So sánh giá trị thang điểm MAP(ASH) với Child-Pugh và MELD trong tiên lượng chảy máu tiêu hóa do vỡ giãn tĩnh mạch thực quản ở bệnh nhân xơ gan=Comparison of the value of MAP(ASH) score with Child-Pugh and MELD in prognosis of variceal bleeding in cirrhosis patients

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Tác giả: Thị Thanh Nga Bùi, Đức Tiến Đào, Quang Huy Dương, Văn Chung Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2024

Mô tả vật lý: tr.79-86

Bộ sưu tập: Metadata

ID: 244944

Thêm vào giỏ

So sánh giá trị thang điểm MAP(ASH) với Child-Pugh (CP) và điểm mô hình bệnh gan giai đoạn cuối (MELD) trong tiên lượng tái chảy máu sớm và tử vong nội viện ở bệnh nhân xơ gan có biến chứng chảy máu tiêu hóa (CMTH) do vỡ giãn tĩnh mạch thực quản (TMTQ). Đối tượng và phương pháp: Mô tả cắt ngang trên 222 bệnh nhan CMTH do vỡ giãn TMTQ có bệnh nền xơ gan điều trị tại Khoa Nội Tiêu hóa, Khoa Hồi sức cấp cứu nội - Bệnh viện Quân y 103 và Viện Điều trị các bệnh Tiêu hóa - Bệnh viện Trung ương Quân đội 108. Tính điểm MAP(ASH), MELD, CP tại thời điểm nhập viện, đối chiếu với tỷ lệ tái chảy máu sớm và tử vong nội viện, từ đó xác định và so sánh giá trị tiên lượng thông qua phân tích diện tích dưới đường cong. Kết quả: Tỷ lệ tái chảy máu và tử vong nội viện lần lượt là 9,0% và 6,8%. Về tiên lượng tái chảy máu sớm, thang điểm MAP(ASH) có giá trị tiên lượng khá (AUROC 0,72
95%CI: 0,59-0,84), còn thang điểm CP, MELD ít có giá trị tiên lượng với AUROC <
0,70. Về tiên lượng tử vong nội viện: Thang điểm MAP(ASH), MELD đều có giá trị tốt với AUROC cùng bằng 0,83 (p<
0,001), trong khi điểm CP chỉ có giá trị tiên lượng khá với AUROC 0,79 (95%CI: 0,66-0,92, p<
0,05). Tuy nhiên, sự khác biệt giữa các thang điểm MAP(ASH), MELD và CP trong tiên lượng chưa có ý nghĩa thống kê. Kết luận: MAP(ASH) là thang điểm có giá trị trong tiên lượng tử vong nội viện cũng như tái chảy máu sớm ở bệnh nhân xơ gan có biến chứng CMTH do vỡ giãn TMTQ, tốt hơn so với điểm CP và MELD nên cần khuyến cáo áp dụng trong thực hành lâm sàng.To compare the value of MAP(ASH) score with Child-Pugh (CP) and model of end-stage liver disease (MELD) score in predicting early rebleeding and in-hospital mortality in cirrhosis patients complicated by esophageal variceal bleeding. Subject and method: Cross-sectional description of 222 patients with esophageal variceal bleeding with underlying cirrhosis treated at the Department of Gastrointestinal and Internal Medicine Emergency Department - 103 Military Hospital and Digestive Diseases Treatment Institute - 108 Military Central Hospital. Calculate MAP(ASH), MELD, CP scores at the time of admission, compare with the rate of early rebleeding and in-hospital mortality, thereby determining and comparing the prognosis value of these scores through analysis of area under the curve. Result: The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the MAP(ASH) score had good prognostic value (AUROC 0.72
95%CI: 0.59-0.84), while the CP and MELD scores had poor predictive value with AUROC <
0.70. Regarding prognosis of in-hospital mortality: MAP(ASH), MELD scores all had good value with both AUROC equal to 0.83 (p<
0.001), while CP only had medium prognostic value with AUROC 0.79 (95%CI: 0.66-0.92
p<
0.05). However, the difference between the MAP(ASH), MELD and CP in prognosis was not statistically significant. Conclusion: MAP(ASH) is a valuable score in predicting in-hospital death as well as early rebleeding in cirrhotic patients with esophageal variceal bleeding, better than CP and MELD scores, so it is necessary to recommended for application in clinical practice.

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