非静脉曲张上消化道出血患者危险分层评估中不同评分系统的应用

目的研究非静脉曲张上消化道出血(NVUGIH)患者危险分层评估中不同评分系统的临床应用价值。方法收集本院2016年1月至2018年6月143例NVUGIH患者临床资料,记录143例患者Glasgow-blatchford(GBS)评分、Rockall评分及AIMS65评分。根据是否接受输血治疗、再出血及预后不同,对患者进行分组。比较不同分组患者GBS、Rockall及AIMS65评分。采用受试者工作(ROC)曲线分析GBS、Rockall及AIMS65三种评分系统对预测NVUGIH患者是否需要输血治疗、再出血及死亡风险的价值,记录曲线下面积(AUC)。结果 143例NVUGIH患者中,32例接受输血治疗,111例未接受输血干预。输血患者GBS、Rockall及AIMS65评分显著高于未输血者,差异有统计学意义(P 0. 05)。143例NVUGIH患者中14例发生再出血,129例未发生再出血。再出血患者GBS、Rockall及AIMS65评分显著高于未再出血者,差异有统计学意义(P 0. 05)。143例NVUGIH中死亡3例,存活140例,死亡组患者GBS、Rockall及AIMS65评分显著高于存活组,差异有统计学意义(P 0. 05)。ROC分析显示AIMS65、GBS及Rockall评分判断NVUGIH患者是否需要接受输血治疗的AUC分别为0. 776、0. 822及0. 809。AIMS65、GBS及Rockall评分判断NVUGIH患者再出血的AUC分别为0. 676、0. 680及0. 843。AIMS65、GBS及Rockall评分判断患者预后的AUC分别为0. 932、0. 849及0. 840。结论 AIMS65、GBS及Rockall评分系统对判断NVUGIH预后均具有较高准确性,而GBS评分系统有助于指导临床输血干预,Rockall评分系统则更适用于预测再出血风险。     

急性非静脉曲张性上消化道出血死亡相关危险因素分析及不同评分系统对其死亡风险的预测价值

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 Blatchford 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90 g/L、血细胞比容25%、血小板计数≤10×10~9 L~(-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(P0.05);经多元回归分析显示,血红蛋白90 g/L、血细胞比容25%、血小板计数≤10×10~9 L~(-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(P0.05);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(P0.05),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。     

AIMS65评分在老年急性非静脉曲张上消化道出血中的应用

目的探讨AIMS65评分系统对老年非静脉曲张性上消化道出血患者(ANUGIB)再出血及死亡的预测价值。方法回顾性分析北京老年医院消化内科2011年3月至2016年11月期间ANUGIB住院患者220例,根据AIMS65评分分为低危组(AIMS65评分2分)和高危组(AIMS65评分≥2分),比较两组死亡与存活、再出血与未再出血患者的AIMS65评分情况。采用SPSS 19.0统计软件对数据进行分析。计量资料用均数±标准差(x±s)表示,两组比较采用t检验。计数资料用百分率表示,组间比较用X~2检验,Pearson相关性分析AIMS65评分与再出血和死亡的相关性。应用受试者工作特征(ROC)曲线下面积(AUC)评估AIMS65评分对再出血和死亡的预测价值。结果再出血患者AIMS65评分高于未出血患者,差异有统计学意义[(3.82±1.55)vs(2.25±1.31);t=7.23,P0.05]。死亡患者AIMS65评分高于未死亡患者,差异有统计学意义[(4.65±1.23)vs(2.53±1.02);t=7.41,P0.05]。AIMS65评分与再出血及死亡呈正相关(r=0.620,r=0.863,P0.01)。AIMS65评分≥2分预测老年ANUGIB患者再出血及死亡的敏感度分别为85.71%和100.00%,特异度分别为34.04%和32.69%,AUC分别为0.719(95%CI:0.621~0.817)和0.892(95%CI:0.858~0.952),对再出血和死亡预测价值高(P0.01)。结论 AIMS65评分系统可用于对老年ANUGIB患者再出血和死亡的预测,值得临床推广。     

