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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
score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding
文章发布日期:2017年09月07日  来源:  作者:崔舒, 王芳, 吕洪敏, 等  点击次数:261次  下载次数:42次

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【摘要】: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χ2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(χ2=4.559,P=0033)、肝性脑病(χ2=25.568,P<0.01)、黑便(χ2=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(χ2=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(χ2=9.374,P=0.002)、肝癌伴血管侵犯或转移(χ2=14.766,P<0.01)、肝性脑病发生率(χ2=16.327,P<0.01),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,P<0.01)水平,以及CTP分级(χ2=25.851,P<0.01)、CTP评分(Z=-3.591,P<0.01)、MELD评分(t=-4.121,P<001)、GBS评分(Z=-3.54,P<0.01)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。
【Abstract】:ObjectiveTo investigate the value of Glasgow-Blatchford score (GBS), Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score in predicting the 1- and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis. MethodsA retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31, 2014. According to the endpoint of death at 6 weeks after admission, the patients were divided into 1-week death group (10 patients), 6-week death group (23 patients), and survival group (179 patients). The Glasgow-Blatchford score, MELD score, CTP score, and CTP score and classification were calculated on admission, and these scores were compared between the three groups. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher′s exact test was used for comparison of categorical data between groups. The Z test was used for comparison of the area under the receiver operating characteristic curve (AUC) of these three scoring systems. ResultsThere were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis (χ2=4.559, P=0.033), hepatic encephalopathy (χ2=25.568, P<0.01), melena (χ2=0.842, P=0.04), and heart failure (P=0.003), pulse rate (Z=-2.943, P=0.003), CTP classification (χ2=12.22, P=0.002), CTP score (Z=-2.505, P=0.012), MELD score (t=-2.395, P=0.018), and GBS score (Z=-2545, P=0.011). There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer (χ2=9.374, P=0.002), liver cancer with vascular invasion or metastasis (χ2=14.766, P<0.01), and hepatic encephalopathy (χ2=16.327, P<0.01), albumin (Z=-2.770, P=0.006), bilirubin (Z=-3.191, P=0.001), hemoglobin (Z=-2.484, P=0.013), blood urea nitrogen (Z=-2.407, P=0.016), international normalized ratio (Z=-2.304, P=0.021), systolic pressure (t=2.69, P=0.008), pulse rate (Z=-3.507, P<0.01), CTP classification (χ2=25.851, P<0.01), CTP score (Z=-3.591, P<0.01), MELD score (t=-4.121, P<0.01), and GBS score (Z=-3.54, P<0.01). GBS score (AUC=0.738, 95% confidence interval [CI]: 0.67-0.80) was superior to MELD score (AUC=0.731, 95%CI: 0.66-0.79) and CTP score (AUC=0.728, 95% CI: 066-0.79) in predicting the risk of death at 1 week. MELD score (AUC=0.761, 95%CI: 0.70-0.89) was superior to CTP score (AUC=0.748, 95%CI: 0.69-0.81) and MELD score (AUC=0.726, 95%CI: 0.66-0.79) in predicting the risk of death at 6 weeks. There was a significant difference in the AUC for predicting the death rate at 1 week between GBS score and CTP score (Z=0.079, P=0037), while there was no significant difference in the AUC for predicting the death rate at 6 weeks between the three scoring systems (P>0.05). ConclusionGBS score is superior to MELD score and CTP score in predicting the risk of death at 1 week in cirrhotic patients with esophagogastric variceal bleeding, and MELD and CTP scores are superior to GBS score in predicting the risk of death at 6 weeks.
【关键字】:Glasgow-Blatchford评分; 肝硬化; 食管和胃静脉曲张; 预后
【Key words】:Glasgow-Blatchford score; liver cirrhosis; esophageal and gastric varices; prognosis
【引证本文】:崔舒, 王芳, 吕洪敏, 等. 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[J]. 临床肝胆病杂志, 2017, 33(10): 1939-1943.

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