2023 年第 1 期 第 18 卷

服用肠溶阿司匹林患者非静脉曲张上消化道出血风险评分的临床应用研究

Study on the clinical application of non-variceal upper gastrointestinal bleeding risk score in patients taking enteric-coated aspirin

作者：尤嘉璐高峰

英文作者：You Jialu Gao Feng

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：阿司匹林；上消化道出血；风险评估

英文关键词：Aspirin;Uppergastrointestinalbleeding;Riskassessment

• 摘要：

• 目的  探讨服用肠溶阿司匹林患者非静脉曲张上消化道出血风险评分（ASA风险评分）的临床应用价值。方法 连续纳入2022年1—7月于首都医科大学附属北京安贞医院住院的正在服用肠溶阿司匹林的患者158例，计算ASA风险评分，≤2分为低危组，＞2分为高危组。比较2组临床资料、住院期间上消化道出血发生情况。采用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价ASA风险评分对服用肠溶阿司匹林患者非静脉曲张上消化道出血的预测价值。结果 158例患者中62例ASA风险评分≤2分（低危组）、96例＞2分（高危组）。高危组ASA风险评分高于低危组［3.0（3.0,5.0）分比1.0（1.0,2.0）分］，差异有统计学意义（Z=-10.599，P＜0.001）。2组年龄、性别分布、体重指数、服用阿司匹林时间和高血压病、冠心病（冠状动脉粥样硬化性心脏病）、心肌梗死、心房颤动、脑血管病、经皮冠状动脉介入及冠状动脉旁路移植术比例比较，差异均无统计学意义（均P＞0.05）。高危组上消化道出血发生率高于低危组［28.1%（27/96）比6.5%（4/62）］，差异有统计学意义（χ2=15.273，P＜0.001）。ROC曲线分析结果显示，ASA风险评分预测非静脉曲张上消化道出血的AUC为0.872（95%置信区间：0.780~0.964，P＜0.001），最佳截断值为6.0分，敏感度为77.4%、特异度为100.0%、准确度为95.6%。结论 ASA风险评分对服用肠溶阿司匹林患者非静脉曲张上消化道出血有较高的预测价值，临床医师可根据评分结果及时调整患者治疗方案并进行针对性治疗及预防，以降低患者上消化道出血风险。

• Objective To investigate the clinical value of non-variceal upper gastrointestinal bleeding risk score in patients taking enteric-coated aspirin (ASA risk score). Methods A total of 158 inpatients taking enteric-coated aspirin in Beijing Anzhen Hospital, Capital Medical University from January to July 2022 were consecutively enrolled. The ASA risk score of patients were calculated. Patients with ASA risk score ≤2 were divided into low-risk group, and patients with ASA risk score >2 were divided into high-risk group. Clinical data and the incidence of upper gastrointestinal bleeding were compared between the two groups. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the predictive value of ASA risk score in non-variceal upper gastrointestinal bleeding in patients taking enteric-coated aspirin. Results Among 158 patients, there were 62 of them with ASA risk score≤2 (low-risk group), and 96 of them with ASA risk score>2 (high-risk group). The ASA risk score in high-risk group was higher than that in low-risk group ［3.0（3.0,5.0） vs 1.0（1.0,2.0）］(Z=-10.599，P＜0.001). There were no significant differences in age, gender, body mass indexes, oral aspirin time and rates of hypertension, coronary atherosclerotic heart disease, myocardial infarction, atrial fibrillation, cerebrovascular diseases, percutaneous coronary intervention and coronary artery bypass grafting (all P>0.05). The rate of upper gastrointestinal bleeding in high-risk group was higher than that in low-risk group ［28.1%（27/96） vs 6.5%（4/62）］（χ2=15.273，P＜0.001）. ROC curve analysis showed that AUC was 0.872 (95% confidence interval: 0.780-0.964, P<0.001) in predicting non-variceal upper gastrointestinal bleeding, the best cut-off value was 6.0, the sensitivity was 77.4%, the specificity was 100.0%, and the accuracy was 95.6%. Conclusions ASA risk score has high predictive value in non-variceal upper gastrointestinal bleeding in patients taking enteric-coated aspirin. Clinicians could timely adjust the treatment plan of patients according to the scoring results , and carry out targeted treatment and prevention for patients to reduce the risk of upper gastrointestinal bleeding.