Value of Multiple Scoring Systems in Evaluating the Prognosis of Liver Cirrhosis Complicated with Esophageal and Gastric Varices Bleeding
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摘要:
目的 比较AIMS65、GBS、MGBS、EGBS、CRS、CANUKA、Child-Turcotte-Pugh（CTP）、MELD、MELD-Na评分系统在肝硬化合并食管胃底静脉曲张破裂出血患者（esophagealgastricvariceal bleeding，EGVB）预后评估中的价值，探讨影响肝硬化合并EGVB患者预后不良的影响因素。 方法 对确诊为肝硬化合并EGVB的患者169例，根据患者是否发生院内再出血或死亡将患者分为预后良好组和预后不良组，计算出每名患者入院时的各模型评分，比较2组患者的临床特点。 结果 预后不良组35例，预后良好组134例，预后不良组的评分均高于预后良好组，AIMS65评分在预测患者是否预后不良时表现最优，且差异具有统计学意义（P < 0.05）。预后良好组患者HB、ALB较预后不良组高，PT、INR较预后不良组低，差异具有统计学意义（P < 0.05），经多因素Logistic回归分析提示ALB可能是肝硬化合并EGVB患者预后不良的独立保护因素。 结论 AIMS65是肝硬化合并食管胃底静脉曲张出血患者预后评估的最佳评分系统；ALB可能是肝硬化合并食管胃底静脉曲张出血患者预后不良的独立保护因素。 -
关键词:
- 肝硬化 /
- 食管胃底静脉曲张出血 /
- 评分系统
Abstract:Objective To compare the values of AIMS65, GBS, MGBS, EGBS, CRS, CANUKA, Child-Turcotte-Pugh （CTP）, MELD, and MELD-Na scoring systems in the evaluation of the prognosis of patients with liver cirrhosis and EGVB, and explore the factors affecting the poor prognosis of patients with liver cirrhosis and EGVB. Methods A total of 169 patients diagnosed with liver cirrhosis and EGVB were divided into a good prognosis group and a poor prognosis group according to whether the patients had rebleeding or death in the hospital. The scores of each model at the time of admission of each patient were calculated, and the clinical characteristics of the two groups of patients were compared. Results There were 35 cases in the poor prognosis group and 134 cases in the good prognosis group. The scores of the poor prognosis group were higher than those of the good prognosis group. The AIMS65 score was the best in predicting whether the patient had a poor prognosis, and the difference was statistically significant （P < 0.05）. The HB and ALB in the good prognosis group were higher than those in the poor prognosis group, and the PT and INR were lower than those in the poor prognosis group. The difference was statistically significant （P < 0.05）. Multivariate logistic regression analysis suggested that ALB may be an independent protection factor for poor prognosis in patients with liver cirrhosis and EDVB. Conclusion AIMS65 is the best scoring system for prognostic evaluation of patients with liver cirrhosis and esophageal varices bleeding; ALB may be an independent protective factor for the poor prognosis of patients with liver cirrhosis and esophageal and gastric varices bleeding. -
Key words:
- Hepatic cirrhosis /
- Esophageal gastric variceal bleeding /
- Scoring system
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图 1 各评分系统对肝硬化EGVB患者不良预后预测的ROC图
Figure 1. ROC diagram of each scoring system for predicting the poor prognosis of patients with liver cirrhosis and EGVB
表 1 预后不良患者与预后良好患者的一般情况对比[（
$\bar x \pm s $ ）/M（P25，P75）/n（%）]Table 1. Comparison of general conditions of patients with poor prognosis and patients with good prognosis [（
$\bar x \pm s $ ）/M（P25，P75）/n（%）]指标 预后不良组（n = 35） 预后良好组（n = 134） t/z P 年龄（岁） 52.00（47.00，63.00） 54.00（46.75，65.00） −0.116 0.907 性别（男/女） 21/14 87/47 0.292 0.589 心率（次/min） 91.26 ± 18.31 86.69 ± 15.67 1.480 0.141 收缩压（mmHg） 107.00（98.00，124.00） 111.00（101.00，124.25） −0.825 0.410 合并糖尿病 6（17.14） 18（13.43） 0.083 0.773 合并肿瘤 11（31.43） 26（19.40） 2.347 0.126 
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表 2 不良预后组与预后良好组各项指标单因素分析[（
$\bar x \pm s $ ）/M（P25，P75）]Table 2. Single factor analysis of various indicators in poor prognosis group and good prognosis group [（
