四项国际消化道内镜围术期抗栓药物应用指南对中国老年患者不良事件的预测能力

摘要

Objective To study the value of British Society of Gastrointerology (BSG),American Society of Gastrointestinal Endoscopy (ASGE),European Society of Gastrointestinal Endoscopy (ESGE) and Japan Gastroenterological Endoscopy Society (JGES) guidelines for predicting adverse events in elderly Chinese patients during gastrointestinal endoscopic perioperation.Methods A total of 3747 patients undergoing gastrointestinal endoscopy were included in this study.The value of BSG,ASGE,ESGE and JGES guidelines for predicting thromboembolism and bleeding in elderly Chinese patients during gastrointestinal endoscopic perioperation was assessed by ROC curve.Results The area under the ROC curve (AUC) for JGES,ASGE+ BSG+ ESGE and for JGES,ASGE+ BSG for predicting thromboembolism and bleeding was 0.605 and 0.591,0.590and 0.591 (95％CI:0.535-0.675,P=0.001;95％CI:0.521-0.660,P=0.004;95％CI:0.522-0.658,P=0.005;95％CI:0.515-0.651,P=0.009).The AUC for JGES,ASGE+BSG+ESGE for predicting acute coronary syndrome was 0.619 and 0.606 (95％CI:0.538-0.700,P=0.001;95％CI..0.525-0.687,P=0.004).The AUC for JGES for predicting the major and minor bleeding events was 0.606 and 0.636 (95 ％ CI.:0.541-0.671,P=0.002;95％CI:0.568-0.703,P=0.001).Conclusion The value of 4 international guidelines is poor for predicting thromboembolism in Chinese elderly people during gastrointestinal endoscopic perioperation.%目的 探讨英国胃肠病学学会(BSG)、美国胃肠道内镜学会(ASGE)、欧洲胃肠内镜学会(ESGE)和日本胃肠内镜学会(JGES)等4项国际指南对中国老年患者消化道内镜围术期不良事件的预测能力.方法 选择接受择期消化道内镜检查患者3747例.采用ROC曲线评价4项国际指南的血栓栓塞风险分层与出血风险分层对消化道内镜围术期不良事件的预测能力.结果 JGES指南、ASGE+ BSG+ ESGE指南预测停用抗血小板药物后总体血栓栓塞ROC曲线下面积分别为0.605(95％ CI:0.535～0.675,P=0.001)和0.591(95％CI:0.521～0.660,P=0.004).JGES指南、ASGE+ BSG指南预测停用抗凝药物后总体血栓栓塞风险的ROC曲线下面积分别为0.590(95％CI:0.522～0.658,P=0.005)和0.591(95％CI:0.515～0.651,P=0.009). JGES指南、ASGE+ BSG+ESGE指南预测停用抗血小板药物后急性冠状动脉综合征(acute coronary syndrome,ACS)风险的ROC曲线下面积分别为0.619(95％CI:0.538～0.700,P=0.001)和0.606(95％CI:0.525～0.687,P=0.004).JGES指南出血风险分层预测总体出血事件和小出血事件的ROC曲线下面积分别为0.606(95％CI:0.541～0.671,P=0.002)和0.636(95％CI:0.568～0.703,P=0.001).结论 4项指南对消化道内镜围术期血栓栓塞风险的预测能力较低.