使用格拉斯哥-布拉奇福德评分和福里斯特分类法对马洛里-魏斯综合征进行有效的内镜治疗。
Effective endoscopic treatment of Mallory-Weiss syndrome using Glasgow-Blatchford score and Forrest classification.
作者信息
Lee Sunpyo, Ahn Ji Yong, Jung Hwoon-Yong, Jung Kee Wook, Lee Jeong Hoon, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Kim Jin-Ho, Kim Seon-Ok
机构信息
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, Korea.
出版信息
J Dig Dis. 2016 Oct;17(10):676-684. doi: 10.1111/1751-2980.12409.
OBJECTIVES
There is limited data on whether scoring systems can be used to predict clinical outcomes in patients with upper gastrointestinal bleeding due to Mallory-Weiss syndrome (MWS). We aimed to evaluate whether the Glasgow-Blatchford score (GBS) could be effective in predicting clinical outcomes of bleeding MWS and to investigate the predictive ability of the Forrest classification for rebleeding and assess the effective endoscopic modalities for bleeding control in MWS.
METHODS
From January 2004 to December 2012 168 patients were diagnosed with MWS in the Asan Medical Center Emergency Department. We analyzed their clinical outcomes, including endoscopic treatment, transfusion and admission as well as the rates of rebleeding and mortality using GBS and the Forrest classification, retrospectively.
RESULTS
Endoscopic treatment was applied to patients. The GBS was significantly higher in patients treated with endoscopic therapy than in the conservative treatment group (6.8 ± 3.7 vs 5.1 ± 4.7, P = 0.011). In patients with a GBS of >6 the rates of endoscopic treatment and rebleeding and the need for transfusion and admission were significantly higher (all P < 0.05). The Forrest classification was able to predict recurrent bleeding (area under the receiver operating characteristic curve 0.723, 95% confidence interval 0.609-0.836, P = 0.025). Hemoclip-based therapy and band ligation achieved higher success rates than did injection therapy alone in preventing rebleeding (96.4%, 88.9% and 71.4%, P = 0.013).
CONCLUSION
In MWS, GBS might be useful for predicting clinical outcomes and the Forrest classification in predicting recurrent bleeding.
目的
关于评分系统能否用于预测马洛里-魏斯综合征（MWS）所致上消化道出血患者的临床结局，相关数据有限。我们旨在评估格拉斯哥-布拉奇福德评分（GBS）能否有效预测出血性MWS的临床结局，并研究弗罗斯特分类法对再出血的预测能力，以及评估MWS出血控制的有效内镜治疗方式。
方法
2004年1月至2012年12月，168例患者在峨山医学中心急诊科被诊断为MWS。我们回顾性分析了他们的临床结局，包括内镜治疗、输血和住院情况，以及使用GBS和弗罗斯特分类法得出的再出血率和死亡率。
结果
对患者进行了内镜治疗。接受内镜治疗的患者GBS显著高于保守治疗组（6.8±3.7 vs 5.1±4.7，P = 0.011）。GBS>6的患者内镜治疗率、再出血率以及输血和住院需求均显著更高（均P<0.05）。弗罗斯特分类法能够预测复发性出血（受试者工作特征曲线下面积为0.723，95%置信区间为0.609 - 0.836，P = 0.025）。在预防再出血方面，基于止血夹的治疗和套扎术的成功率高于单纯注射治疗（分别为96.4%、88.9%和71.4%，P = 0.013）。
结论
在MWS中，GBS可能有助于预测临床结局，而弗罗斯特分类法有助于预测复发性出血。
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