Child-Pugh评分、MELD评分、MELD-Na评分、APASAL评分和R评分对肝硬化伴食管胃静脉曲张再出血及死亡的预测价值

马佳丽; 陈旭; 何玲玲; 魏红山; 李坪

doi:10.3969/j.issn.1001-5256.2020.06.018

Child-Pugh评分、MELD评分、MELD-Na评分、APASAL评分和R评分对肝硬化伴食管胃静脉曲张再出血及死亡的预测价值

DOI: 10.3969/j.issn.1001-5256.2020.06.018

首都医科大学附属北京地坛医院消化内科

基金项目:

首都医科大学附属北京地坛医院青年人才发展基金“萌芽”支持计划项目(DTMY201807)；首都临床特色应用研究(Z181100001718084)；北京市医院管理中心消化内科学科协同发展中心专项(XXZ04)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 1901
- HTML全文浏览量: 89
- PDF下载量: 273
- 被引次数: 34
出版历程
- 出版日期: 2020-06-20

Value of Child-Pugh score,Model for End-Stage Liver Disease score,MELD combined with serum sodium concentration,APASAL score,and R-score in predicting rebleeding and death in cirrhotic patients with esophagogastric variceal bleeding

Research funding:

摘要

摘要:
目的验证Child-Pugh评分、MELD评分、MELD-Na评分、APASAL评分和R评分5种风险评分系统对肝硬化伴食管胃静脉曲张出血患者再出血及死亡的诊断价值。方法选取2013年1月-2016年1月因肝硬化伴食管胃静脉曲张破裂出血于首都医科大学附属北京地坛医院行内镜下治疗,并为出血首次行内镜治疗且随访时间超过3年的患者。观察指标包括年龄、性别、体质量、血压、血常规、肝肾功能、凝血、腹部超声等影像学指标及肝性脑病、腹水、感染等并发症发生情况。以静脉曲张再出血为主要研究终点,以死亡为次要研究终点。计量资料两组间比较采用t检验或Wilcoxon秩和检验;计数资料两组间比较采用χ2检验。相关性分析采用Spearman相关分析。采用受试者工作特征曲线（ROC曲线）评价5种风险评分系统对患者再出血及死亡的诊断价值。结果共纳入305例患者,其中53例（17. 38%）患者在随访过程中出现了静脉曲张再出血。再出血组与无再出血组患者比较,年龄、ALT、DBil、国际化标准比值、门静脉内径、MELD评分、MELD-Na评分及R评分差异均有统计学意义（P值均<0. 05）。相...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 出血 /
- 死亡
Abstract:
Objective To investigate the value of Child-Pugh score,Model for End-Stage Liver Disease( MELD) score,MELD combined with serum sodium concentration( MELD-Na score),APASAL score,and R-score in predicting rebleeding and death in cirrhotic patients with esophagogastric variceal bleeding. Methods The patients with liver cirrhosis and gastroesophageal variceal bleeding who underwent endoscopic therapy for bleeding for the first time in Beijing Ditan Hospital,Capital Medical University,from January 2013 to January 2016 and were followed up for more than 3 years were enrolled. Observation indices included age,sex,body weight,blood pressure,routine blood test results,hepatic and renal function,coagulation,radiological examination( including abdominal ultrasound),and complications( including hepatic encephalopathy,ascites,and infection). Variceal rebleeding was the primary endpoint,and death was the secondary endpoint. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed,and the receiver operating characteristic( ROC) curve was used to investigate the value of these five risk scoring systems in the diagnosis of rebleeding and death. Results A total of 305 patients were enrolled,among whom 53( 17. 38%) experienced variceal rebleeding during follow-up. There were significant differences between the rebleeding group and the non-rebleeding group in age,alanine aminotransferase,direct bilirubin,international normalized ratio,diameter of the portal vein,MELD score,MELD-Na score,and R-score( all P < 0. 05). The correlation analysis showed a significant correlation between any two scores except between APASAL score and MELD score/R-score and between MELD-Na score and R-score( all P < 0. 05). The ROC curve analysis showed that MELD score,MELD-Na score,and R-score had a certain value in predicting rebleeding,with an area under the ROC curve( AUC) of 0. 645( 95% confidence interval [CI]: 0. 563-0. 727,P = 0. 001),0. 637( 95% CI: 0. 552-0. 723,P = 0. 002),and 0. 647( 95% CI: 0. 565-0. 729,P = 0. 001),respectively,and Child-Pugh score had a certain diagnostic value for death,with an AUC of 0. 610( 95% CI: 0. 541-0. 680,P = 0. 002). Conclusion Child-Pugh score,MELD score,MELD-Na score,APASAL score,and R-score have a limited value in predicting variceal rebleeding,and only Child-Pugh score has a certain diagnostic value for death.
- liver cirrhosis /
- esophageal and gastric varices /
- hemorrhage /
- death

