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摘要：
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摘要：目的 探讨改良危重症营养风险（modified nutrition risk in critically ill，mNUTRIC）
评分、血小板-白蛋白-胆红素（platelet-albumin-bilirubin，PALBI）评分在肝硬化上消
化道出血预后评估中的临床价值。方法 选择深圳市龙岗区第二人民医院消化科2020年1月
1日至2023年6月30日期间收治的145例肝硬化上消化道出血患者，根据30 d患者生存情
况分为死亡组（31例）和生存组（114例）。比较两组患者的性别、年龄、纤维蛋白
原（fibrinogen，FIB）、凝血酶原时间（prothrombin time，PT）、活化部分凝血酶时
间（activated partial thrombin time，APTT）、凝血酶原活动度（prothrombin activity，
PTA）、红细胞计数、白细胞计数、血红蛋白、血小板计数、总胆红素、白蛋白、乳
酸、肌酐、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、mNUTRIC评分、PALBI
评分、终末期肝病模型（model for end stage liver disease，MELD）评分、Child-Turcotte-
Pugh（CTP）评分等资料。采用多因素Logistic回归分析患者近期预后的影响因素，绘
制受试者工作特征（receiver operating characteristic，ROC）曲线分析各评分系统对患者
30 d死亡的预测价值。结果 死亡组患者肺部感染比例（13/31例比23/114例）、肝性脑病
发生率（9/31例比10/114例）、输血量 [（921.56 ± 84.30）ml比（687.17 ± 71.62）ml]、
PT [（19.74 ± 2.78）s比（17.33 ± 2.52）s]、APTT [（42.16 ± 3.32）s比（38.53 ± 2.73）s]、
总胆红素 [（97.50 ± 13.14）μmol/L比（90.35 ± 12.77）μmol/L]、乳酸 [（2.83 ± 0.75）mmol/L比
（1.89 ± 0.67）mmol/L]、肌酐 [（210.61 ± 19.85）μmol/L比（192.37 ± 20.04）μmol/L]、
mNUTRIC评分 [（5.74 ± 1.21）分比（3.22 ± 0.97）分]、MELD评分 [（16.89 ± 4.61）分
比（11.43 ± 3.54）分]、CTP评分 [（10.36 ± 2.48）分比（8.12 ± 2.07）分] 均显著高于存
活组患者，PTA [（46.03 ± 6.15）s比（62.74 ± 8.13）s]、血小板 [（53.29 ± 10.38）× 109/L比
（71.60 ± 11.22）× 109/L]、PALBI评分 [（－1.42 ± 0.39）分比（－1.94 ± 0.47）分] 均显著
低于存活组患者（P均＜ 0.05）。多因素Logistic回归分析表明肺部感染（OR = 2.127，
95%CI：1.244～3.698，P = 0.026）、肝性脑病（OR = 1.832，95%CI：1.164～2.850，
P ＜ 0.001）、输血量（OR = 1.537，95%CI：1.055～2.241，P = 0.045）、血乳酸（OR =
1.837，95%CI：1.021～3.242，P = 0.021）、mNUTRIC评分（OR = 1.634，95%CI：
1.116～2.373，P ＜ 0.001）、PALBI评分（OR = 1.470，95%CI：1.035～2.068，P ＜
0.001）、MELD评分（OR = 1.594，95%CI：1.113～3.249，P ＜ 0.001）、CTP评分
（OR = 1.452，95%CI：1.019～2.640，P ＜ 0.001）是肝硬化上消化道出血患者预后不
良的独立危险因素。mNUTRIC评分（0.819）、PALBI评分（0.804）的ROC曲线下面
积均高于MELD评分（0.754；z = 2.541、2.420，P = 0.015、0.019）和CTP评分（0.771；
z = 2.364、2.397，P = 0.024、0.022），mNUTRIC评分联合PALBI评分预测的ROC曲线
下面积（0.895）分别高于mNUTRIC评分和PALBI评分单独预测（z = 2.982、3.362，P =
0.002、0.001）。结论 mNUTRIC评分联合PALBI评分在肝硬化上消化道出血预后评估中
具有较高的临床价值。
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Abstract: Objective To investigate the clinical value of the Modified Critical Care Nutrition
Risk (mNUTRIC) score and Platelet Albumin Bilirubin (PALBI) score on evaluating
the prognosis of upper gastrointestinal bleeding in liver cirrhosis. Methods Total of 145
patients with upper gastrointestinal bleeding due to liver cirrhosis admitted to the Digestive
Department of the Second People’s Hospital of Longgang District in Shenzhen City from
January 1st, 2020 to June 30th, 2023 were selected. The patients were divided into death group
(31 cases) and survival group (114 cases) based on their 30-day survival status. Gender, age,
fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT),