Glasgow-Blatchford评分对肝硬化食管胃底静脉曲张破裂出血患者早期预后的预测价值

目的比较Glasgow-Blatchford评分(GBS评分)、Child-Pugh评分(CTP评分)和终末期肝病模型(MELD)评分对预测肝硬化伴食管胃底静脉曲张破裂出血1周和6周预后的价值。方法回顾性收集自2014年1月1日-2014年12月31日在天津市第三中心医院住院的202例肝硬化伴食管胃底静脉曲张出血患者的病历资料。以入院后6周的最后结局死亡为研究终点,分为1周内死亡组(n=10)、6周内(包含1周)死亡组(n=23)、存活组(n=179)。分别计算其入院时的GBS评分、MELD评分和CTP评分及分级,比较各评分系统在1周内或6周内死亡组和生存组的差异。符合正态分布的计量资料组间比较采用两独立样本t检验,不符合正态分布的采用Mann-Whitney U检验。计数资料组间比较采用χ~2检验或Fisher检验。各评分系统之间受试者工作特征曲线下面积(AUC)的比较采用Z检验。结果 1周内死亡组与生存组相比,肝癌伴血管侵犯或转移(χ~2=4.559,P=0.033)、肝性脑病(χ~2=25.568,P0.01)、黑便(χ~2=0.842,P=0.04)、心力衰竭发生率(P=0.003)、脉搏(Z=-2.943,P=0.003),以及CTP分级(χ~2=12.22,P=0.002)、CTP评分(Z=-2.505,P=0.012)、MELD评分(t=-2.395,P=0.018)、GBS评分(Z=-2.545,P=0.011)差异均有统计学意义;6周内死亡组与生存组相比,肝癌(χ~2=9.374,P=0.002)、肝癌伴血管侵犯或转移(χ~2=14.766,P0.01)、肝性脑病发生率(χ~2=16.327,P0.01),Alb(Z=-2.770,P=0.006)、胆红素(Z=-3.191,P=0.001)、Hb(Z=-2.484,P=0.013)、血尿素氮(Z=-2.407,P=0.016)、INR(Z=-2.304,P=0.021)、收缩压(t=2.69,P=0.008)、脉搏(Z=-3.507,P0.01)水平,以及CTP分级(χ~2=25.851,P0.01)、CTP评分(Z=-3.591,P0.01)、MELD评分(t=-4.121,P0.01)、GBS评分(Z=-3.54,P0.01)差异均有统计学意义。预测1周死亡风险,GBS评分[AUC=0.738,95%可信区间(95%CI):0.67~0.80]优于MELD评分(AUC=0.731,95%CI:0.66~0.79)及CTP评分[AUC=0.728,95%CI:0.66~0.79)]。预测6周死亡风险,MELD评分(AUC=0.761,95%CI:0.70~0.89)优于CTP评分(AUC=0.748,95%CI:0.69~0.81)及GBS评分(AUC=0.726,95%CI:0.66~0.79)。3种评分系统之间预测1周病死率AUC的比较,GBS评分与CTP评分之间差异有统计学意义(Z=0.079,P=0.037),余各评分系统之间以及3种评分系统预测6周病死率比较,差异均无统计学意义(P值均0.05)。结论对于肝硬化伴食管胃底静脉曲张破裂出血患者1周死亡风险的预测方面,GBS评分优于MELD评分及CTP评分,6周死亡风险的预测方面,MELD及CTP评分优于GBS评分。     

