常用评分方法对危重型急性胰腺炎诊断价值的回顾性单中心临床研究  

The diagnostic value of scoring systems in critical acute pancreatitis： a single center retrospective study

作　　者：陈玉辉[1] 许志平[2] 杨栋梁[1] 童智慧[1] 李维勤[1] 

机构地区：[1]南京军区南京总医院全军普外科研究所、南京大学医学院,南京210002 [2]聊城市人民医院

出　　处：《中华胰腺病杂志》2015年第3期145-149,共5页Chinese Journal of Pancreatology

基　　金：国家自然科学基金（81300360）

摘　　要：目的 探讨常用的几类评分系统对危重型急性胰腺炎患者早期临床诊断的价值.方法 收集2007年1月至2013年6月间南京军区南京总医院全军普通外科研究所收治的发病72 h内入院的急性胰腺炎（AP）患者184例,按照DBC法分为轻型、中型、重型及危重型AP.采用受试者工作特征曲线下面积（AUC）的方法预测危重型AP.采用Z检验及Logistic回归分析几种AP评分系统的诊断价值.结果 Sofa、BISAP评分和CTSI早期诊断危重型AP的AUC分别为0.896、0.877和0.862,最佳诊断界值分别为4.5、9.5和2.5,APACHEⅡ和Ranson评分的AUC分别为0.807和0.707,最佳诊断界值分别为8.5和3.5.Z检验分析结果显示,Sofa、BISAP评分和CTSI早期诊断危重型AP价值显著高于Ranson评分,差异有统计学意义（P值均＜0.05）;三者亦高于APACHEⅡ评分,但差异元统计学意义（P值均＞0.05）.Logistic回归分析显示APACHEⅡ、Sofa、BISAP评分和CTSI指数高是发生危重型AP的危险因素（P值均＜0.05）.结论 Sofa、BISAP评分和CTSI早期诊断危重型AP可能具有重要的临床意义。Objective To investigate the early diagnostic value of traditional scoring systems in critical acute pancreatitis.Methods From Jan 2007 to Ju12013,consecutive 184 patients with AP who were admitted to the surgical intensive care unit of the Institute of General Surgery,Nanjing Generai Hospital of Najing Militery Region within 72 h from the onset of the disease were studied.Patients were assigned to four groups,including mild,moderate,severe and critical AP according to the determinant based classification and the receiver operating characteristics（ROC） curve was used to predict the presence of critical AP,and Z test and logistic regression was applied to determine the diagnostic value of traditional scoring systems.Results The area under ROC （AUC） of Sofa,BISAP and CTSI score for early diagnosis of critical AP was 0.896,0.877 and 0.862;the best cut off value was 4.5,9.5 and 2.5.Moreover,the AUC of APACHE Ⅱ and Ranson score was 0.807 and 0.707,and the best cut off value was 8.5 and 3.5,respectively.Z test showed early diagnosis rate of Sofa,BISAP,CTSI score was significantly higher than that in Ranson score,and the difference between the two groups was statistically significant （P 〈 0.05）;though they were higher than APACHE Ⅱ score,the difference between the two groups was not statistically significant （P 〉 O.05）.Logistic regression showed that high APACHE Ⅱ,Sofa,BISAP and CTSI score were independent risk factors for the development of critical AP （P 〈 0.05）.Conclusions Sofa,CTSI and BISAP score may be clinically important for early diagnosis of critical AP.

关 键 词：胰腺炎 急性坏死性 早期诊断 评分系统 回顾性研究 

分 类 号：R576[医药卫生—消化系统]