非靜脈曲張性上消化道出血預(yù)后的危險因素及四種評分系統(tǒng)的應(yīng)用研究
發(fā)布時間：2018-07-13 21:19
【摘要】：背景:上消化道出血是臨床常見的消化科急重癥,雖然藥物治療的不斷進步與內(nèi)鏡技術(shù)的不斷提高,其死亡率未見明顯下降。目前多種非靜脈曲張性上消化道出血(non-variceal upper gastrointestinal bleeding,NVUGIB)評分系統(tǒng)先后報道,對于各評分系統(tǒng)的預(yù)測價值,不同研究差異較大,對于指南推薦應(yīng)用的Full Rockall Score(FRS)和Glasgow-Blatchford Score(GBS)評分系統(tǒng),以及近年新建立的AIMS65評分系統(tǒng)和Progetto Nazionale Emorragia Digestiva(PNED)評分系統(tǒng)的對比,國內(nèi)研究較少。這些評分系統(tǒng)在中國人群NVUGIB患者中的臨床預(yù)測能力與應(yīng)用價值,以及不良結(jié)局的危險因素需要進一步研究。目的:1、分析NVUGIB患者的臨床特征,利用GBS、AIMS65、FRS和PNED評分系統(tǒng)對NVUGIB患者進行評估,研究不同評分系統(tǒng)對再出血、死亡和臨床干預(yù)的預(yù)測價值,尋找預(yù)測的最佳診斷界值;2、探討NVUGIB患者不同臨床結(jié)局下的危險因素,為進一步制定適用于我國NVUGIB患者的評分系統(tǒng)奠定基礎(chǔ)。方法:1、通過對天津醫(yī)科大學(xué)總醫(yī)院消化科2015年1月1日至2016年12月31日入院的394例非靜脈曲張性上消化道出血的患者進行回顧性分析,收集每位患者住院期間資料,分析其一般臨床特征。分別按照GBS、AIMS65、FRS和PNED評分系統(tǒng)對每位患者進行上消化道出血累計評分,繪制受試者工作特征曲線(receiver-operating characteristic curve,ROC曲線),計算ROC曲線下面積(the area under the receiver-operating characteristic curve,AUROC),評價不同評分系統(tǒng)對再出血、死亡、臨床干預(yù)的預(yù)測價值,并尋找最佳的診斷界值。2、采用logistic單因素與多因素回歸分析,進而探討與NVUGIB不同臨床結(jié)局相關(guān)的危險因素。結(jié)果:1、消化性潰瘍、惡性腫瘤、糜爛性病變是NVUGIB的主要病因,分別占60.6%、13.7%、11.2%,男女比例為3.2:1。NVUGIB平均住院天數(shù)9.6±5.1天,住院再出血發(fā)生率9.1%,死亡患者占4.1%,需要進行臨床干預(yù)治療的患者共189例,比例為48.0%,其中輸血41.3%,內(nèi)鏡下止血9.1%,外科治療6.6%,介入治療占3.3%。2、各評分系統(tǒng)死亡患者評分較存活患者高,再出血患者評分較非再出血患者評分高,臨床干預(yù)患者四種評分比非臨床干預(yù)者均高,差異均有統(tǒng)計學(xué)意義。3.、PNED評分系統(tǒng)對死亡預(yù)測AUROC為0.933,高于GBS、AIMS65和FRS評分系統(tǒng)(p0.05),AUROC分別為0.809、0.813、0.809,后三者對死亡的預(yù)測能力相當(dāng)。GBS和FRS對再出血具有預(yù)測價值,其AUROC分別為0.715和0.702,預(yù)測能力相當(dāng),均高于AIMS65(AUROC 0.597),AIMS65預(yù)測再出血能力欠佳。預(yù)測臨床干預(yù)治療方面,GBS、AIMS65、FRS評分系統(tǒng)三者的曲線下面積分別為0.656(95%CI,0.607-0.703;p0.001),0.613(95%CI,0.563-0.662;p0.001),0.620(95%CI,0.570-0.668;p0.001),無統(tǒng)計學(xué)差異。GBS對于再出血、死亡、臨床干預(yù)判斷的最佳界值7,9,7,PNED評分對死亡判斷的最佳界值為3,而AIMS65和FRS評分對再出血、死亡、臨床干預(yù)治療的最佳診斷界值為:AIMS65是1,0,0,FRS是4,5,3。4、血紅蛋白、白蛋白、PTINR、血尿素氮與再出血相關(guān),其獨立危險因素為PTINR、血紅蛋白和白蛋白。上消化道再出血、輸血、年齡超過65歲、血紅蛋白、白蛋白、PTINR、血尿素氮與NVUGIB死亡相關(guān),而預(yù)測死亡的獨立危險因素為PTINR和血尿素氮。年齡超過65歲、血紅蛋白、白蛋白、血尿素氮與臨床干預(yù)治療相關(guān),多因素回歸分析:血紅蛋白和白蛋白水平是NVUGIB臨床干預(yù)治療的獨立危險因素。結(jié)論:1、消化性潰瘍、惡性腫瘤、黏膜糜爛性病變?nèi)允欠庆o脈曲張性上消化道出血的主要原因。2、PNED是對NVUGIB死亡預(yù)測的有效評分系統(tǒng),臨床預(yù)測價值高于GBS、AIMS65和FRS;GBS、FRS評分系統(tǒng)對于預(yù)測再出血具有較好的預(yù)測價值,優(yōu)于AIMS65評分;但對于臨床干預(yù),GBS、AIMS65和FRS三種評分系統(tǒng)雖然具有一定的預(yù)測價值,但評分結(jié)果不佳,并非理想預(yù)測工具。3、PTINR、血紅蛋白和白蛋白是預(yù)測再出血的獨立危險因素。PTINR和血尿素氮是預(yù)測NVUGIB死亡的獨立危險因素。血紅蛋白和白蛋白是預(yù)測臨床干預(yù)治療的獨立危險因素。
[Abstract]:Background: hemorrhage in the upper digestive tract is a common severe acute severe disease in the Department of digestive department. Although the continuous improvement of drug treatment and the continuous improvement of endoscopy, the mortality rate has not decreased significantly. At present, various non variceal upper gastrointestinal bleeding (non-variceal upper gastrointestinal bleeding, NVUGIB) scoring system has been reported for each score. The value of the system is very different from the different research. For the recommended application of the Full Rockall Score (FRS) and Glasgow-Blatchford Score (GBS) scoring system, as well as the newly established AIMS65 scoring system and Progetto Nazionale Emorragia Digestiva score system in recent years, the domestic research is less. These scoring systems are in China. The clinical predictive and applied value of NVUGIB patients and the risk factors for adverse