辽宁评分与多种无创评分系统预测肝硬化患者高危食管静脉曲张及出血或再出血的价值比较

目的　比较辽宁评分与终末期肝病模型（model for end?stage liver disease, MELD）、终末期肝病血清钠模型（model for end?stage liver disease?Na,MELD?Na）及Blatchford评分在预测肝硬化患者高危食管静脉曲张（esophageal varices, EVs）、1年内出血或再出血及输血治疗方面的价值。方法　收集2018年1月—2019年9月间因肝硬化于广西医科大学第一附属医院就诊,首次行内镜检查证实有EVs的170例患者的临床资料,计算首次内镜检查时的辽宁评分、MELD、MELD?Na及Blatchford评分,并随访1年记录出血或再出血情况。绘制受试者工作特征（receiver operating characteristic, ROC）曲线并应用曲线下面积（area under curve, AUC）评价4种评分系统预测肝硬化患者高危EVs、1年内出血或再出血及输血治疗的准确性,获取最佳诊断界值,并以最佳诊断界值分组,比较高危EVs占比、首次内镜检查后1年内出血或再出血的比例。结果　辽宁评分预测肝硬化患者内镜下高危EVs的最佳诊断界值为0.45,AUC为0.702（95%CI：0.612~0.781,P<0.01）,明显优于MELD、MELD?Na及Blatchford评分（AUC分别为0.593、0.648、0.610）。辽宁评分≥0.45组及<0.45组的高危EVs患者比例分别为71.8%（89/124）及34.8%（16/46）,两组差异有统计学意义（χ2=19.442,P<0.01）。辽宁评分预测患者首次内镜检查后1年内出血或再出血的AUC为0.680（95%CI： 0.595~0.765,P<0.01）,高于MELD、MELD?Na及Blatchford评分（AUC分别为0.605、0.615、0.598）。Blatchford评分预测患者住院期间输血治疗的AUC为0.775（95%CI：0.687~0.863,P<0.01）,明显优于MELD、MELD?Na、辽宁评分（AUC分别为0.653、0.719、0.631）。结论　辽宁评分在预测肝硬化患者高危EVs及首次内镜检查后1年内出血或再出血方面,优于MELD、MELD?Na、Blatchford评分系统。Blatchford评分能有效预测肝硬化合并EVs患者住院期间是否需输血治疗。     

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

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P0.05)。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P0.05);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P0.05)。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;P0.05);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;P0.05);GBS与fRS对死亡的预测价值相当(0.785和0.774;P0.05);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;P0.05)。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。     

Rockall和Blatchford评分系统对急性非静脉曲张性上消化道出血的风险评价比较

背景:急性非静脉曲张性上消化道出血(ANVUGIB)是消化科常见的临床急症,Rockall和Blatchford评分系统常用于ANVUGIB风险分层。目的:探讨Rockall和Blatchford评分系统对ANVUGIB患者的输血、外科手术和死亡的预测价值。方法:采用Rockall和Blatchford评分系统对590例ANVUGIB住院患者进行危险程度分级评分,应用受试者工作特征(ROC)曲线下面积(AUC)评估两个评分系统对输血、外科手术和死亡的预测价值。结果:输血、外科手术和死亡的ANVUGIB患者Rockall和Blatchford评分显著高于相应未输血、未行外科手术和存活者(P0.01)。Rockall评分系统预测输血、外科手术和死亡的AUC分别为0.785(95%CI:0.743~0.828,P=0.000)、0.765(95%CI:0.693~0.837,P=0.000)、0.835(95%CI:0.703~0.966,P=0.005);Blatchford评分系统预测输血、外科手术和死亡的AUC分别为0.812(95%CI:0.775~0.848,P=0.000)、0.870(95%CI:0.811~0.930,P=0.000)、0.784(95%CI:0.614~0.954,P=0.017)。结论:Rockall和Blatchford评分系统对ANVUGIB患者的输血、外科手术和死亡有较好的预测价值;Rockall评分系统对死亡的预测价值高于Blatchford评分系统,Blatchford评分系统对输血、外科手术的预测价值高于Rockall评分系统。     

