡率、再出血率、输血率及内镜下治疗率均相应增加。AIMS65评分预测UGIB患者死亡、再出血、输血及内镜下治疗的ROC曲线下面积分别为0.870(95%CI:0.837~0.899)、0.642(95%CI:0.598~0.685)、0.673(95%CI:0.629~0.714)、0.553(95%CI:0.508~0.598),而Blatchford评分分别为0.717(95%CI:0.675~0.757)、0.755(95%CI:0.714~0.793)、0.764(95%CI:0.723~0.801)、0.662(95%CI:0.618~0.704)。另外,AIMS65评分预测非静脉曲张性UGIB患者死亡、再出血、输血及内镜下治疗的ROC曲线下面积分别为0.810(95%CI:0.764~0.850)、0.649(95%CI:0.598~0.693)、0.592(95%CI:0.545~0.631)、0.547(95%CI:0.501~0.591),预测静脉曲张性UGIB患者的ROC曲线下面积分别为0.917(95%CI:0.862~0.973)、0.838(95%CI:0.746~0.893)、0.768(95%CI:0.729~0.805)、0.727(95%CI:0.687~0.764)。结论:对于UGIB患者,AIMS65评分对死亡的预测价值明显优于Blatchford评分,对内镜下治疗的预测能力较差;而Blatchford评分对再出血、输血及内镜下治疗的预测价值优于AIMS65评分。另外,对于静脉曲张性UGIB患者,AIMS65评分均有较好的预后评价能力;而对于非静脉曲张性UGIB,AIMS65评分预测死亡、再出血的价值较高。
- 上消化道出血 /
- 死亡 /
- 再出血 /
- 预后 /
- AIMS65
Abstract: Objective: To compare the predictive value of AIMS65 and Blatchford score for mortality, rebleeding, blood transfusion and endoscopic intervention of patients with upper gastrointestinal bleeding(UGIB).Methods: A retrospective cohort study was performed in 486 patients who attended the Gastroenterology department of Qingdao Eighth People's Hospital with UGIB from Jan. 2013 to Jun. 2019. The AIMS65 and Blatchford score were calculated for all patients respectively. The rates of mortality, rebleeding, blood transfusion and endoscopic intervention and their areas under the receiver operating characteristic(ROC) curve were calculated to verify the predictive value. In addition, for the patients with variceal and nonvariceal UGIB, the AIMS65 score was calculated to assess the predictive value.Results: Of the 486 patients with UGIB, 33 died, 55 experienced rebleeding, 268 received blood transfusion, and 91 experienced endoscopic intervention. The areas under ROC curve of AIMS65 for mortality, rebleeding, blood transfusion and endoscopic intervention were 0.870(95%CI: 0.837-0.899), 0.642(95%CI: 0.598-0.685), 0.673(95%CI: 0.629-0.714) and 0.553(95%CI: 0.508-0.598), respectively. The areas under ROC curve of Blatchford score were 0.717(95%CI: 0.675-0.757), 0.755(95%CI: 0.714-0.793), 0.764(95%CI: 0.723-0.801) and 0.662(95%CI: 0.618-0.704), respectively. The areas under ROC curve of AIMS65 in predicting mortality, rebleeding, blood transfusion and endoscopic intervention of patients with nonvariceal UGIB were 0.810(95%CI: 0.764-0.850), 0.649(95%CI: 0.598-0.693), 0.592(95%CI: 0.545-0.631) and 0.547(95%CI: 0.501-0.591), respectively. The areas under ROC curve of AIMS65 in predicting mortality, rebleeding, blood transfusion and endoscopic intervention of patients with variceal UGIB were 0.917(95%CI: 0.862-0.973), 0.838(95%CI: 0.746-0.893), 0.768(95%CI: 0.729-0.805) and 0.727(95%CI: 0.687-0.764), respectively.Conclusion: For UGIB, the AIMS65 score is superior to the Blatchford score to predict mortality, whereas the Blatchford score is superior for predicting rebleeding, blood transfusion and endoscopic intervention. And the AIMS65 score can predict the outcomes of patients with variceal UGIB, and can predict the mortality, rebleeding of patients with nonvariceal UGIB.
