关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 天冬氨酸氨基转移酶/血小板比值指数, 白蛋白-胆红素评分, AIMS65, 评估价值

Abstract: Objective To investigate the value of a combination of aspartate aminotransferase/platelet ratio index (APRI), albumin-bilirubin score (ALBI) and AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score for evaluating the severity and prognosis of esophageal-gastric variceal hemorrhage (EGVB) in cirrhosis.Methods A total of 120 liver cirrhotic patients with EGVB admitted from July 2020 to September 2022 were included in the observation group. Sixty patients with liver cirrhosis with esophageal and gastric fundus varices without bleeding were included in the control group. Patients in the observation group were divided into mild (n=20), moderate (n=42) and severe (n=58) subgroups according to the degrees of esophageal and gastric varices (EGV) under endoscopy; or with (n=74) and without (n=46) clinical adverse event subgroups according to the prognostic manifestation of EGV before hospitalization. The scores of APRI, ALBI and AIMS65 were compared among all groups. The correlations between APRI, ALBI and AIMS65 scores and liver stiffness (LSM), and Child-Pugh classification of liver function and Acute Physiological and Chronic Health Status Scoring System Ⅱ (APACHEⅡ) scores were analyzed by Pearson. Receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of combined APRI, ALBI and AIMS65 scores in evaluating the prognosis of EGVB in cirrhosis.Results The APRI, ALBI and AIMS65 scores of the observation group were 3.25±0.68, -1.80±0.46 and 3.16±0.57 points, which were higher than those of the control group (2.14±0.51, -2.79±0.54 and 2.39±0.48 points), with statistically significant differences (t=9.037, 10.459, 8.253, all P<0.05). The scores of APRI, ALBI and AIMS65 in the moderate and severe variceal subgroup were 3.52±0.78, -1.32±0.40 and 3.27±0.64 points, which were higher than those in the moderate subgroup (2.47±0.59, -1.98±0.53 and 2.64±0.52 points), and 1.83±0.46, -3.16±0.65 and 2.23±0.46 points in mild subgroup showed a decreasing trend, and the difference was statistically significant (F=18.792, 16.265, 14.537, all P<0.05). The scores of APRI, ALBI and AIMS65 in the with clinical adverse event subgroup were 3.78±0.83, -1.27±0.31 and 3.57±0.65, which were higher than those in the without clinical adverse event subgroup (2.69±0.64, -1.81±0.37 and 2.38±0.50). The difference was statistically significant (t=8.436, 9.035, 8.725, all P<0.05). Pearson analysis showed that the APRI, ALBI and AIMS65 scores of EGVB patients with cirrhosis were positively correlated with LSM, Child-Pugh grade and APACHEⅡ score (P<0.01). The ROC curve showed that the area under curve (AUC), sensitivity and specificity of a combination of APRI, ALBI and AIMS65 scores for evaluating the prognosis of EGVB patients with cirrhosis were higher than that of any individual score (P<0.01).Conclusion APRI, ALBI and AIMS65 scores have value in evaluating the severity and prognosis of EGVB in patients with cirrhosis, and a combined detection has better efficacy.

Key words: Liver cirrhosis, esophageal-gastric variceal hemorrhage, APRI, ALBI, AIMS65, Value of appraisal