血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值

目的研究应用血清前白蛋白(PA)水平联合终末期肝病模型(MELD)评分预测失代偿期乙型肝炎肝硬化患者预后的临床价值。方法 2015年12月～2016年12月我院治疗的失代偿期乙型肝炎肝硬化患者231例,随访6个月。常规检测血清PA水平、计算MELD评分和Child-Pugh评分(CTP评分),在MELD评分的基础上,加入PA项目的评分,建立MELD联合PA评分模型。应用受试者工作特征曲线(ROC)分析各指标对患者死亡的预测效能。结果在随访的6个月里,死亡83例;死亡组血清PA水平为(32.2±9.3)mg/L,显著低于生存组的[(47.3±26.4)mg/L,P0.05];死亡组MELD评分为(24.1±5.6)分,明显高于生存组的[(18.0±6.7)分,P0.05];死亡组CTP评分为(11.8±1.2)分,明显高于生存组的[(9.0±2.0)分,P0.05];ROC曲线分析结果显示,MELD评分预测死亡的ROC下面积(AUC)为0.868(95%CI:0.823～0.912),显著高于CTP评分的[0.753(95%CI:0.690～0.816),P0.05]或血清PA的[0.675(95%CI:0.606～0.743),P0.05];进一步采用MELD联合PA评分分析的AUC为0.896(95%CI:0.857～0.935),显著高于MELD评分(P0.05)。结论应用血清PA联合MELD评分对失代偿期乙型肝炎肝硬化患者6个月内死亡的预测效能显著高于MELD评分或CTP评分,其临床应用价值还需要扩大验证。     

CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值

目的探讨肝功能评分(CTP)-终末期肝病模型(MELD)联合血清M30和M65对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法选择2017年1月至2020年1月南京市第二医院接受治疗的HBV-ACLF患者106例,根据90 d预后分为生存组51例与死亡组55例。比较两组患者一般情况、实验室指标、血清M30和M65水平,受试者特征曲线分析下面积CTP-MELD评分联合血清M30和M65与HBV-ACLF短期预后的关系。结果死亡组患者的CTP、MELD评分分别为(23.02±5.18)分和(31.18±5.89)分,高于存活组的(10.49±1.05)分和(13.21±1.34)分(t=16.949、21.276,均P<0.01);死亡组的血清M30、M65水平分别为(1685.12±413.32)U/L和(2799.41±712.05)U/L,均高于存活组的(1001.40±316.49)U/L和(1808.85±669.43)U/L(t=9.507、8.608,均P<0.01)。CTP、MELD、M30、M65单独预测90 d病死的AUC分别为0.624(95%CI:0.525~0.716)、0.804(95%CI:0.716~0.875)、0.750(95%CI:0.656~0.829)、0.887(95%CI:0.810~0.940),4项联合的AUC为0.919(95%CI:0.850~0.963),明显优于CTP、MELD、M30单项评价(P<0.05),高于M65单项评价但差异无统计学意义(P>0.05)。结论CTP、MELD评分和血清M30、M65能够较好地预测HBV-ACLF患者短期预后,且4项联合检测具有更高的预测价值。     

AIMS65评分系统对急性上消化道出血预后的评估价值

目的探讨AIMS65评分系统对急性静脉曲张性上消化道出血(acute variceal upper gastrointestinal bleeding,AVUGIB)及急性非静脉曲张性上消化道出血(acute non-variceal upper gastrointestinal bleeding,ANVUGIB)复发率及死亡率的评估价值.方法记录郑州大学第一附属医院2013-10/2016-07收治的339例符合研究标准及资料完整的患者的临床资料,出院后随访30d,并将死亡或出院后30d的疾病转归作为临床研究终点.计算不同患者的AIMS65分值,并计算复发率及死亡率,采用受试者工作特征曲线和曲线下面积(area under curve,AUC)分别预测患者复发率及死亡率的准确度.结果随着AIMS65分值的增加,急性上消化道出血的复发率及死亡率相应升高(P0.05).AIMS65评分系统评估AVUGIB复发率和死亡率的AUC分别为0.717(95%CI:0.568-0.866,P0.05),0.857(95%CI:0.747-0.967,P0.05),而ANVUGIB则为0.768(95%CI:0.652-0.884,P0.05),0.857(95%CI:0.733-0.981,P0.05).结论 AIMS65评分系统不仅可以用于ANVUGIB,也可以用于AVUGIB.     