$\bar x \pm s $ ）/M（P25，P75）]指标 预后不良组（n = 35） 预后良好组（n = 134） t/z P 血红蛋白（g/L） 74.57 ± 19.87 86.31 ± 25.40 −2.536 0.012* 白细胞（×109/L） 5.68（3.61，9.11） 4.78（3.18，7.05） −1.389 0.165 血小板（×109/L） 81.00（57.00，113.00） 80.00（59.75，119.50） −0.107 0.915 白蛋白（g/L） 25.28 ± 5.69 30.05 ± 5.85 −4.314 < 0.001* 总胆红素（μmol/L） 28.40（18.30，49.80） 24.95（16.58，35.43） −1.629 0.103 尿素（mmol/L） 8.58（5.30，11.82） 6.71（4.87，10.06） −1.847 0.065 肌酐（μmol/L） 68.00（56.00，88.00） 65.50（53.75，79.50） −0.990 0.322 PT（s） 18.10（15.80，21.70） 16.30（15.08，17.93） −3.135 0.002* INR 1.52（1.35，1.92） 1.33（1.21，1.49） −3.453 0.001* Na+（mmol/L） 137.20（135.50，139.20） 138.15（136.38，140.55） −1.618 0.106 ALT（U/L） 36.00（26.00，49.00） 36.50（27.00，51.00） −0.008 0.994 AST（U/L） 45.00（27.00，74.00） 43.00（27.75，65.00） −0.634 0.526 *P < 0.05。
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表 3 预后不良影响因素的二分类Logistic回归分析
Table 3. Binary logistic regression analysis of factors influencing poor prognosis
指标 B SE Wald df P OR OR的95%CI 下限 上限 Hb −0.004 0.010 0.135 1 0.713 0.996 0.978 1.015 ALB −0.116 0.047 6.221 1 0.013 0.890 0.813 .975 PT −0.721 0.662 1.187 1 0.276 0.486 0.133 1.779 INR×100 0.070 0.059 1.393 1 0.238 1.072 0.955 1.203
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表 4 预后不良组和预后良好组中九种评分系统的分值与对比[M（P25，P75）]
Table 4. Comparison of scores of nine scoring systems in the poor prognosis group and the good prognosis group [M（P25，P75）]
评分系统 预后不良组（n = 35） 预后良好组（n = 134） z P AIMS65 2.00（1.00，3.00） 1.00（0.00，2.00） −4.33 < 0.001* GBS 13.00（11.00，15.00） 10.50（8.00，13.00） −3.56 < 0.001* MGBS 10.00（7.00，11.00） 7.00（5.00，10.00） −2.67 0.008* EGBS 14.00（12.00，16.00） 11.00（9.00，14.00） −3.73 < 0.001* CRS 3.00（2.00，4.00） 1.50（0.00，3.00） −2.98 0.003* CANUKA 10.00（8.00，11.00） 8.00（7.00，10.00） −3.51 < 0.001* CTP 9.00（8.00，12.00） 8.00（7.00，9.00） −3.88 < 0.001* MELD 12.00（10.00，16.00） 10.00（8.00，13.00） −3.82 < 0.001* MELD-Na 12.07（11.00，17.75） 10.00（8.00，13.80） −3.83 < 0.001* *P < 0.05。
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表 5 各评分系统对肝硬化EGVB患者预后不良预测价值的对比
Table 5. Comparison of the predictive value of each scoring system for the poor prognosis of patients with liver cirrhosis and EGVB
评分 AUROC 95%CI AUROC差值 95%CI P AIMS65 0.728 0.654～0.793 参考 CTP 0.710 0.635～0.777 0.0181 −0.0634～0.0996 0.6630 MELD-Na 0.710 0.635～0.777 0.0179 −0.0683～0.104 0.6840 MELD 0.709 0.634～0.776 0.0190 −0.0701～0.108 0.6762 EGBS 0.704 0.629～0.772 0.0237 −0.0848～0.132 0.6689 GBS 0.695 0.619～0.763 0.0332 −0.0860～0.152 0.5854 CANUKA 0.691 0.615～0.760 0.0371 −0.0764～0.151 0.5219 CRS 0.661 0.584～0.732 0.0674 −0.0500～0.185 0.2604 MGBS 0.646 0.569～0.718 0.0820 −0.0393～0.203 0.1853
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表 6 各评分系统对肝硬化EGVB患者预后不良的预测价值及最佳阈值
Table 6. The predictive value and optimal threshold of each scoring system for poor prognosis of patients with liver cirrhosis and EDVB
评分 AUROC Youdenindex Cut-off SE 95%CI Sp 95%CI AIMS65 0.728 0.3226 > 1 62.86 44.9～78.5 69.40 60.9～77.1 CTP 0.710 0.2900 > 7 85.71 69.7～95.2 43.28 34.8～52.1 MELD-Na 0.710 0.3237 > 10 77.14 59.9～89.6 55.22 46.4～63.8 MELD 0.709 0.3188 > 10 71.43 53.7～85.4 60.45 51.6～68.8 EGBS 0.704 0.3610 > 11 77.14 59.9～89.6 58.96 50.1～67.4 GBS 0.695 0.2714 > 10 77.14 59.9～89.6 50.00 41.2～58.8 CANUKA 0.691 0.3399 > 8 74.29 56.7～87.5 59.70 50.9～68.1 CRS 0.661 0.2853 > 2 62.86 44.9～78.5 65.67 57.0～73.7 MGBS 0.646 0.2252 > 5 97.14 85.1～99.9 25.37 18.3～33.6
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