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[目的]评估Blatchford,Rockall,MELD评分系统对肝硬化胃底食管静脉曲张患者预后的预测价值。[方法]选择2009年2月~2013年2月我院收治的肝硬化胃底食管静脉曲张出血患者146例,采用Blatchford,Rockall,MELD评分系统对患者进行评分和危险度分级,计算各个危险度患者的再出血率、病死率。采用ROC曲线下面积分析3种评分系统对患者6个月内死亡的预测价值。[结果]生存组和死亡组患者Blatchford评分差异均无统计学意义。而生存组患者Rockall和MELD评分均小于死亡组(P<0.05)。随着Blatchford,Rockall,MELD评分的增加,肝硬化胃底食管静脉曲张出血患者再出血率和病死率均逐渐增加。Blatchford评分低危组再出血比率高于其余2种评分系统,而Rockall评分高危组患者再出血比率显著高于其余2种评分组(P<0.05)。在病死率方面,Rockall高危组患者病死率高达94.1%,显著高于其余2种评分系统(P<0.05)。Blatchford,Rockall,MELD评分系统评价患者6个月内病死率的ROC曲线下面积分别为0.56、0.61、0.85(P<0.05)。[结论]Blatchford,Rockall,MELD评分系统可作为肝硬化胃底食管静脉曲张出血患者危险性和预后的评估指标,而MELD评分系统对患者死亡的预测价值优于其余2种评分系统。
[Objective] To evaluate the predictive value of Blatchford, Rockall, MELD scoring system in prognosis of patients with esophageal varices of liver cirrhosis. [Methods] One hundred and sixty-six patients with esophageal varices of liver cirrhosis who were admitted to our hospital from February 2009 to February 2013 were selected. The patients were scored and graded according to Blatchford, Rockall and MELD scoring system to calculate the risk Rebleeding rate of patients, fatality rate. The area under the ROC curve was used to analyze the predictive value of the three scoring systems for patients within 6 months of death. [Results] There was no significant difference in Blatchford score between survival group and death group. The Rockall and MELD scores in survival group were less than those in death group (P <0.05). With the increase of Blatchford, Rockall and MELD scores, the rebleeding rate and case fatality rate of patients with esophageal varices of liver cirrhosis increased gradually. Blatchford score was higher in the low-risk group than in the other two scoring systems, while the rate of rebleeding in the high-risk group of Rockall was significantly higher than that in the other two groups (P <0.05). In the case-fatality rate, the mortality rate of high-risk patients with Rockall was as high as 94.1%, significantly higher than the other two scoring systems (P <0.05). The area under the ROC curve of the 6-month mortality rates of Blatchford, Rockall and MELD scoring system were 0.56, 0.61 and 0.85 respectively (P <0.05). [Conclusion] The Blatchford, Rockall and MELD scoring system can be used as risk and prognostic indicators for patients with esophageal variceal bleeding due to liver cirrhosis. MELD scoring system is superior to the other two scoring systems in predicting patient mortality.