脂肪肝诊断联合APACHE-Ⅱ评分提高预测重症急性胰腺炎的能力  

A combination of hepatic steatosis with APACHE- Ⅱ score improves the ability of predicting severe acute pancreatitis

作　　者：郝一鸣[1] 王士琪 冯全新[1] 冯向英[1] 余鹏飞[1] 白槟[1] 邱兆岩 王谦[1] 赵青川[1] 

机构地区：[1]第四军医大学西京消化病医院消化外科,西安710032

出　　处：《中华普通外科杂志》2016年第1期23-26,共4页Chinese Journal of General Surgery

摘　　要：目的明确脂肪肝是否为重症急性胰腺炎的暴露因素，判断脂肪肝诊断联合急性生理学和慢性健康评估 （ acute physiology and chronic health evaluation, APACHE- Ⅱ ）评分预测重症急性胰腺炎的能力。方法回顾性分析148例急性胰腺炎患者的临床资料，分为重症急性胰腺炎组（41例）和轻症急性胰腺炎组（107例）。比较两组患者的一般资料。根据APACHE-Ⅱ评分，进行亚组分析。计算联合预测的敏感性、特异性和ROC曲线下面积。结果脂肪肝与重症急性胰腺炎呈正相关。合并脂肪肝的患者发生重症急性胰腺炎的概率是未合并脂肪肝的5．33倍（OR=5．33，P=0．003）。亚组分析结果表明，入院24h内APACHE-Ⅱ评分〈8分的患者，合并脂肪肝的患者较未合并脂肪肝的患者，重症胰腺炎发生率（（34．5％比6．9％，P〈0．001）、全身并发症发生率更高（31％比5．7％，P〈0．001）。入院24h内APACHE—Ⅱ评分I〉8分的患者，合并脂肪肝的患者较未合并脂肪肝的患者．重症胰腺炎发生率（100％比65％，P=0．029）、全身并发症发生率更高（100％比65％，P=0．029）。人院24h内APACHE-Ⅱ评分预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为61．0％、93．5％、0．772。脂肪肝预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为53．7％、82．2％、0．680。两个指标联合预测重症急性胰腺炎的敏感性、特异性、ROC曲线下面积分别为85．4％、75．7％、0．861。结论脂肪肝和重症急性胰腺炎具有相关性。脂肪肝诊断联合APACHE—Ⅱ评分可以提高预测重症急性胰腺炎的能力。Objective To identify whether hepatic steatosis is the exposure factor of severe acute pancreatitis （SAP） and to investigate the prognostic efficacy of combining hepatic steatosis with APACHE-Ⅱ score in predicting the severity of SAP. Methods Clinicopathological data of 148 patient diagnosed as acute pancreatitis in Xijing Hospital from April 2011 to September 2013 were retrospectively analyzed. There were 41 severe acute pancreatitis（SAP） patients and 107 mild acute pancreatitis （MAP）. The prognosis of patients with and without hepatic steatosis were compared in the subgroups of patients with APACHE- Ⅱ scores 〈 and ≥8. The sensitivity, specificity, ROC curve of combining hepatic steatosis with APACHE-Ⅱ score in predicting SAP were evaluated. Results Hepatic steatosis was independently correlated with SAP （ OR = 5.33, P = 0. 003 ）. The incidence of SAP with hepatic steatosis is 5.33 times higher than the incidence of SAP without hepatic steatosis. In patients with an APACHE- Ⅱ score 〈 8, those with hepatic steatosis had a higher incidence of SAP （34.5% vs. 6.9, P 〈 0. 001 ） and systemic complications （31% vs. 5.7% , P 〈 0. 001 ）. In patients with an APACHE-Ⅱ score≥8, those with hepatic steatosis also had a higher incidence of SAP （ 100% vs. 65% , P = 0. 029） and systemic complications （100% vs. 65% , P = 0. 029）. The sensitivity and specificity of APACHE-Ⅱscore was 61.0% and 93.5%, the ROC curve area was 0. 772. The sensitivity and specificity of hepatic steatosis was 53.7% and 82.2% , the ROC curve area was 0. 680. The sensitivity and specificity of combining hepatic steatosis with APACHE- Ⅱ score was 85.4% and 75.5% , the ROC curve area was 0. 861. Conclusions Hepatic steatosis correlates with a worse prognosis of AP. Combining hepatic steatosis withAPACHE-Ⅱ score can improve the ability of predicting SAP.

关 键 词：胰腺炎  急性坏死性 脂肪肝 诊断 

分 类 号：R641[医药卫生—外科学]