摘要
目的探讨上消化道出血(UGIB)患者营养状态对其临床结局的影响。方法选取2009年1月—2011年2月收治于武汉市第五人民医院消化科的UGIB患者413例,根据入院时营养风险评分(NRS2002)将患者分为高营养风险(H-NR,NRS2002≥3分)组和低营养风险(L-NR,NRS2002<3分)组。比较住院期间两组患者临床结局(住院时间、再出血发生率、院内死亡率)。应用受试者工作特征曲线(ROC曲线)评价NRS2002对患者再出血和院内死亡的预测价值。结果 H-NR组患者NRS2002为(4.0±1.0)分,高于L-NR组患者的(1.4±0.5)分(t=29.210,P<0.001)。两组患者的男性比例、治疗方法分布情况比较,差异均无统计学意义(P>0.05);基础疾病分布情况比较,差异有统计学意义(P<0.05);其中H-NR组十二指肠溃疡发生率低于L-NR组,胃溃疡发生率高于L-NR组(P<0.05)。H-NR组患者住院时间为(7.9±3.5)d,长于L-NR组患者的(7.0±2.5)d(t=2.775,P=0.006)。H-NR组患者再出血发生率、院内死亡率均高于L-NR组患者(P<0.05)。NRS2002预测UGIB患者再出血的ROC曲线下面积(AUC)=0.794〔95%CI(0.708,0.890),P<0.001〕,灵敏度和特异度分别为0.778和0.698,NRS2002最佳截断值为3.5分;NRS2002预测UGIB患者院内死亡的AUC=0.827〔95%CI(0.723,0.932),P<0.001〕,灵敏度和特异度分别为0.765和0.851,NRS2002最佳截断值为4.5分。结论 H-NR与UGIB患者的临床不良结局有关,NRS2002对UGIB患者的临床结局有较好的预测价值,值得临床推广应用。
Objective To investigate the influence of nutritional status of patients with upper gastrointestinal hemorrhage （UGIB） on their clinical outcomes. Methods Enrolled 413 UG1B patients who were admitted into Wuhan Fifth People＇s Hospital from January 2009 to February 2011. According to NRS2002 scores at admission, the patients were divided into high nutritional risk group （ H-NR, NRS2002 ≥ 3 ） and low nutritional risk group （ L-NR, NRS2002 〈 3 ） . Comparison was made between the two groups in clinical outcomes （ length of hospital stay, incidence of rehaemorrhagia and death rate） during hospitalization. ROC curves were used to assess the value of NRS2002 in the prediction of rehaemorrhagia and death. Results NRS2002 of H-NR group was higher than that of L-NR group [ （4. 0 ± 1. 0） vs. （ 1.4 ± 0. 5 ）, t = 29. 210, P 〈 0.001 ] . There were no significant differences between the two groups in male proportion and the distribution of treatment methods （ P 〉 0.05）. There were significant differences between the two group in the distribution of basic diseases; H-NR group was lower in the incidence of duodenal ulcer and was higher in the incidence of gastric ulcer than L-NR group （ P 〈 0. 05 ） . Patients in H-NR group had longer length of hospital stay than patients in L-NR group [ （ 7.9 ± 3.5 ） d vs. （7.0 ± 2.5 ） d; t = 2. 775, P =0. 006] . H-NR group was higher （P 〈 0. 05 ） than L-NR group in the incidence of rehaemorrhagia and death rate during hospitalization. The AUC of NRS2002 predicting rehaemorrhagia in UGIB patients was 0. 794 [95% CI （0. 708, 0. 890） ; P 〈 0. 001 ] , and its sensitivity and specificity were 0. 778 and 0. 698, with a best cut off value of 3.5 ; the AUC of NRS2002 predicting death of UGIB patients during hospitalization was 0. 827 [ 95% CI （0. 723, 0. 932） , P 〈0. 001 ~, and its sensitivity and specificity were 0. 778 and 0. 698, with a best cut off value of 4. 5. Conclusion H-NR is correlated with clinical adverse outcomes o
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第3期282-284,291,共4页
Chinese General Practice
关键词
胃肠出血
营养状况
预后
Gastrointestinal hemorrhage
Nutritional status
Prognosis