outcomes need further study. Objective: 1. Analyze the clinical features of NVUGIB patients and evaluate the NVUGIB patients by using GBS, AIMS65, FRS and PNED scoring systems to study the predictive value of different scoring systems for rebleeding, death and clinical intervention. To find the best diagnostic value of prediction; 2, to explore the risk factors of NVUGIB patients with different clinical outcomes, and to lay the foundation for further formulating the scoring system for NVUGIB patients in China. Methods: 1, 394 cases of non variceal upper gastrointestinal tract were admitted to the Department of digestive department of General Hospital Affiliated to Tianjin Medical University from January 1, 2015 to December 31, 2016. The patients with bleeding were analyzed retrospectively, collected the data of each patient and analyzed their general clinical features. The cumulative score of upper gastrointestinal bleeding was performed on each patient according to the GBS, AIMS65, FRS and PNED scoring system respectively, and the subjects' work characteristic curve (receiver-operating characteristic curve, ROC curve) was drawn and the ROC curve was calculated. The lower area (the area under the receiver-operating characteristic curve, AUROC) was used to evaluate the predictive value of different scoring systems for rebleeding, death, and clinical intervention, and to find the best diagnostic value.2, using logistic single factor and multivariate regression analysis to explore the risk factors associated with NVUGIB clinical outcomes. Results: 1, Peptic ulcer, malignant tumor and erosive disease were the main causes of NVUGIB, which accounted for 60.6%, 13.7%, 11.2% respectively. The ratio of male and female to 3.2:1.NVUGIB was 9.6 + 5.1 days, the incidence of rebleeding in hospital was 9.1%, and the mortality was 4.1%. There were 189 patients needing clinical intervention, with the proportion of 48%, 41.3% of blood transfusions and endoscopy hemostasis. 9.1%, surgical treatment 6.6%, intervention therapy accounted for 3.3%.2, the score system death patients score higher than the survival patients, rebleeding score higher than non rebleeding score, four types of clinical intervention patients were higher than non clinical intervention, the difference was statistically significant.3., the PNED score system to death prediction AUROC was 0.933, higher than GBS, AIMS65 And the FRS scoring system (P0.05), AUROC was 0.809,0.813,0.809, and the latter three had a predictive value for death by.GBS and FRS. The AUROC was 0.715 and 0.702, respectively. The predictive ability was equal to AIMS65 (AUROC 0.597), and AIMS65 predicted a poor rebleeding ability. The area under the curve of the three sub system were 0.656 (95%CI, 0.607-0.703; p0.001), 0.613 (95%CI, 0.563-0.662; p0.001), 0.620 (95%CI, 0.570-0.668; p0.001), and there was no statistical difference in.GBS for rebleeding, death, and clinical intervention, the best boundary value was 3. The best diagnostic value of blood, death, and clinical intervention is that AIMS65 is 1,0,0, FRS is 4,5,3.4, hemoglobin, albumin, PTINR, blood urea nitrogen is associated with rebleeding, and its independent risk factors are PTINR, hemoglobin and albumin. The upper digestive tract rebleeding, blood transfusion, more than 65 years old, hemoglobin, albumin, PTINR, blood urea nitrogen and NVUGIB death The independent risk factors for