HTML全文

参考文献(29)

[1] KRIGE JE,SHAW JM,BORNMAN PC. The evolving role of endoscopic treatment for bleeding esophageal varices[J].World J Surg,2005,29(8):966-973.

[2] D'AMICO G,PASTA L,MORABITO A,et al. Competing risks and prognostic stages of cirrhosis:A 25-year inception cohort study of 494 patients[J]. Aliment Pharmacol Ther,2014,39(10):1180-1193.

[3] MERLI M,NICOLINI G,ANGELONI S,et al. Incidence and natural history of small esophageal varices in cirrhotic patients[J]. J Hepatol,2003,38(3):266-272.

[4] North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study[J]. N Engl J Med,1988,319(15):983-989.

[5] HAQ I,TRIPATHI D. Recent advances in the management of variceal bleeding[J]. Gastroenterol Rep(Oxf),2017,5(2):113-126.

[6] KIM YD. Management of acute variceal bleeding[J]. Clin Endosc,2014,47(4):308-314.

[7] IBRAHIM M,MOSTAFA I,DEVIRE J. New developments in managing variceal bleeding[J]. Gastroenterology,2018,154(7):1964-1969.

[8] BOSCH J,GARCA-PAGN JC. Prevention of variceal rebleeding[J]. Lancet,2003,361(9361):952-954.

[9] TSOCHATZIS EA,BOSCH J,BURROUGHS AK. Liver cirrhosis[J]. Lancet,2014,383(9930):1749-1761.

[10] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Endoscopy,Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会内镜学分会．肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]．临床肝胆病杂志，2016,32(2):203-219.

[11] MALINCHOC M,KAMATH PS,GORDON FD,et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology,2000,31(4):864-871.

[12] CHEN WT,LIN CY,SHEEN IS,et al. MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding[J]. World J Gastroenterol,2011,17(16):2120-2125.

[13] WANG J,WANG AJ,LI BM,et al. MELD-Na:Effective in predicting rebleeding in cirrhosis after cessation of esophageal variceal hemorrhage by endoscopic therapy[J]. J Clin Gastroenterol,2014,48(10):870-877.

[14] ORLOFF MJ,VAIDA F,ISENBERG JI,et al. Child-Turcotte score versus MELD for prognosis in a randomized controlled trial of emergency treatment of bleeding esophageal varices in cirrhosis[J]. J Surg Res,2012,178(1):139-146.

[15] ROCKALL TA,LOGAN RF,DEVLIN HB,et al. Risk assessment after acute upper gastrointestinal haemorrhage[J]. Gut,1996,38(3):316-321.

[16] SRIRAJASKANTHAN R,CONN R,BULWER C,et al. The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhage[J]. Int J Clin Pract,2010,64(7):868-874.

[17] CHENG DW,LU YW,TELLER T,et al. A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed:A prospective comparison of scoring systems[J]. Aliment Pharmacol Ther,2012,36(8):782-789.

[18] Digestive Endoscopy Group of Endoscopists Committee of Chinese Medical Doctor Association. Guidenlines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding(2018,Hangzhou)[J]. Natl Med J China,2019,99(8):571-578.(in Chinese)中国医师协会内镜医师分会消化内镜专业委员会．急性非静脉曲张性上消化道出血诊治指南(2018年，杭州)[J]．中华医学杂志，2019,99(8):571-578.

