消化性溃疡出血患者的 Rockall 评分≥6 分有长期溃疡再出血的风险：一项为期 3.5 年的前瞻性纵向研究。

Peptic ulcer bleeding patients with Rockall scores ≥6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study.

机构信息

Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

J Gastroenterol Hepatol. 2018 Jan;33(1):156-163. doi: 10.1111/jgh.13822.

DOI:10.1111/jgh.13822

PMID:28497645

Abstract

BACKGROUND AND AIM

Patients with high Rockall scores have increased risk of rebleeding and mortality within 30 days after peptic ulcer bleeding, but long-term outcomes deserve follow-up after cessation of proton pump inhibitors. The paper aimed to validate whether patients with high Rockall scores have more recurrent ulcer bleeding in a 3.5-year longitudinal cohort.

METHODS

Between August 2011 and July 2014, 368 patients with peptic ulcer bleeding were prospectively enrolled after endoscopic hemostasis to receive proton pump inhibitors for at least 8 to 16 weeks. These subjects were categorized into either a Rockall scores ≥6 group (n = 257) or a Rockall scores <6 group (n = 111) and followed up until July of 2015 to assess recurrent ulcer bleeding.

RESULTS

The proportion of patients with rebleeding during the 3.5-year follow-up was higher in patients with Rockall scores ≥6 than in those with scores <6 (10.51 vs. 3.63 per 100 person-year, P = 0.004, log-rank test). Among patients with Rockall scores ≥6, activated partial thromboplastin time prolonged ≥1.5-fold (P = 0.045), American Society of Anesthesiologists physical status class ≥III (P = 0.02), and gastric ulcer (P = 0.04) were three additional independent factors found to increase rebleeding risk. The cumulative rebleeding rate was higher in patients with Rockall scores ≥6 with more than or equal to any two additional factors than in those with fewer than two additional factors (15.69 vs. 7.63 per 100 person-year, P = 0.012, log-rank test).

CONCLUSIONS

Patients with Rockall scores ≥6 are at risk of long-term recurrent peptic ulcer bleeding. The risk can be independently increased by the presence of activated partial thromboplastin time prolonged ≥1.5-fold, American Society of Anesthesiologists class ≥III, and gastric ulcer in patients with Rockall scores ≥6.

摘要

背景与目的

对于消化性溃疡出血患者，Rockall 评分较高者在出血后 30 天内再出血和死亡的风险增加，但质子泵抑制剂停药后需要对长期结局进行随访。本研究旨在验证在一个 3.5 年的纵向队列中，Rockall 评分较高的患者是否有更多的复发性溃疡出血。

方法

2011 年 8 月至 2014 年 7 月，368 例接受内镜止血后接受质子泵抑制剂治疗至少 8 至 16 周的消化性溃疡出血患者前瞻性入组。将这些患者分为 Rockall 评分≥6 组（n=257）或 Rockall 评分<6 组（n=111），并随访至 2015 年 7 月，以评估复发性溃疡出血。

结果

在 3.5 年的随访期间，Rockall 评分≥6 组患者的再出血率高于 Rockall 评分<6 组（每 100 人年 10.51% vs. 3.63%，P=0.004，log-rank 检验）。在 Rockall 评分≥6 的患者中，活化部分凝血活酶时间延长≥1.5 倍（P=0.045）、美国麻醉医师协会身体状况分级≥III 级（P=0.02）和胃溃疡（P=0.04）是另外三个独立的增加再出血风险的因素。Rockall 评分≥6 且存在≥2 个附加因素的患者的累积再出血率高于存在<2 个附加因素的患者（每 100 人年 15.69% vs. 7.63%，P=0.012，log-rank 检验）。