临床肝胆病杂志2017，Vol.33Issue(10)：1939-1943,5.DOI:10.3969/j.issn.1001-5256.2017.10.018
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
Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding
摘要
Abstract
Objective To 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.Methods A 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.Results There 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 (x2 =4.559,P =0.033),hepatic encephalopathy (x2 =25.568,P ＜ 0.01),melena (x2 =0.842,P =0.04),and heart failure (P =0.003),pulse rate (Z =-2.943,P =0.003),CTP classification (x2 =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 (x2 =9.374,P =0.002),liver cancer with vascular invasion or metastasis (x2 =14.766,P ＜ 0.01),and hepatic encephalopathy (x2 =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 (x2 =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).Conclusion GBS 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.关键词
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分类
医药卫生引用本文复制引用
崔舒,王芳,吕洪敏,王凤梅..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):1939-1943,5.基金项目
天津市卫计委科技基金项目(2014KY03) （2014KY03）
天津市卫计委科技基金攻关项目(16KG151) （16KG151）
天津市卫计委科技基金项目(2010KZ123) （2010KZ123）