Prognostic value of risk scoring systems for cirrhotic patients with variceal bleeding

BACKGROUND Acute variceal bleeding is one of the deadliest complications of cirrhosis,with a high risk of in-hospital rebleeding and mortality.Some risk scoring systems to predict clinical outcomes in patients with upper gastrointestinal bleeding have been developed.However,for cirrhotic patients with variceal bleeding,data regarding the predictive value of these prognostic scores in predicting in-hospital outcomes are limited and controversial.AIM To validate and compare the overall performance of selected prognostic scoring systems for predicting in-hospital outcomes in cirrhotic patients with variceal bleeding.METHODS From March 2017 to June 2019,cirrhotic patients with acute variceal bleeding were retrospectively enrolled at the Second Affiliated Hospital of Xi'an Jiaotong University.The clinical Rockall score(CRS),AIMS65 score(AIMS65),GlasgowBlatchford score(GBS),modified GBS(m GBS),Canada-United KingdomAustralia score(CANUKA),Child-Turcotte-Pugh score(CTP),model for endstage liver disease(MELD) and MELD-Na were calculated.The overall performance of these prognostic scoring systems was evaluated.RESULTS A total of 330 cirrhotic patients with variceal bleeding were enrolled;the rates of in-hospital rebleeding and mortality were 20.3% and 10.6%,respectively.For inhospital rebleeding,the discriminative ability of the CTP and CRS were clinically acceptable,with area under the receiver operating characteristic curves(AUROCs) of 0.717(0.648-0.787) and 0.716(0.638-0.793),respectively.The other tested scoring systems had poor discriminative ability(AUROCs 0.7).For inhospital mortality,the CRS,CTP,AIMS65,MELD-Na and MELD showed excellent discriminative ability(AUROCs 0.8).The AUROCs of the m GBS,CANUKA and GBS were relatively small,but clinically acceptable(AUROCs 0.7).Furthermore,the calibration of all scoring systems was good for either inhospital rebleeding or death.CONCLUSION For cirrhotic patients with variceal bleeding,in-hospital rebleeding and mortality rates remain high.The CTP and CRS can be used clinically to predict in-hospital rebleeding.The performances of the CRS,CTP,AIMS65,MELD-Na and MELD are excellent at predicting in-hospital mortality.     

Different scoring systems to predict 6-week mortality in cirrhosis patients with acute variceal bleeding: a retrospective analysis of 202 patients

Objective: Determine the optimal scoring system for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with acute variceal bleeding (AVB). Prediction effects of six scoring systems, AIMS65 score, Glasgow-Blatchford (GBS) score, full Rockall (FRS) score, the model for end-stage liver disease (MELD), the MELD-Na model and the Child-Turcotte-Pugh (CTP) score were analyzed in this study.

Methods: A total of 202 liver cirrhosis patients with AVB were enrolled between 1 January 2014, and 31 December 2014. All subjects were scored according to AIMS65, GBS, FRS, MELD, MELD-Na and CTP scoring systems on the first day of admission. The primary endpoint of the study was 6-week mortality. The prediction effect of these scoring systems for 6-week mortality was compared by ROC curve and the area under the curve (AUC).

