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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2026, Vol. 16 ›› Issue (02) : 156 -161. doi: 10.3877/cma.j.issn.2095-2015.2026.02.011

论著

急性下消化道出血患者安全出院风险评分的构建与验证
李晨阳1, 汪涛1, 徐忠瑞2, 黄福秀2, 李淑玲1, 徐衍2, 周旋2, 赵慧2, 张宁宁2, 陈超1,†()   
  1. 1100853　北京，解放军总医院第一医学中心消化内科医学部
    2100048　北京，解放军总医院第四医学中心消化内科
  • 收稿日期:2025-01-11 出版日期:2026-04-01
  • 通信作者: 陈超

Construction and validation of a risk score for safe discharge of patients with acute lower gastrointestinal bleeding

Chenyang Li1, Tao Wang1, Zhongrui Xu2, Fuxiu Huang2, Shuling Li1, Yan Xu2, Xuan Zhou2, Hui Zhao2, Ningning Zhang2, Chao Chen1,†()   

  1. 1Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing 100853, China
    2Department of Gastroenterology, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China
  • Received:2025-01-11 Published:2026-04-01
  • Corresponding author: Chao Chen
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引用本文：

李晨阳, 汪涛, 徐忠瑞, 黄福秀, 李淑玲, 徐衍, 周旋, 赵慧, 张宁宁, 陈超. 急性下消化道出血患者安全出院风险评分的构建与验证[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 156-161.

Chenyang Li, Tao Wang, Zhongrui Xu, Fuxiu Huang, Shuling Li, Yan Xu, Xuan Zhou, Hui Zhao, Ningning Zhang, Chao Chen. Construction and validation of a risk score for safe discharge of patients with acute lower gastrointestinal bleeding[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(02): 156-161.

目的

探讨急性下消化道出血患者安全出院的独立危险因素，构建风险评分并评估其预测能力。

方法

回顾性分析2015年1月至2020年12月在解放军总医院第一医学中心和第四医学中心因急性下消化道出血住院治疗的754例患者临床资料，经排除标准排除，最终共纳入355例患者建立训练集，根据是否安全出院分为发生组（n=197）和未发生组（n=158）。前瞻性收集了2021年1月至2023年10月因急性LGIB住院诊治的患者235例，经排除标准排除，最终共纳入133例患者建立验证集。采用单因素分析、多因素Logistic回归分析影响安全出院的独立危险因素，构建风险评分，采用受试者工作特征曲线来评估该评分的预测价值。

结果

通过单因素分析、多因素Logistic回归分析发现，肝病史、下消化道出血病史、新鲜出血、血红蛋白下降、白蛋白下降为影响安全出院的独立危险因素（P<0.05），以此构建的风险评分曲线下面积为0.827，优于Oakland评分等预测模型。

结论

肝病史、下消化道出血病史、新鲜出血、血红蛋白下降、白蛋白下降为影响急性下消化道出血患者安全出院的独立危险因素，以此构建的风险评分对患者安全出院有较高的预测价值，有助于急性下消化道出血患者的预后风险评估。

关键词: 下消化道出血, 风险评分, 危险因素, 风险预测
Objective

To investigate the prognostic risk factors associated with acute lower gastrointestinal bleeding, construct a risk score and validate its predictive ability.

Methods

A retrospective analysis was conducted on the clinical data of 754 patients who were hospitalized for acute lower gastrointestinal bleeding at the First Medical Center and the Fourth Medical Center of the Chinese People's Liberation Army General Hospital from January 2015 to December 2020. After excluding the cases that did not meet the criteria, a total of 355 patients were included in the training set. These patients were divided into the safe discharge group (n=197) and the non-safe discharge group (n=158) based on whether they were discharged safely. From January 2021 to October 2023, 235 patients who were hospitalized and treated for acute LGIB were prospectively collected. After excluding the patients who did not meet the criteria, a total of 133 patients were finally included to establish the validation set. Univariate analysis and multivariate Logistic regression were used to identify the independent risk factors influencing safe discharge. A risk score was constructed, and the predictive value of this score was evaluated using receiver operating characteristic curve.

