急性非静脉曲张性上消化道出血再出血危险 因素分析及预测模型构建

Analysis of Risk Factors for Rebleeding in Acute Non-Variceal Upper Gastrointestinal Bleeding and Construction of Prediction Models

摘要: 急性非静脉曲张性上消化道出血(ANVUGIB)是消化内科常见急症，再出血发生率高达10%~15%，且显著增加患者死亡率、住院时间及医疗负担。现代诊疗强调从“单一止血”向“多维度风险分层与个体化干预”转变。本文系统综述ANVUGIB再出血的危险因素，包括患者基础状况、合并症、药物暴露、治疗方式及实验室指标等，并对现有风险预测模型(如Glasgow-Blatchford评分、Rockall评分、AIMS65评分及新型预测模型)进行评述。研究表明，高龄、吸烟饮酒、合并高血压/糖尿病/慢性肾病、使用抗血小板药或NSAIDs、内镜下Forrest Ia~IIb级病变、低血红蛋白、高血尿素氮/肌酐比、凝血功能异常等是再出血的关键风险因素。现有模型存在维度单一、预测效能有限、缺乏外部验证及干预衔接不足等问题。未来需构建多中心、大样本、整合多维度指标的预测模型，并推动“风险评估–干预决策”一体化，以提升ANVUGIB的精准管理水平。

Abstract: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common emergency in gastroenterology, with a rebleeding rate as high as 10%~15%, which significantly increases patient mortality, hospital stay and medical burden. Modern diagnosis and treatment emphasize the transformation from “single hemostasis” to “multi-dimensional risk stratification and individualized intervention”. This article systematically reviews the risk factors for rebleeding in ANVUGIB, including patients’ basic conditions, comorbidities, drug exposure, treatment methods and laboratory indicators, and comments on existing risk prediction models (such as Glasgow-Blatchford score, Rockall score, AIMS65 score and new prediction models). Studies have shown that advanced age, smoking and drinking, complicated with hypertension/diabetes/chronic kidney disease, use of antiplatelet drugs or NSAIDs, endoscopic Forrest Ia~IIb lesions, low hemoglobin, high blood urea nitrogen/creatinine ratio, and abnormal coagulation function are key risk factors for rebleeding. Existing models have problems such as single dimension, limited prediction efficiency, lack of external verification and insufficient intervention connection. In the future, it is necessary to construct a multi-center, large-sample prediction model integrating multi-dimensional indicators, and promote the integration of “risk assessment-intervention decision-making” to improve the precise management level of ANVUGIB.