Glasgow-Blatchford和AIMS65评分系统在急性消化道出血患者预后评估中的价值

Prognostic value of GBS and AIMS65 score to acute gastrointestinal bleeding

摘要:

目的 探讨Glasgow-Blatchford（GBS）和AIMS65评分对急诊内镜检查的消化道出血患者的预后价值。方法 选取2009年1月-2011年1月在该院需行急诊消化道内镜检查的急性消化道出血患者作为研究对象，对其临床资料进行回顾性分析。结果 180例符合条件的患者进行了220例次内镜检查（121例食管胃十二指肠镜检查，99例结肠镜检查）。随访期间，46例（25.56%）患者出现再出血。86例患者（47.78%）为低危GBS评分（分数≤11），94例患者（52.22%）为高危GBS评分（分数≥12）。高危组与低危组患者再出血频率差异无统计学意义，而高危组死亡率（29.79%）明显高于低危组（10.47%，P <0.001）。单独研究下消化道出血组时，高危组死亡率（26.93%）仍高于低危组（6.01%，P <0.05）。94例患者（52.22%）为高危AIMS65评分（0分或1分），86例患者（47.78%）为低危AIMS65评分（≥3分）。高危组与低危组患者再出血频率差异无统计学意义，而高危组死亡率（32.98%）明显高于低危组（6.98%，P <0.001）。单独研究下消化道出血组时，高危组死亡率（28.12%）仍高于低危组（5.93%，P <0.05）。Cox多变量分析显示输血、并存肿瘤、未使用内镜止血和高AIMS65评分是低生存率的独立预后因素。结论 GBS和AIMS65两种评分中，AIMS65评分是急性胃肠道出血患者有效的预后因子。

Abstract:

Objective To evaluate the prognostic value of Glasgow-Blatchford score and AIMS65 score to acute gastrointestinal bleeding. Methods The medical records of patients who had underwent emergency gastrointestinal endoscopy for suspected gastrointestinal bleeding from January 2009 to January 2011 were retrospectively analyzed. Results 220 endoscopies (121 esophagogastroduodenoscopies, 99 colonoscopies) for 180 patients met the inclusion criteria. During the follow-up, 46 patients (25.56%) experienced rebleeding, 86 patients (47.78%) were low risk (GBS score less than or equal to 11), 94 patients (52.22%) were high-risk GBS (score = 12). There was no significant difference in the frequency of rebleeding between the high risk group and the low risk group, while the mortality rate in the high risk group (29.79%) was significantly higher than that in the low risk group (10.47%, P < 0.001), The mortality of lower digestive tract hemorrhage group in the high risk group (26.93%) was still higher than that in the low risk group (6.01%, P < 0.05). 94 patients (52.22%) were high-risk AIMS65 (0 or 1), 86 patients (47.78%) were low-risk AIMS65 (more than 3). There was no significant difference in the frequency of rebleeding between the high risk group and the low risk group, while the mortality rate in the high risk group (32.98%) was significantly higher than that in the low risk group (6.98%, P < 0.001), The mortality in the high risk group (28.12%) was higher than that in the low risk group (5.93%; P < 0.05) in lower digestive tract hemorrhage group. Cox multivariate analysis revealed blood transfusion, co-existing malignancy, absence of endoscopic hemostasis, and high AIMS65 score to be independent prognostic factors for poor OS. Conclusion The AIMS65 score is useful for predicting the prognosis of patients with acute gastrointestinal bleeding.