AIMS65评分联合血清GAS、PGE2、BAR对急性非静脉曲张性上消化道出血患者预后的评估价值

摘要 目的：探讨AIMS65评分联合血清胃泌素（GAS）、前列腺素E₂（PGE₂）、血尿素氮/白蛋白比值（BAR）对急性非静脉曲张性上消化道出血（ANVUGIB）患者内镜下止血治疗后预后的评估价值。方法：选取2020年5月～2022年5月北京市和平里医院消化内科收治的108例的ANVUGIB患者，根据患者住院28 d内的预后分为预后不良组和预后良好组。收集患者临床资料，检测血清GAS、PGE₂水平和计算AIMS65评分、BAR。采用单因素和多因素Logistic回归分析ANVUGIB患者内镜下止血治疗后预后不良的影响因素，受试者工作特征（ROC）曲线分析AIMS65评分、GAS、PGE₂和BAR对ANVUGIB患者内镜下止血治疗后预后不良的评估价值。结果：108例ANVUGIB患者预后不良发生率为37.96％（41/108）。单因素分析显示，预后不良组年龄大于预后良好组，心率、休克指数、AIMS65评分、GAS、BAR高于预后良好组，PGE₂水平低于预后良好组（P均＜0.05）。多因素Logistic回归分析显示，年龄增加和休克指数、AIMS65评分、GAS、BAR升高为ANVUGIB患者内镜下止血治疗后预后不良的独立危险因素，PGE₂升高为其独立保护因素（P均＜0.05）。ROC曲线分析显示，AIMS65评分联合GAS、PGE₂和BAR评估ANVUGIB患者内镜下止血治疗后预后不良的曲线下面积大于AIMS65评分、GAS、PGE₂和BAR单独评估。结论：预后不良的ANVUGIB患者AIMS65评分、GAS、BAR均高于预后良好的患者，AIMS65评分联合GAS、PGE₂和BAR评估ANVUGIB患者内镜下止血治疗后预后的价值较高。

Prognostic Value of AIMS65 Score Combined with Serum GAS, PGE2 and BAR in Patients with Acute Non-Varicose Upper Gastrointestinal Bleeding

ABSTRACT Objective: To investigate the value of AIMS65 score combined with serum gastrin (GAS), prostaglandin E₂ (PGE₂) and urea nitrogen/albumin ratio (BAR) in assessing clinical outcomes after endoscopic hemostatic treatment in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: A total of 108 ANVUGIB patients, who were admitted to the Gastroenterology Department of Beijing Hepingli Hospital between May 2020 and may 2022, were selected and divided into poor prognosis and good prognosis groups according to the prognosis of the patients within 28 d of hospitalization. Patients'' clinical data were collected, serum GAS and PGE₂ levels were measured and AIMS65 score and BAR were calculated. Multi-factor logistic regression was used to analyze the factors influencing poor prognosis after endoscopic hemostasis treatment in patients with ANVUGIB. The value of the AIMS65 score, GAS, PGE₂ and BAR in assessing poor prognosis after endoscopic hemostasis treatment in patients with ANVUGIB was analyzed using receiver operating characteristic(ROC) curves. Results: The incidence of poor prognosis in 108 patients with ANVUGIB after endoscopic hemostasis treatment was 37.96%(41/108). Univariate analysis showed that the poor prognosis group was older than the good prognosis group, with higher heart rate, shock index, AIMS65 score, GAS and BAR than the good prognosis group, and lower PGE₂ levels than the good prognosis group(all P<0.05). Multivariate logistic regression analysis showed that increasing age and shock index, aims65 score, gas and bar elevation were independent risk factors for poor outcome after endoscopic hemostatic therapy in ANVUGIB patients, and increasing PGE₂ was an independent protective factor(all P<0.05). ROC curve analysis showed that the area under the curve for the AIMS65 score combined with GAS, PGE₂ and BAR to assess poor prognosis after endoscopic hemostasis treatment in patients with ANVUGIB was greater than for the AIMS65 score, GAS, PGE₂ and BAR alone(all P<0.05). Conclusion: The AIMS65 score, GAS and BAR of patients with poor prognosis of ANVUGIB were higher than those with good prognosis. The AIMS65 score combined with GAS, PGE₂ and BAR is of high value in assessing clinical outcomes after endoscopic hemostatic treatment in patients with ANVUGIB.