Results

Through univariate analysis and multivariate Logistic regression analysis, it was found that history of liver disease, history of lower gastrointestinal bleeding, fresh bleeding, decrease in hemoglobin, and decrease in albumin were independent risk factors affecting safe discharge (P<0.05). The area under the risk score curve constructed based on these factors was 0.827, which was superior to the prediction models such as the Oakland score.

Conclusion

History of liver disease, history of lower gastrointestinal bleeding, fresh bleeding, decreased hemoglobin, and decreased albumin are independent risk factors affecting the safe discharge of patients with acute lower gastrointestinal bleeding. The risk score constructed based on these factors has a high predictive value for the safe discharge of patients and is helpful for the prognosis risk assessment of patients with acute lower gastrointestinal bleeding.

Key words: Lower gastrointestinal bleeding, Risk score, Risk factors, Risk prediction
表1 急性下消化道出血患者基线人口学特征
变量 训练集 验证集 P值
(n=355) (n=133)
年龄[岁,M(Q1,Q3)] 63(51,75) 63(48,75) 0.756
性别[例(%)]     0.946
女 148(41.7) 55(41.4)  
男 207(58.3) 78(58.6)  
下消化道出血病史[例(%)] 112(31.5) 43(32.3) 0.869
合并症[例(%)]      
心脏病 85(23.9) 33(24.8) 0.842
卒中 39(11.0) 13(9.8) 0.699
肝病 10(2.8) 4(3.0) >0.999
肾脏病 16(4.5) 5(3.8) 0.717
高血压 146(41.1) 52(39.1) 0.684
糖尿病 58(16.3) 20(15.0) 0.727
肺病 8(2.3) 4(3.0) 0.743
肿瘤 44(12.4) 18(13.5) 0.736
结肠息肉病史[例(%)] 21(5.9) 7(5.3) 0.783
用药史[例(%)]     0.989
阿司匹林 32(9.0) 12(9.0)  
氯吡格雷 14(3.9) 5(3.8)  
双联抗血小板 8(2.3) 4(3.0)  
华法林 8(2.3) 4(3.0)  
新型口服抗凝药 2(0.6) 1(0.8)  
抗凝、抗血小板 2(0.6) 1(0.8)  
糖皮质激素 3(0.8) 0(0.0)  
非甾体抗炎药 7(2.0) 3(2.3)  
症状和体征      
新鲜出血[例(%)] 116(32.7) 45(33.8) 0.808
直肠指诊[例(%)] 111(31.3) 44(33.1) 0.701
心率[次/min,M(Q1,Q3)] 78(71,84) 77(70,82) 0.667
收缩压(mmHg,±s) 129±18 128±17 0.522
舒张压？
实验室检查[M(Q1,Q3)]      
白细胞(×103/μL) 6.10(4.60,7.50) 6.10(4.60,7.40) 0.646
血红蛋白(g/L) 115(85,132) 114(82,131) 0.734
红细胞比容(%) 35(27,40) 35(26,40) 0.814
血小板(×103/μL) 212(162,263) 215(165,265) 0.619
尿素氮(mg/dL) 86.4(68.58,113.4) 86.4(70.2,113.4) 0.962
肌酐(mg/dL) 0.8(0.66,0.94) 0.8(0.66,0.94) 0.859
白蛋白(g/dL) 37.7(34.1,41.4) 37.7(34.4,41.5) 0.900
