乳酸参数对非静脉曲张性上消化道出血患者急诊死亡和30 d内再出血的预测价值

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摘要目的探讨乳酸参数在预测非静脉曲张性上消化道出血患者急诊死亡和30 d内再出血的价值。方法回顾性分析2017-05至2023-10联勤保障部队987医院收治的924例成人非静脉曲张性上消化道出血(NVUGIB)患者的临床资料,测定静脉乳酸水平,记录入院24 h内起始、最高和平均乳酸水平,并计算乳酸清除率(LCR)。研究结局包括急诊死亡和入院后30 d内再出血。结果急诊死亡患者起始乳酸、最高乳酸、平均乳酸水平显著高于存活者,LCR显著低于存活组,差异均有统计学意义(P＜0.05)。此外,30 d内再出血患者LCR显著低于未出血者(P＜0.05)。经多因素logistic回归分析,结果显示起始乳酸、最高乳酸、平均乳酸、LCR和AIMS65评分均是影响NVUGIB急诊死亡的独立危险因素(P＜0.05);LCR和AIMS65评分是影响NVUGIB患者30 d再出血的独立影响因素(P＜0.05)。起始乳酸、最高乳酸、平均乳酸、LCR预测NVUGIB急诊死亡的ROC曲线下面积(AUC)分别为0.833(95%CI:0.763～0.903)、0.813(95%CI:0.736～0.890)、0.809(95%CI:0.723～0.896)、0.766(95%CI:0.684～0.848)。LCR预测NVUGIB患者30 d再出血的AUC可达到0.844(95%CI:0.789～0.899)。当上述乳酸参数与AIMS65评分联合时,模型的死亡和再出血风险预测能力均有所提高。结论乳酸水平升高或LCR降低与NVUGIB预后不良有关,乳酸参数有望成为NVUGIB急诊死亡和30 d再出血风险分层的早期预测标志物。

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关键词 ：乳酸, 乳酸清除率, 非静脉曲张性上消化道出血, 急诊死亡, 30 d再出血

Abstract：Objective To investigate the value of lactic acid parameters in predicting emergency death and rebleeding within 30 days in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Methods Clinical data of 924 adult NVUGIB patients admitted to the the 987th Hospital of PLA Joint logistics Support Force from May 2017 to October 2023 were retrospectively analyzed. The level of intravenous lactate was determined, the initial, highest and average lactate levels were recorded within 24 h after admission, and lactate clearance rate(LCR) was calculated. Study outcomes included death in the emergency department and rebleeding within 30 days after admission. Results The levels of initial lactic acid, maximum lactic acid and average lactic acid in emergency patients were significantly higher than those in survivors(P＜0.05), and the LCR was significantly lower than that in survival group, with statistical significance (P＜0.05). In addition, the LCR of patients with rebleeding within 30 days was significantly lower than that of those without bleeding (P＜0.05). Multivariate logistic regression analysis showed that initial lactic acid, maximum lactic acid, average lactic acid, LCR and AIMS65 scores were independent risk factors for emergency death with NVUGIB (P＜0.05). LCR and AIMS65 scores were independent influencing factors for 30 days of rebleeding in NVUGIB patients (P＜0.05). The area under ROC curve (AUC) of initial lactic acid, maximum lactic acid, average lactic acid and LCR in predicting emergency death of NVUGIB were 0.833(95%CI: 0.763-0.903), 0.813(95%CI: 0.736-0.890), 0.809(95%CI: 0.736-0.890) and 0.766(95%CI: 0.684-0.848), respectively. The AUC of LCR in predicting rebleeding within 30 days in patients with NVUGIB reached 0.844 (95%CI: 0.789-0.899). When the above lactate parameters were combined with AIMS65 score, the prediction ability of the model for the risk of death and rebleeding was improved. Conclusions Elevated lactate levels or decreased LCR are associated with poor prognosis of NVUGIB, and lactate parameters are expected to be an early predictor of NVUGIB emergency death and 30-day rebleeding risk stratification.

Key words： lactic acid lactate clearance rate nonvariceal upper gastrointestinal bleeding emergency death rebleeding within 30 days

收稿日期: 2024-06-10

ZTFLH:

R573.2

基金资助:陕西省重点研发计划(2019SF-207)

通讯作者: 刘彦君,E-mail:xsclyj2024@qq.com

作者简介: 梁君蓉,硕士,副主任医师。

引用本文:

梁君蓉, 周永强, 胡康, 李春燕, 何晓一, 刘彦君. 乳酸参数对非静脉曲张性上消化道出血患者急诊死亡和30 d内再出血的预测价值[J]. 武警医学, 2025, 36(4): 325-332. LIANG Junrong, ZHOU Yongqiang, HU Kang, LI Chunyan, HE Xiaoyi, LIU Yanjun. Value of lactic acid parameters in predicting emergency death and rebleeding within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Med. J. Chin. Peop. Armed Poli. Forc., 2025, 36(4): 325-332.

链接本文:

https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2025/V36/I4/325

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