Results: The scores of nonsurvival group evaluated by the AIMS65, GBS, FRS, MELD, MELD-Na and CTP (2.6?±?1.1, 12.9?±?2.7, 6.6?±?1.8, 26.9?±?6.5, 31.6?±?9.3, 9.6?±?2.2, respectively) were higher than those of the survival group (1.2?±?1.1, 10.2?±?3.4, 5.1?±?1.6, 21.0?±?6.4, 22.8?±?8.2, 7.7?±?2.0, respectively) (p?Conclusions: AIMS65 and MELD-Na scoring systems are recommended for evaluation of 6-week bleeding-related mortality in liver cirrhosis patients with AVB.     

Glasgow Blatchford,pre-endoscopic Rockall and AIMS65 scores show no difference in predicting rebleeding rate and mortality in variceal bleeding

Objective: To compare the performance of the Glasgow Blatchford score (GBS), pre-endoscopic Rockall score (PRS) and AIMS65 score in predicting specific clinical endpoints following variceal upper gastrointestinal hemorrhage (UGIH).

Material and methods: Between January 2008 and December 2013, we retrospectively analyzed 225 consecutive hospitalized patients managed for endoscopically confirmed UGIH.

Results: A total of 225 patients (mean age 61.3 years), mostly diagnosed with alcoholic cirrhosis (195/86.7%), presented with variceal UGIH during the study period. Rebleeding occurred in 22 (9.8%) patients and 30-day mortality was 39 (17.3%). Initial hemostasis was achieved with N-butyl cyanoacrylate (151/79.1%) and endoscopic variceal ligation (40/20.9%), while secondary rebleeding prophylaxis in 110 (48.9%) patients was accomplished using endoscopic variceal ligation (92%). The majority of patients died from the underlying disease, while 12 (30.8%) died from bleeding. Median hospital stay was 6 (1–35) days. There was no statistically significant difference among AIMS65, GBS and PRS in predicting mortality (AUROC 0.70 vs. 0.64 vs. 0.66) or rebleeding rates (AUROC 0.74 vs. 0.60 vs. 0.67). The GBS was superior in predicting the need for blood transfusion compared to AIMS65 score (AUROC 0.75 vs. 0.61, p?=?0.01) and PRS (AUROC 0.75 vs. 0.58, p?=?0.009).

Conclusions: The AIMS65, GBS and PRS scores are comparable but not useful for predicting outcome in patients with variceal UGIH because of poor discriminative ability. The GBS is superior in predicting the need for transfusion compared to AIMS65 score and PRS.     

MELD-Na模型评分对评估肝硬化食管胃底静脉曲张出血患者短期预后的临床价值

目的评价Child-Pugh、终末期肝病模型（MELD）及MELD-Na模型评分对肝硬化食管胃底静脉曲张出血患者短期再出血及预后的预测价值。方法分别计算104例肝硬化食管胃底静脉曲张出血患者的Child-Pugh、MELD及MELD-Na分值,并随访其再出血及死亡。运用ROC曲线及曲线下面积（AUC）比较三种评分系统判断患者短期预后的准确性。结果除去10例非出血原因死亡的患者外,94例患者在随访3个月内有49例（52.13%）再出血;再出血与未再出血患者Child-Pugh、MELD和MELD-Na分值无显著性差异;104例患者在随访3个月内有15例患者死亡,死亡患者MELD-Na（26.6412.50）与生存患者（20.354.54）比较,差异有统计学意义（P〈0.001）;在判断患者预后的ROC曲线AUC比较中,Child-Pugh分级（0.703）〉MELD-Na评分（0.661）〉MELD评分（0.627）。结论 Child-Pugh、MELD和MELD-Na评分均可有效地预测肝硬化食管胃底静脉曲张出血患者的短期预后,但不能有效预测短期再出血。     

Validation of prognostic scores for clinical outcomes in cirrhotic patients with acute variceal bleeding

