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

崔舒; 王芳; 吕洪敏; 王凤梅

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

DOI: 10.3969/j.issn.1001-5256.2017.10.018

天津医科大学三中心临床学院天津市第三中心医院肝病科天津市人工细胞重点实验室天津市肝胆疾病研究所

基金项目:

天津市卫计委科技基金项目(2014KY03);天津市卫计委科技基金攻关项目(16KG151);天津市卫计委科技基金项目(2010KZ123)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2017-04-24
- 出版日期: 2017-10-20

Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding

The Third Central Clinical College of Tianjin Medical University, Department of Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease

Research funding:

摘要

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）、...
- Glasgow-Blatchford评分 /
- 肝硬化 /
- 食管和胃静脉曲张 /
- 预后
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 ( 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) . 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.
- Glasgow-Blatchford score /
- liver cirrhosis /
- esophageal and gastric varices /
- prognosis

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参考文献(14)

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