各评分系统对胰腺炎疾病严重程度预测价值的临床研究

摘要

目的：探讨各评分系统对急性胰腺炎（acute pancreatitis，AP）疾病严重程度预测价值的差异。方法回顾性分析156例 AP 患者的临床资料，记录患者入院时的 c-反应蛋白（CRP）等实验室检测值，结合中国胰腺炎诊治指南（2007）将患者分为轻症胰腺炎（mild acute pancreatitis， MAP）组、重症胰腺炎（severe acute pancreatitis，SAP）组。按照各评分系统的相应评分标准对患者进行急性生理学和慢性健康状况评分（APACHEⅡ）、Ranson、BISAP、CTSI 评分。按照APACHEⅡ≥8分、Ranson≥3分、BISAP≥2分、CTSI≥3分、CRP≥21．4 mg／L 的标准分别将患者区分为 MAP 组、SAP 组，ROC 曲线比较各评分系统对 AP 疾病严重程度预测价值的差异。结果156例 AP 患者，确诊为 SAP21例，另135例诊断为 MAP。APACHEⅡ≥8分、Ranson≥3分、BISAP≥2分、CTSI≥3分、CRP≥21．4 mg／L 预测 SAP 的 AUC 分别为0．78（95％CI：0．70～0．84），0．69（95％CI：0．62～0．76），0．74（95％CI：0．66～0．80），0．69（95％ CI：0．61～0．76），0．68（95％CI：0．57～0．78），各评分系统间差异无统计学意义。结论各评分系统对 SAP 的预测价值差异无统计学意义，在临床工作中，SAP 的早期预测应参考多种评价体系，临床获取及应用更为简便的单一实验室指标的参考意义，值得进一步深入研究。%Objective To investigate different scoring systems in predicting the severity of acute pancreatitis(AP).Methods The clinical data of 1 56 patients with AP were retrospectively reviewed.Ser-um c-reactive protein(CRP)levels were measuredat admission.According to the Chinese guidelines for the management of acute pancreatitis(2007),all the patients were categorizedas either mild acute pancre-atitis(MAP)or severe acute pancreatitis(SAP).Ranson,acute physiology and chronic health evaluation (APACHE)-Ⅱ,bedside index for severity in acute pancreatitis(BISAP),and computed tomography se-verity index(CTSI)scoring systemswere calculated according to the corresponding grading standardsin all patients.Patients were divided into MAP group(APACHEⅡ <8,Ranson <3,BISAP <2,CTSI <3 and CRP <21 .4)and SAP group (APACHEⅡ≥8,Ranson≥3,BISAP≥2,CTSI≥3 and CRP≥21 .4)ac-cording to the scoring results.ROC curve was used to compare the difference among the systems.Results Among the 1 56 patients,21 (1 3.5%)were classified as SAP and 1 35 as (86.5%)MAP.AUCs for Ranson,BISAP,APACHEⅡ,CTSI,and CRP in predicting SAP were 0.69 (95%CI:0.62-0.76),0.74 (95%CI:0.66-0.80),0.78 (95%CI:0.70-0.84),0.69 (95%CI:0.61 -0.76),and 0.68 (95%CI:0.57-0.78),respectively.There were no significant differences among these scoring systems.Conclusion There were no significant differencesin predicting the severity of AP among these scoring systems. Therefore,the early prediction of SAP should consider multiple scoring systems,and the referential signifi-cance of accessing and applying a simpler laboratory indicator deserves further studies.