PALBI联合AMIS65评分系统用于肝硬化急性上消化道出血患者预后评估的价值分析

摘要/Abstract

摘要： 目的研究PALBI联合AMIS65评分系统用于肝硬化急性上消化道出血患者预后评估的临床价值。方法选择2017年9月至2021年3月期间无锡市第五人民医院收治的230例肝硬化合并急性上消化道出血患者。根据入院30 d内生存情况,分为生存组(n=201)和死亡组(n=29),采集和比较两组患者性别、年龄等流行病学资料和血常规、肝肾功能、凝血功能等血液学指标。比较两组患者PALBI评分和AMIS65评分,通过单因素分析和基于偏最大似然估计前进法logistic回归分析确定死亡的独立影响因素,应用ROC曲线评估PALBI和AMIS65评分单独和联合预测死亡的预测价值。结果死亡组患者凝血酶原时间(21.64 ± 2.97 vs 20.12 ± 2.68, t=2.816, P=0.005)、总胆红素(34.76 ± 2.78 vs 26.87 ± 3.02, t=13.277, P＜0.001)、国际标准化比值(1.55 ± 0.21 vs 1.33 ± 0.38, t=4.649, P＜0.001)、PALBI评分(-1.43 ± 0.31 vs -1.94 ± 0.26, t=9.629, P＜0.001)和AMIS65评分(3.45 ± 0.58 vs 2.09 ± 0.41, t=12.195, P＜0.001)明显高于生存组;死亡组患者白蛋白(27.54 ± 6.01 vs 31.98 ± 5.01, t=4.346, P＜0.001)、血小板计数(71.99 ± 18.23 vs 83.56 ± 24.25, t=1.829, P=0.049)和Child-Pugh分级 A比例(3.45% vs 33.83%, χ² = 26.117, P＜0.001)明显低于生存组。logistic回归分析显示,PALBI评分(OR=1.597, 95%CI: 1.597~2.449)和AMIS65评分(OR=2.162, 95%CI: 1.499~3.357)是肝硬化急性上消化道出血预后的独立影响因素,得到方程为logit(P)=-0.541+0.682XPALBI评分+0.771XAMIS65评分。ROC曲线结果显示,PALBI评分单独预测最佳临界值为-1.69分,对应的灵敏度为79.31%,特异度为80.60%,AUC为0.801(95%CI: 0.750~0.852);AMIS65评分单独预测临界值为2.73分,对应的灵敏度为65.52%,特异度为62.69%,AUC为0.760(95%CI: 0.707~0.812);回归联合检测最佳截断值对应的灵敏度、特异度和AUC分别为96.55%,95.52%和0.975(95%CI: 0.924~0.986),联合预测的灵敏度、特异度和AUC均显著高于PALBI评分和AMIS65评分单独预测(P<0.05),具有一定的预测价值。结论 PALBI评分和AMIS65评分是肝硬化急性上消化道出血预后的独立影响因素,且回归分析表明联合检测预测价值更高。

关键词: 血小板-白蛋白-胆红素评分, AMIS65评分, 肝硬化, 急性上消化道出血, 预后

Abstract: Objective To explore the prognostic value of PALBI combined with AMIS65 scoring system in cirrhotic patients with acute upper gastrointestinal bleeding.Methods A total of 230 patients with cirrhosis complicated with acute upper gastrointestinal bleeding admitted from September 2017 to March 2021 were selected. According to 30 days’ survival status after admission the patients were divided into a survival group (N=201) and a death group (N=29). Epidemiological data including age and sex, and laboratory examination Results including routine blood test, hepatic and renal function, and coagulation function were collected and compared, The scores of PALBI and AMIS65 on admission were calculated and compared between the two groups. Single factor analysis and logistic regression analysis based on partial maximum likelihood estimation were used to determine the independent influencing factors of prognosis, and the receiver operating characteristic (ROC) curve was used to evaluate the value of individual and combined detection in predicting death.Results Prothrombin time (21.64 ± 2.97 vs 20.12 ± 2.68, t=2.816, P=0.005), total bilirubin (34.76 ± 2.78 vs 26.87 ± 3.02, t=13.277, P<0.001), international standardized ratio (1.55 ± 0.21 vs 1.33 ± 0.38, t=4.649, P<0.001), PALBI score (-1.43 ± 0.31 vs -1.94 ± 0.26, t = 9.629, P<0.001) and AMIS65 scores (3.45 ± 0.58 vs 2.09 ± 0.41, t=12.195, P<0.001) in the death group were significantly higher than those of the survival group. Albumin (27.54 ± 6.01 vs 31.98 ± 5.01, t=4.346, P<0.001) and platelet count (71.99 ± 18.23 vs 83.56 ± 24.25,t=1.829, P=0.049) and Child-Pugh grade A ratio (3.45% vs 33.83%, χ² = 26.117, P<0.001) in the death group were significantly lower than those in the survival group. Logistic regression analysis showed that PALBI score (OR=1.597, 95%CI: 1.597~2.449) and AMIS65 score (OR=2.162, 95%CI: 1.499~3.357) were independent factors affecting the prognosis of acute upper digestive tract bleeding in cirrhosis, and the equation was logit (P)=-0.541+0.682XPALBI score +0.771XAMIS65 score. ROC curve analysis showed that PALBI score alone predicted the optimal critical value was -1.69 score, with a corresponding sensitivity of 79.31%, specificity of 80.60%, and AUC of 0.801 (95%CI: 0.750~0.852). The predictive optimal critical value of AMIS65 score alone was 2.73 score, with a corresponding sensitivity of 65.52%, specificity of 62.69%, and AUC of 0.760 (95%CI: 0.707~0.812). The sensitivity, specificity and AUC corresponding to the optimal truncation value of regression combined detection were 96.55%, 95.52% and 0.975 (95%CI: 0.924~0.986) respectively, and the sensitivity, specificity and AUC of combined prediction were significantly higher than those of PALBI score and AMIS65 score alone (P<0.05), which showed certain predictive value.Conclusion PALBI score and AMIS65 score were independent factors affecting the prognosis of acute upper digestive tract in cirrhosis, and regression analysis combined with detection had higher predictive value.

Key words: Platelet-albumin-bilirubin score, AMIS65 score, Liver cirrhosis, Acute upper gastrointestinal bleeding, Prognosis

董其刚, 许军. PALBI联合AMIS65评分系统用于肝硬化急性上消化道出血患者预后评估的价值分析[J]. 肝脏, 2022, 27(6): 662-667.

DONG Qi-gang, XU Jun. The prognostic value of PALBI in combination with AMIS65 scoring system in liver cirrhotic patients with acute upper gastrointestinal bleeding[J]. Chinese Hepatolgy, 2022, 27(6): 662-667.

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