[19] SARIN SK,KUMAR A,ANGUS PW,et al. Diagnosis and management of acute variceal bleeding:Asian Pacific Association for Study of the Liver recommendations[J]. Hepatol Int,2011,5(2):607-624.

[20] GRAHAM DY,SMITH JL. The course of patients after variceal hemorrhage[J]. Gastroenterology,1981,80(4):800-809.

[21] JAIRATH V,REHAL S,LOGAN R,et al. Acute variceal haemorrhage in the United Kingdom:Patient characteristics,management and outcomes in a nationwide audit[J]. Dig Liver Dis,2014,46(5):419-426.

[22] HE L,LI P,JIANG Y,et al. A new algorithm for predicting long-term survival in chronic hepatitis B patients with variceal bleeding after endoscopic therapy[J]. Dig Liver Dis,2019,51(8):1166-1171.

[23] BELL H,JAHNSEN J,KITTANG E,et al. Long-term prognosis of patients with alcoholic liver cirrhosis:A 15-year followup study of 100 Norwegian patients admitted to one unit[J].Scand J Gastroenterol,2004,39(9):858-863.

[24] JEPSEN P,OTT P,ANDERSEN PK,et al. Clinical course of alcoholic liver cirrhosis:A Danish population-based cohort study[J]. Hepatology,2010,51(5):1675-1682.

[25] PARK DK,UM SH,LEE JW,et al. Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices[J]. J Gastroenterol Hepatol,2004,19(9):1042-1051.

[26] CHO H,NAGATA N,SHIMBO T,et al. Recurrence and prognosis of patients emergently hospitalized for acute esophageal variceal bleeding:A long-term cohort study[J]. Hepatol Res,2016,46(13):1338-1346.

[27] GARCIA-TSAO G,ABRALDES JG,BERZIGOTTI A,et al.Portal hypertensive bleeding in cirrhosis:Risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.

[28] HOLSTER IL,TJWA ET,MOELKER A,et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+β-blocker for prevention of variceal rebleeding[J].Hepatology,2016,63(2):581-589.

[29] AMITRANO L,GUARDASCIONE MA,BENNATO R,et al.MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices[J]. J Hepatol,2005,42(6):820-825.

施引文献

期刊类型引用(25)

