Ernst A A, Haynes M L, Nick T G, Weiss S J
Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
Am J Emerg Med. 1999 Jan;17(1):70-2. doi: 10.1016/s0735-6757(99)90021-9.
This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (GI) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of GI bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. A total of 63 (51%) presented with blood in stool and 53 (43%) with bloody emesis; 8 (6%) had blood in both emesis and stool. A total of 31 (25%) patients had a lower GI bleed, 88 (70%) had an upper, and 5 (4%) had both upper and lower bleeding sources. The mean BUN level was 24 mg/dL, the mean Cr level 1.03 mg/dL, and the mean BUN/Cr ratio was 24. The mean hemoglobin (Hb) level was 11.3 g/dL, the mean Hct was 32 g/dL, and 51% required transfusion. Upper GI bleeding was significantly correlated with age younger than 50 (P = .01) and male gender (P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper GI source of bleeding (P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).
本研究旨在评估血尿素氮/肌酐（BUN/Cr）比值对区分胃肠道（GI）出血的上消化道来源与下消化道来源的作用。对1995年8月至1996年8月因GI出血诊断而就诊于急诊科（ED）的患者病历进行回顾性分析，记录出血来源、初始BUN、Cr、BUN/Cr比值、血细胞比容（Hct）及输血需求。共有124例患者符合纳入标准，其中71例（57%）为男性。共有63例（51%）出现便血，53例（43%）出现呕血；8例（6%）呕血和便血均有。共有31例（25%）患者为下消化道出血，88例（70%）为上消化道出血，5例（4%）上下消化道均有出血来源。平均BUN水平为24mg/dL，平均Cr水平为1.03mg/dL，平均BUN/Cr比值为24。平均血红蛋白（Hb）水平为11.3g/dL，平均Hct为32g/dL，51%的患者需要输血。上消化道出血与年龄小于50岁（P = 0.01）及男性（P = 0.01；比值比，3.13）显著相关。考虑年龄和性别因素后，BUN/Cr比值与上消化道出血来源显著相关（P = 0.03），比值大于36时，敏感性为90%，特异性为27%。使用年龄、性别和BUN/Cr比值的受试者工作特征曲线下面积为0.73（95%置信区间，0.62至0.84）。