Background. The Rockall, Glasgow-Blatchford, and AIMS65 are useful and validated scoring systems for predicting the outcomes of patients with nonvariceal gastrointestinal bleeding. However, there are no validated evidence for using them to predict outcomes on variceal bleeding. The aim of this study was to evaluate and compare the prognostic accuracy of different nonvariceal bleeding scores with other liver-specific scoring systems in cirrhotic patients. Material and methods. A retrospective multicenter study that included 160 cirrhotic patients with acute variceal bleeding. The AUROC’s to predict in-hospital mortality, and rebleeding, were analyzed for each scoring system.Results. Overall in-hospital mortality occurred in 13% and in-hospital rebleeding in 12% of patients. The systems with the best AUROC value for predicting mortality were MELD (0.828; 95% CI 0.748-0.909), and AIMS65 (0.817; 95% CI 0.724-0.909). The best score systems for predicting rebleeding were Glasgow-Blatchford (0.756; 95% CI 0.640-0.827), and Rockall (0.691; 95% CI 0.580-0.802).Conclusions. In addition to liver-specific scores, the AIMS65 score is accurate for predicting in-hospital mortality in cirrhotic patients with acute variceal bleeding. Other scoring systems might be useful for predicting significant clinical outcomes in these patients.     

Clinical Scoring Systems in Predicting the Outcomes of Small Bowel Bleeding

Background: The aim was to assess the clinical Glasgow–Blatchford score (GBS), Rockall score (CRS), and AIMS65 score in predicting outcomes (rebleeding, need for intervention, and length of stay) among patients with small bowel hemorrhage.Methods: We conducted a retrospective study of patients with small bowel bleeding (SBB). Rebleeding, need for intervention, and length of stay was investigated by 3 scoring systems. The area under the receiver operator characteristic curve was used to analyze the performance of 3 scoring systems.Results: Among 162 included patients, the scores of rebleeding, intervention, and length of stay ≥10 days groups were higher than no rebleeding, non-intervention, and length of stay <10 days groups, respectively (P < .05). The CRS, GBS, and AIMS65 scoring systems demonstrated statistically significant difference in predicting rebleeding (AUROC 0.693 vs. 0.790 vs. 0.740; all P < .01), intervention (AUROC: 0.726 vs. 0.825 vs. 0.773; all P < .01) and length of stay (AUROC 0.651 vs. 0.631 vs. 0.635; all P < .05). Higher cut-off scores achieved better sensitivity/specificity [rebleeding (CRS > 2, GBS > 7, AIMS65 > 0); need for intervention (CRS > 2, GBS > 7, AIMS65 > 0); length of stay (CRS > 0, GBS > 7, AIMS65 > 1)] in the risk stratification.Conclusions: The GBS system is reliable to be recommended for routine use in predicting rebleeding and the need for intervention for early decision making in patients with SBB. The 3 scoring systems are poorly useful in predicting length of stay.     

五种评分系统判断TACE术治疗原发性肝癌患者发生肝功能不全效能比较研究

目的 比较CTP评分、终末期肝病模型(MELD)、MELD联合吲哚菁绿(ICG)清除试验(MELD-ICG)评分、慢性肝功能不全(CLD)评分和改良的白蛋白胆红素(mALBI)评分预测经肝动脉化疗栓塞(TACE)治疗的原发性肝癌(PLC)患者术后发生早期肝功能不全的效能。方法 2018年12月～2019年12月我院收治的87例PLC患者,均接受TACE治疗,分别计算术前CTP、MELD、MELD-ICG、CLD和ALBI五种模型评分,随访术后发生肝功能失代偿情况。绘制受试者工作曲线(ROC)并计算曲线下面积(AUC)对五种评分的预测效能作出比较。结果 在87例患者中,术后发生肝功能不全27例(31.0%);术前,肝功能不全组CTP、MELD、MELD-ICG、CLD和mALBI评分分别为(6.9±1.1)、12.0(10.0～14.0)、27.4(20.2～35.0)、(1.5±0.9)和(2.6±1.5),显著高于60例肝功能代偿组; CTP、MELD、MELD-ICG、CLD和mALBI评分预测的AUC分别为:0.708、0.787、0.827、0.735和0.723,其中MELD-ICG预测术后发生肝功能不全的AUC为0.827(95%CI:0.730～0.899),显著高于CTP或CLD或mALBI。结论 CTP、MELD、MELD-ICG、CLD和mALBI五种评分系统均是预测PLC患者TACE术后发生肝功能不全的有效工具,但以MELD-ICG评分的预测价值最佳。     

