血清PGE-2和血乳酸水平与急性上消化道出血病情严重程度及预后的相关性分析

Correlation analysis of serum PGE-2 and blood lactate levels with severity and prognosis of acute upper gastrointestinal bleeding

摘要:

目的 探讨血清前列腺素E-2（PGE-2）和血乳酸水平与急性上消化道出血（AUGB）病情严重程度及预后的关系。方法 选取2018年5月—2021年10月厦门长庚医院收治的211例AUGB患者为研究对象，自AUGB患者入院治疗后随访30 d收集患者基本资料。通过不同病情严重程度AUGB患者的血清PGE-2和血乳酸水平，分析影响AUGB患者预后的因素，检测血清PGE-2和血乳酸水平预测AUGB患者预后。结果 重度AUGB病情组血清PGE-2水平低于轻度和中度AUGB病情组（P <0.05），重度AUGB病情组血乳酸水平高于轻度和中度AUGB病情组（P <0.05）；中度AUGB病情组血清PGE-2水平低于轻度AUGB病情组（P <0.05），中度AUGB病情组血乳酸水平高于轻度AUGB病情组（P <0.05）。211例AUGB患者随访期间死亡20例，其余191例生存。多因素Logistic回归分析结果显示，AUGB次数［O^R=4.063（95% CI：1.672，9.875）］、MEWS［O^R=6.080（95% CI：2.502，14.776）］、Rockall评分［O^R=6.855（95% CI：2.821，16.660）］、血乳酸［O^R=4.175（95% CI：1.718，10.145）］、血清PGE-2［O^R=3.927（95% CI：1.616，9.545）］是影响AUGB患者预后的危险因素（P <0.05）。受试者工作特征曲线分析结果显示，血清PGE-2、血乳酸及二者联合预测AUGB患者预后的敏感性分别为75.00%（95% CI：0.506，0.904）、70.00%（95% CI：0.457，0.872）和70.00%（95% CI：0.457，0.872），特异性分别为80.10%（95% CI：0.736，0.854）、77.49%（95% CI：0.708，0.831）和90.05%（95% CI：0.847，0.938），AUC分别为0.772（95% CI：0.660，0.884）、0.766（95% CI：0.671，0.861）和0.907（95% CI：0.847，0.968）。结论 血清PGE-2、血乳酸不仅与AUGB患者病情有关，也与AUGB患者预后有关，且血清PGE-2联合血乳酸预测AUGB患者的预后效能良好。

Abstract:

Objective To investigate the relationship of serum prostaglandin E-2 (PGE-2), blood lactate levels with the severity and prognosis of acute upper gastrointestinal bleeding (AUGB).Methods A total of 211 patients with AUGB who were admitted to the hospital from May 2018 to October 2021 were selected as the research subjects, and the AUGB patients were followed up for 30 d after admission, and the basic data of the patients were collected. The levels of PGE-2 and lactate in AUGB patients with different disease severity were analyzed, the factors affecting the prognosis of AUGB patients were analyzed, and the value of serum PGE-2 and blood lactate levels in predicting the prognosis of AUGB patients was analyzed.Results The level of PGE-2 in the severe AUGB disease group was lower than that in the mild and moderate AUGB disease group, and the lactic acid level in the severe AUGB disease group was higher than that in the mild and moderate AUGB disease group (P < 0.05). The level of PGE-2 in the moderate AUGB disease group was lower than that in the mild AUGB disease group, and the lactate level in the moderate AUGB disease group was higher than that in the mild AUGB disease group (P < 0.05). Of the 211 AUGB patients, 20 died during the follow-up period, and the remaining 191 survived. Logistic multivariate regression analysis showed: AUGB times [O^R = 4.063, (95% CI: 1.672, 9.875) ], Modified Early Warning Score (MEWS) score [O^R = 6.080, (95% CI: 2.502, 14.776) ], Rockall score [O^R = 6.855, (95% CI: 2.821, 16.660) ], lactate [O^R = 4.175, (95% CI: 1.718, 10.145) ], and PGE-2 [O^R = 3.927, (95% CI: 1.616, 9.545) ] levels were the risk factors affecting the prognosis of AUGB patients factor (P < 0.05). The results of ROC curve analysis showed that the sensitivities of serum PGE-2, lactate, and their combination in predicting the prognosis of patients with AUGB were 75.00% (95% CI: 0.506, 0.904), 70.00% (95% CI: 0.457, 0.872), and 70.00% (95% CI: 0.457, 0.872); the specificity was 80.10% (95% CI: 0.736, 0.854), 77.49% (95% CI: 0.708, 0.831), and 90.05% (95% CI: 0.847, 0.938); the AUC were 0.772 (95% CI: 0.660, 0.884), 0.766 (95% CI: 0.671, 0.861), and 0.907 (95% CI: 0.847, 0.968).Conclusion Serum PGE-2 and lactate are not only related to the condition of AUGB patients, but also to the prognosis of AUGB patients, and PGE-2 combined with lactate has a good effect on predicting the prognosis of AUGB patients.