predicting death are PTINR and blood urea nitrogen. Age over 65 years old. Hemoglobin, albumin, blood urea nitrogen are associated with clinical intervention. Multivariate regression analysis: hemoglobin and albumin levels are independent risk factors for NVUGIB clinical intervention. Conclusion: 1, peptic ulcer, malignant tumor, mucous chyle. Rotten disease is still the main cause of non variceal upper gastrointestinal bleeding.2, PNED is an effective scoring system for predicting NVUGIB death, and the clinical predictive value is higher than GBS, AIMS65 and FRS; GBS, FRS scoring system has better predictive value for predicting rebleeding than AIMS65 score, but three comments on clinical intervention, GBS, AIMS65, and FRS. Although the sub-system has a certain predictive value, the score is not good, it is not an ideal predictor.3, PTINR, hemoglobin and albumin are independent risk factors for predicting rebleeding,.PTINR and blood urea nitrogen are independent risk factors for predicting NVUGIB death. Hemoglobin and white egg white are independent risk factors for predicting clinical intervention.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R573.2
本文編號：2120775
[Abstract]:Background: hemorrhage in the upper digestive tract is a common severe acute severe disease in the Department of digestive department. Although the continuous improvement of drug treatment and the continuous improvement of endoscopy, the mortality rate has not decreased significantly. At present, various non variceal upper gastrointestinal bleeding (non-variceal upper gastrointestinal bleeding, NVUGIB) scoring system has been reported for each score. The value of the system is very different from the different research. For the recommended application of the Full Rockall Score (FRS) and Glasgow-Blatchford Score (GBS) scoring system, as well as the newly established AIMS65 scoring system and Progetto Nazionale Emorragia Digestiva score system in recent years, the domestic research is less. These scoring systems are in China. The clinical predictive and applied value of NVUGIB patients and the risk factors for adverse outcomes need further study. Objective: 1. Analyze the clinical features of NVUGIB patients and evaluate the NVUGIB patients by using GBS, AIMS65, FRS and PNED scoring systems to study the predictive value of different scoring systems for rebleeding, death and clinical intervention. To find the best diagnostic value of prediction; 2, to explore the risk factors of NVUGIB patients with different clinical outcomes, and to lay the foundation for further formulating the scoring system for NVUGIB patients in China. Methods: 1, 394 cases of non variceal upper gastrointestinal tract were admitted to the Department of digestive department of General Hospital Affiliated to Tianjin Medical University from January 1, 2015 to December 31, 2016. The patients with bleeding were analyzed retrospectively, collected the data of each patient and analyzed their general clinical features. The cumulative score of upper gastrointestinal bleeding was performed on each patient according to the GBS, AIMS65, FRS and PNED scoring system respectively, and the subjects' work characteristic curve (receiver-operating characteristic curve, ROC curve) was drawn and the ROC curve was calculated. The lower area (the area under the receiver-operating characteristic curve, AUROC) was used to evaluate the predictive