MELD-Na评估肝硬化食管胃底静脉曲张出血患者短期预后的价值

目的 评价Child-Pugh、终末期肝病模型(MELD)、及MELD-Na评分对肝硬化食管胃底静脉曲张出血患者短期再出血及预后的预测价值.方法 分别计算104例肝硬化食管胃底静脉曲张出血患者的Child-Pugh、MELD及MELD-Na 分值,并随访其再出血及死亡.运用ROC 曲线及曲线下面积(AUC)比较三种评分...     

血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值*

目的 研究应用血清前白蛋白（PA）水平联合终末期肝病模型（MELD）评分预测失代偿期乙型肝炎肝硬化患者预后的临床价值。方法 2015年12月~2016年12月我院治疗的失代偿期乙型肝炎肝硬化患者231例,随访6个月。常规检测血清PA水平、计算MELD评分和Child-Pugh评分（CTP评分）,在MELD评分的基础上,加入PA项目的 评分,建立MELD联合PA评分模型。应用受试者工作特征曲线（ROC）分析各指标对患者死亡的预测效能。结果 在随访的6个月里,死亡83例;死亡组血清PA水平为（32.2±9.3）mg/L,显著低于生存组的[（47.3±26.4） mg/L,P<0.05];死亡组MELD评分为（24.1±5.6）分,明显高于生存组的[（18.0±6.7）分,P<0.05];死亡组CTP评分为（11.8±1.2）分,明显高于生存组的[（9.0±2.0）分,P<0.05];ROC曲线分析结果显示,MELD评分预测死亡的ROC下面积（AUC）为0.868（95%CI：0.823~0.912）,显著高于CTP评分的[0.753（95%CI：0.690~0.816）,P<0.05]或血清PA的[0.675（95%CI：0.606~0.743）,P<0.05];进一步采用MELD联合PA评分分析的AUC为0.896（95%CI：0.857~0.935）,显著高于MELD评分（P<0.05）。结论 应用血清PA联合MELD评分对失代偿期乙型肝炎肝硬化患者6个月内死亡的预测效能显著高于MELD评分或CTP评分,其临床应用价值还需要扩大验证。     

三种评分方法预测肝硬化并食管静脉曲张破裂再出血风险的价值比较

目的 比较终末期肝病模型(MELD)、MELD-Na及Child-Pugh评分对失代偿期肝硬化并食管静脉曲张破裂出血患者3个月及1年内再出血风险的预测价值.方法 回顾性分析2003年1月至2008年10月收治的病历资料失代偿期肝硬化并食管静脉曲张破裂出血患者365例并随访1年.将患者分为低钠血症组与血钠正常组,记录每例患者入院第1天的MELD-Na、MELD、Child-Pugh评分,随访患者在3及12个月内的再出血情况,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),比较MELD-Na、MELD、Child-Pugh评分三者预测再出血风险的准确率,并应用正态Z检验对三者曲线下面积进行比较.结果 MELD-Na和MELD预测患者3个月内再出血风险的AUC分别为0.825和0.779,预测1年内再出血风险的AUC则分别为0.842和0.802,均高于Child-Pugh评分(0.678和0.634,P值均＜0.05),但MELD-Na和MELD间差异无统计学意义(P＞0.05).结论 MELD-Na及MELD均能预测失代偿期肝硬化并食管静脉曲张破裂出血患者再出血风险,且均优于Child-Pugh评分.MELD-Na弥补了MELD的部分不足.