国际标准化比值 1.10(1.00,1.10) 1.10(1.00,1.14) 0.662
再出血[例(%)] 94(26.5) 31(23.3) 0.475
输血[例(%)] 68(19.2) 26(19.5) 0.922
止血治疗[例(%)]     0.990
内镜治疗 29(8.2) 10(7.5)  
介入治疗 27(7.6) 10(7.5)  
手术治疗 37(10.4) 13(9.8)  
图1 训练集多因素分析森林图
表2 训练集急性下消化道出血患者单因素分析
变量 安全出院[例(%)] OR 95% CI P值
未发生组(n=158) 发生组(n=197)
男性 97(46.9) 110(53.1) 0.80 0.52~1.22 0.292
年龄≥60岁 88(40.6) 129(59.4) 1.51 0.98~2.32 0.061
下消化道出血病史 68(60.7) 44(39.3) 0.38 0.24~0.60 <0.001
合并症          
心脏病 30(35.3) 55(64.7) 1.65 1.00~2.76 0.051
高血压 70(47.9) 76(52.1) 0.79 0.52~1.21 0.276
卒中 20(51.3) 19(48.7) 0.74 0.38~1.44 0.368
肺病 4(50.0) 4(50.0) 0.80 0.19~3.42 0.752
肝病 8(80.0) 2(20.0) 0.19 0.03~0.78 0.039
肾脏病 6(37.5) 10(62.5) 1.35 0.49-4.06 0.565
糖尿病 31(53.4) 27(46.6) 0.65 0.37~1.14 0.136
肿瘤 21(47.7) 23(52.3) 0.86 0.46~1.63 0.646
结肠息肉病史 7(33.3) 14(66.7) 1.65 0.67~4.45 0.292
症状和体征          
新鲜出血 68(58.6) 48(41.4) 0.43 0.27~0.67 <0.001
直肠指诊 53(47.7) 58(52.3) 0.83 0.53~1.30 0.408
心率≥100次/min 16(64.0) 9(36.0) 0.42 0.18~0.97 0.047
收缩压<100 mmHg 8(42.1) 11(57.9) 0.90 0.34~2.28 0.829
实验室检查          
白细胞≥10×109/L 20(66.7) 10(33.3) 0.37 0.16~0.80 0.013
血红蛋白<100 g/L 88(71.0) 36(29.0) 5.62 3.51~9.16 <0.001
红细胞比容<35% 100(59.5) 68(40.5) 3.27 2.12~5.09 <0.001
血小板<150×109/L 31(46.3) 36(53.7) 1.09 0.64~1.86 0.747
尿素氮≥30 mg/dL 155(44.2) 196(55.8) 3.79 0.48~77.10 0.250
肌酐≥1.5 mg/dL 8(50.0) 8(50.0) 0.79 0.29~2.20 0.652
白蛋白<30 g/L 37(84.1) 7(15.9) 8.30 3.80~20.87 <0.001
国际标准化比值≥1.5 4(40.0) 6(60.0) 1.21 0.34~4.80 0.771
表3 H2ALB评分
预测因子 分值
肝病 无 0
有 3
下消化道出血病史 无 0
有 1
新鲜出血 无 0
有 1
血红蛋白 ≥100 g/L 0
<100 g/L 2
白蛋白 ≥30 g/L 0
<30 g/L 1
图2 预测急性下消化道出血患者安全出院的ROC曲线注：2A本评分在训练集的ROC曲线；2B不同评分在验证集的ROC曲线
图3 验证集H2ALB评分分布
表4 不同评分预测性能比较（AUC，95% CI）
评分 再出血 输血 止血治疗 安全出院
H2ALB 0.765(0.680~0.851) 0.839(0.762~0.916) 0.772(0.682~0.861) 0.827(0.759~0.895)
Oaklanda 0.604(0.490~0.717) 0.570(0~425~0.714) 0.567(0.442~0.692) 0.553(0.448~0.659)
Birminghamb 0.592(0.478~0.707) 0.565(0.428~0.702) 0.466(0.346~0.585) 0.450(0.347~0.553)
SALGIBc 0.577(0.461~0.694) 0.564(0.424~0.703) 0.487(0.369~0.604) 0.569(0.470~0.668)
aP/ bP/ cP 0.013/0.006/0.007 0.001/<0.001/<0.001 0.019/<0.001/<0.001 <0.001/<0.001/<0.001
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