value of different scoring systems for rebleeding, death, and clinical intervention, and to find the best diagnostic value.2, using logistic single factor and multivariate regression analysis to explore the risk factors associated with NVUGIB clinical outcomes. Results: 1, Peptic ulcer, malignant tumor and erosive disease were the main causes of NVUGIB, which accounted for 60.6%, 13.7%, 11.2% respectively. The ratio of male and female to 3.2:1.NVUGIB was 9.6 + 5.1 days, the incidence of rebleeding in hospital was 9.1%, and the mortality was 4.1%. There were 189 patients needing clinical intervention, with the proportion of 48%, 41.3% of blood transfusions and endoscopy hemostasis. 9.1%, surgical treatment 6.6%, intervention therapy accounted for 3.3%.2, the score system death patients score higher than the survival patients, rebleeding score higher than non rebleeding score, four types of clinical intervention patients were higher than non clinical intervention, the difference was statistically significant.3., the PNED score system to death prediction AUROC was 0.933, higher than GBS, AIMS65 And the FRS scoring system (P0.05), AUROC was 0.809,0.813,0.809, and the latter three had a predictive value for death by.GBS and FRS. The AUROC was 0.715 and 0.702, respectively. The predictive ability was equal to AIMS65 (AUROC 0.597), and AIMS65 predicted a poor rebleeding ability. The area under the curve of the three sub system were 0.656 (95%CI, 0.607-0.703; p0.001), 0.613 (95%CI, 0.563-0.662; p0.001), 0.620 (95%CI, 0.570-0.668; p0.001), and there was no statistical difference in.GBS for rebleeding, death, and clinical intervention, the best boundary value was 3. The best diagnostic value of blood, death, and clinical intervention is that AIMS65 is 1,0,0, FRS is 4,5,3.4, hemoglobin, albumin, PTINR, blood urea nitrogen is associated with rebleeding, and its independent risk factors are PTINR, hemoglobin and albumin. The upper digestive tract rebleeding, blood transfusion, more than 65 years old, hemoglobin, albumin, PTINR, blood urea nitrogen and NVUGIB death The independent risk factors for predicting death are PTINR and blood urea nitrogen. Age over 65 years old. Hemoglobin, albumin, blood urea nitrogen are associated with clinical intervention. Multivariate regression analysis: hemoglobin and albumin levels are independent risk factors for NVUGIB clinical intervention. Conclusion: 1, peptic ulcer, malignant tumor, mucous chyle. Rotten disease is still the main cause of non variceal upper gastrointestinal bleeding.2, PNED is an effective scoring system for predicting NVUGIB death, and the clinical predictive value is higher than GBS, AIMS65 and FRS; GBS, FRS scoring system has better predictive value for predicting rebleeding than AIMS65 score, but three comments on clinical intervention, GBS, AIMS65, and FRS. Although the sub-system has a certain predictive value, the score is not good, it is not an ideal predictor.3, PTINR, hemoglobin and albumin are independent risk factors for predicting rebleeding,.PTINR and blood urea nitrogen are independent risk factors for predicting NVUGIB death. Hemoglobin and white egg white are independent risk factors for predicting clinical intervention.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R573.2
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相關(guān)期刊論文 前4條
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