prothrombin activity (PTA), red blood cell count, white blood cell count, hemoglobin, platelet
count, total bilirubin, albumin, lactate, creatinine, alanine aminotransferase (ALT), mNUTRIC
score, PALBI score, model for end stage liver disease (MELD) score, Child-Turcott-Pugh
(CTP) score of patients in two groups were compared. Multiple Logistic regression was used
to analyze the influencing factors of recent prognosis, and receiver operating characteristic
(ROC) curve was used to analyze the predictive value of each scoring system on 30 d
mortality. Results The incidence of pulmonary infection (13/31 cases vs. 23/114 cases),
incidence of hepatic encephalopathy (9/31 cases vs. 10/114 cases), blood transfusion volume
[(921.56 ± 84.30) ml vs. (687.17 ± 71.62) ml], PT [(19.74 ± 2.78)s vs. (17.33 ± 2.52)s], APTT
[(42.16 ± 3.32)s vs. (38.53 ± 2.73)s], total bilirubin [(97.50 ± 13.14) μmol/L vs. (90.35 ±
12.77) μmol/L], lactate [(2.83 ± 0.75) mmol/L vs. (1.89 ± 0.67) mmol/L], creatinine [(210.61 ±
19.85) μmol/L vs. (192.37 ± 20.04) μmol/L], mNUTRIC score [(5.74 ± 1.21) score vs. (3.22 ± 0.97)
score], MELD score [(16.89 ± 4.61) score vs. (11.43 ± 3.54) score] and CTP score [(10.36 ± 2.48)
score vs. (8.12 ± 2.07) score] of patients in death group were significantly higher than those of
survival group, while PTA [(46.03 ± 6.15) s vs. (62.74 ± 8.13) s], platelet count [(53.29 ± 10.38) × 109/L vs.
(71.60 ± 11.22) × 109/L] and PALBI score [(－1.42 ± 0.39) score vs. (－1.94 ± 0.47) score]
were significantly lower than those of survival group (all P ＜ 0.05). Multivariate Logistic
regression analysis showed that pulmonary infection (OR = 2.127，95%CI：1.244～3.698，
P = 0.026), hepatic encephalopathy (OR = 1.832，95%CI：1.164～2.850，P ＜ 0.001),
blood transfusion volume (OR = 1.537, 95%CI: 1.055～2.241, P = 0.045), lactate (OR = 1.837,
95%CI: 1.021～3.242, P = 0.021), mNUTRIC score (OR = 1.634, 95%CI: 1.116～2.373,
P ＜ 0.001), PALBI score (OR = 1.470, 95%CI: 1.035～2.068, P ＜ 0.001), MELD score
(OR = 1.594, 95%CI: 1.113～3.249, P ＜ 0.001) and CTP score (OR = 1.452, 95%CI:
1.019～2.640, P ＜ 0.001) were independent risk factors for poor prognosis in patients with
upper gastrointestinal bleeding in liver cirrhosis. The area under the ROC curve of mNUTRIC
score (0.819) and PALBI score (0.804) were higher than that of MELD score (0.754; z =
2.541, 2.420, P = 0.015, 0.019) and CTP score (0.771; z = 2.364, 2.397, P = 0.024, 0.022),
respectively. The area under the ROC curve of mNUTRIC score combined with PALBI score
(0.895) was higher than that of mNUTRIC score and PALBI score alone (z = 2.982, 3.362,
P = 0.002, 0.001). Conclusion The combination of mNUTRIC and PALBI scores had a high
clinical value on evaluating the prognosis of upper gastrointestinal bleeding in liver cirrhosis.
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