- upper gastrointestinal bleeding /
- mortality /
- rebleeding /
- prognosis /
- AIMS65

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参考文献(20)

[1]	钱欧,庄则豪,徐兰英,等.内镜下OTSC治疗急性非静脉曲张性上消化道出血回顾性对照研究[J].临床急诊杂志,2020,21(7):549-552.
[2]	冯琛,乔峤,史乃蕴,等.生长抑素联合不同剂量耐信对消化道出血临床疗效及安全性的影响[J].中国中西医结合消化杂志,2020,28(3):173-176.
[3]	Tantai XX,Liu N,Yang LB,et al.Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding[J].World J Gastroenterol,2019,25(45):6668-6680.
[4]	Blatchford O,Murray WR,Blatchford M.A risk score to predict need for treatment for upper-gastrointestinal haemorrhage[J].Lancet,2000,356(9238):1318-1321.
[5]	Saltzman JR,Tabak YP,Hyett BH,et al.A simple risk score accurately predicts in-hospital mortality,length of stay,and cost in acute upper GI bleeding[J].Gastrointest Endosc,2011,74(6):1215-1224.
[6]	Kim MS,Choi J,Shin WC.AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding[J].BMC Gastroenterol,2019,19(1):136.
[7]	Shafaghi A,Gharibpoor F,Mahdipour Z,et al.Comparison of three risk scores to predict outcomes in upper gastrointestinal bleeding;modifying Glasgow-Blatchford with albumin[J].Rom J Intern Med,2019,57(4):322-333.
[8]	Alexandrino G,Carvalho R,Reis J.Comparison of the AIMS65 Score with Other Risk Stratification Scores in Upper Variceal and Nonvariceal Gastrointestinal Bleeding[J].Gut Liver,2018,12(1):111-113.
[9]	奚黎婷,朱锦舟,杨奕,等.急性非静脉曲张性上消化道出血评分系统的研究进展[J].中国中西医结合消化杂志,2020,28(9):726-730.
[10]	《中华消化外科杂志》编辑委员会,《中华消化杂志》编辑委员会.急性非静脉曲张性上消化道出血多学科防治专家共识(2019版)[J].中华消化外科杂志,2019,18(12):1094-1100.
[11]	Chang A,Ouejiaraphant C,Akarapatima K,et al.Prospective Comparison of the AIMS65 Score,Glasgow-Blatchford Score,and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding[J].Clin Endosc,2020.
[12]	陈剑,唐帅,唐小华.AIMS65评分在急性上消化道出血患者危险分级及预后评估中的作用[J].临床急诊杂志,2015,16(10):760-763.
[13]	Cúrdia Goncalves T,Barbosa M,Xavier S,et al.AIMS65 score:a new prognostic tool to predict mortality in variceal bleeding[J].Scand J Gastroenterol,2017,52(4):469-470.
[14]	Abougergi MS,Charpentier JP,Bethea E,et al.A Prospective,Multicenter Study of the AIMS65 Score Compared With the Glasgow-Blatchford Score in Predicting Upper Gastrointestinal Hemorrhage Outcomes[J].J Clin Gastroenterol,2016,50(6):464-469.
[15]	Talley N,Potter M.Glasgow Blatchford score predicted intervention or death better than 4 other prediction models in upper GI bleeding[J].Ann Intern Med,2017,166(8):JC47.
[16]	Mustafa Z,Cameron A,Clark E,et al.Outpatient management of low-risk patients with upper gastrointestinal bleeding:can we safely extend the Glasgow Blatchford Score in clinical practice?[J].Eur J Gastroenterol Hepatol,2015,27(5):512-515.
[17]	Rout G,Sharma S,Gunjan D,et al.Comparison of various prognostic scores in variceal and non-variceal upper gastrointestinal bleeding:A prospective cohort study[J].Indian J Gastroenterol,2019,38(2):158-166.
[18]	Lu X,Zhang X,Chen H.Comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems for the prediction of the risk of in-hospital death among patients with upper gastrointestinal bleeding[J].Rev Esp Enferm Dig,2020,112(6):467-473.
[19]	刘旭,郭晓钟,李宏宇,等.AIMS65评分系统在急性非静脉曲张上消化道出血患者中应用[J].创伤与急危重病医学,2018,6(3):132-134.
[20]	Stanley AJ,Laine L,Dalton HR,et al.Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding:international multicentre prospective study[J].BMJ,2017,356:i6432.