1.	陈炜. 终末期肝病模型联合血清钠评分对肝衰竭患者短期预后的预测价值. 川北医学院学报. 2024(02): 247-251 . 百度学术
2.	王学英. MELD-Na评分联合NLR预测肝硬化食管胃静脉曲张破裂出血后再出血的临床价值. 罕少疾病杂志. 2024(05): 70-72 . 百度学术
3.	林小洪，吴文楠，荀振. 血小板-白蛋白-胆红素评分与肝硬化患者肝功能Child-Turcotte-Pugh分级的相关性分析. 福建医科大学学报. 2024(01): 37-43 . 百度学术
4.	孙玉，秦维，王丹，郑艳丽，霍玉玲. 前白蛋白及纤维蛋白原水平与代偿期肝硬化食管静脉曲张发生的关系. 中国肝脏病杂志(电子版). 2024(02): 7-12 . 百度学术
5.	石红. 延续性护理服务方案对肝硬化食管胃静脉曲张内镜下精准断流术后的临床影响研究. 基层医学论坛. 2024(20): 114-116+142 . 百度学术
6.	李欣忆，李娇娇，孙蔚. 肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后发生显性肝性脑病的列线图预测模型建立及评价. 临床肝胆病杂志. 2024(08): 1605-1611 . 本站查看
7.	杨丹，周健. 多种无创预测模型在肝硬化门静脉高压中的研究进展. 中国临床研究. 2024(11): 1778-1783 . 百度学术
8.	陈刚，谷光丽，何映雪，唐尧. 血清表皮生长因子对肝硬化食管胃静脉曲张患者再出血的诊断价值分析. 转化医学杂志. 2024(10): 1698-1702 . 百度学术
9.	喻雪珂，黎孟玲，彭思远，申月明，梁纶熙，曾亚. 食管胃底静脉曲张破裂出血对肝硬化患者1年死亡结局的影响及相关因素研究. 中国全科医学. 2023(14): 1745-1752 . 百度学术
10.	郝艳萍，韩靓，仇晶辉，滕圣智，王建华. 乙肝肝硬化食管胃静脉曲张急性出血患者内镜下治疗后发生菌血症的危险因素分析. 中国消毒学杂志. 2023(03): 182-184 . 百度学术
11.	顾达，童聪，赵祥安，向晓星. PC/SD、FIB-4指数、CTP评分、MELD评分、MELD-Na评分在预测肝硬化食管静脉曲张出血套扎术后1年内再出血的价值评估. 胃肠病学和肝病学杂志. 2023(03): 289-294 . 百度学术
12.	朱会明，张华，张金荣，吴雪华，吴柳，刘义安. 肝硬化血瘀证患者食管胃底静脉曲张相关性研究. 中国中医急症. 2023(04): 665-668 . 百度学术
13.	周苏云，周影，程新月. 肝硬化患者发生肝性脑病的影响因素分析及对预检分诊意义的探讨. 中西医结合护理(中英文). 2023(03): 130-132 . 百度学术
14.	葛琴. 血府逐瘀汤联合双歧杆菌三联活菌治疗酒精性肝硬化的疗效研究. 中医临床研究. 2023(20): 142-145 . 百度学术
15.	邱荣金，卢劲瑜，苏雪梅，郑凤祥，廖丽芳. 预防使用抗生素对食管胃静脉曲张内镜下治疗的影响评估. 中国现代药物应用. 2023(19): 99-101 . 百度学术
16.	邢恩涛，赵孟杰，金鹏飞，武振东，刘志春. 肝硬化门静脉高压TIPS术后HVPG下降相关因素. 青岛大学学报(医学版). 2023(05): 759-762 . 百度学术
17.	刘媛，徐建光，何雪云，万秀萍，林小花，王莉娟，郑临海. 血钙浓度联合MELD评分对肝硬化严重程度的预测价值. 浙江中西医结合杂志. 2022(02): 129-130+149 . 百度学术
18.	张春燕，田正方，朱经科，晁燕茹. 肝硬化患者食管静脉曲张套扎术后再出血影响因素分析及干预对策. 黑龙江医药科学. 2022(02): 96-99 . 百度学术
19.	俞斌，屠军，沈玉玲. AIMS65评分预测肝硬化食管胃底静脉曲张破裂出血患者死亡的价值. 胃肠病学和肝病学杂志. 2022(07): 737-742 . 百度学术
20.	刘益，周自忠，刘刚，徐海荣. 食管胃底静脉曲张破裂出血患者急诊TIPS术后肝性脑病发生特征及危险因素分析. 肝脏. 2022(06): 658-661 . 百度学术
21.	廖翔. 肝硬化患者SAAG与食管胃底静脉曲张破裂出血的关系研究. 现代诊断与治疗. 2022(11): 1646-1648+1692 . 百度学术
22.	张春燕，田正方，朱经科，晁燕茹. 肝硬化患者食管静脉曲张套扎术后再出血影响因素分析. 黑龙江医药科学. 2022(05): 171-173 . 百度学术
23.	曾伍姣，张知洪，陈令民，李亦明. 血管紧张素Ⅱ水平在肝硬化患者诊断中的应用及与MELD评分关系研究. 肝胆外科杂志. 2021(01): 60-63 . 百度学术
24.	祝强，杨继敏，刘中亮. 八种评分系统对肝硬化失代偿期患者短期预后的预测价值. 中国医药科学. 2021(19): 18-22 . 百度学术
25.	赵媛，赵明，范玉梅，邵建营. 失代偿期乙型肝炎肝硬化患者不同病毒学应答状态对生存率及肝癌患病率的影响. 中国实用医刊. 2020(23): 50-52 . 百度学术