三种评分法对重症急性胰腺炎病人并发胰腺感染预测价值的比较研究  

A comparative study on three scores in the prediction of acute pancreatitis complicated with pancreatic infection

作　　者：伏添 王学莉 童智慧[2] 李维勤[2] 

机构地区：[1]汉中市三二0一医院重症医学科,陕西汉中723000 [2]南京军区南京总医院普通外科,江苏南京210002

出　　处：《肠外与肠内营养》2016年第3期129-132,共4页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金青年项目资助(81200334)

摘　　要：目的:探讨序贯器官衰竭评估(SOFA)评分、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分和腹部CT胰腺外炎症(EPIC)评分对预测重症急性胰腺炎(SAP)并发胰腺感染的意义。方法:选取127例SAP病人进行研究,入院24 h内对病人进行SOFA、APACHEⅡ和EPIC评分,分析三种评分方法对预测病人病情的价值。结果:感染组病人三种评分均高于非感染组,且差异均有显著性统计学意义(P<0.05)。在已并发胰腺感染的SAP病人中,发现APACHEⅡ评分、SOFA评分和EPIC评分的AUC数值依次为0.787、0.786、0.765,说明三种评分在感染预后的评估中具有一定的价值。EPIC评分和APACHEⅡ评分的灵敏度相等,均高于SOFA评分;APACHEⅡ评分和SOFA评分的特异性均高于EPIC评分。将三种评分做Logstic回归分析显示,EPIC评分对SAP并发胰腺感染有预测价值(P<0.05)。结论:三种评分法对SAP病人的感染预后评估有一定的价值。EPIC评分为SAP并发胰腺感染的危险因素,具有预测作用,可帮助临床早期采取必要的临床干预。Objective： To investigate the significance of SOFA, APACHE H and extrapancreatic inflammation on CT（EPIC） score in predicting severe acute pancreatitis complicated with pancreatic in- fection. Methods： 127 Patients included in this study were collected from two different hospitals： 87 cases inthe Jinling Hospital between March 2012 to June 2012 and 127 casesin our hospital between July 2012 to December 2014. The EPIC score, APACHE Ⅱ score and SOFA scorewere caculated within 24 h after admission. Logistic regression and receiver operating characteristic curve were used for analysis. Results ： The EPIC score, APACHE Ⅱ score and SOFA score were significantly higher in patients complicated with pancreatic infections than those of patients without pancreatic infections （ P 〈 0.05 ）. The AUC of APACHE Ⅱscore, SOFA score and EPIC score are 0.787, 0.786, 0.765, respectively and no difference could be detected among the three scores in the prediction of pancreatic infection, suggestingconsiderable and equal predictive accuracy of the three scoring systems. The sensitivity of the EPIC score and the APACHEⅡ score is a bit higher than the SOFA score, and the specificity of the SOFA score and the APACHEⅡ scoreis higher than the EPIC score. Logstic regression analysis shows that only EPIC score haddefinite predictive value for SAP complicated with pancreatic infection （P 〈 0. 05 ）. Conclusion ： All the three scoring systems are valuable in evaluating the prognosis of SAP patients. The EPIC score could serve as a risk factor for pancreatic infection, and may help facilitate necessary clinical interventions.

关 键 词：重症急性胰腺炎 胰腺感染 急性生理与慢性健康评估Ⅱ 序贯器官衰竭评估 腹部CT胰 腺外炎症 评分 

分 类 号：R576[医药卫生—消化系统] R151.42[医药卫生—内科学]