基于大样本数据库比较APACHEⅡ、Ranson、BISAP和CTSI评分在早期预测急性胰腺炎病情严重程度的价值  

Comparison of APACHEⅡ, Ranson, BISAP and CTSI scores in early prediction of the severity of acute pancreatitis based on large sample database

作　　者：何文华[1] 郑西 祝荫[1] 夏亮[1] 朱勇[1] 曾皓[1] 刘丕[1] 吕农华[1] He Wenhua;Zheng Xi;Zhu Yin;Xia Liang;Zhu Yong;Zeng Hao;Liu Pi;Lu Nonghua(Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang 330006, China)

机构地区：[1]南昌大学第一附属医院消化内科,南昌330006

出　　处：《中华胰腺病杂志》2019年第3期172-176,共5页Chinese Journal of Pancreatology

基　　金：国家临床重点建设专科项目(卫办医政函(2011)872号)江西省科技计划项目(20151BBG70219).

摘　　要：目的评估APACHEⅡ、Ranson、BISAP和CTSI评分系统预测急性胰腺炎(AP)患者从轻症AP(MAP)发展为中度重症AP(MSAP)、重症AP(SAP)及死亡风险的准确性。方法从AP数据库选取2014年至2017年间发病3 d内入院的2 080例患者,按修订的亚特兰大新分类标准对病情严重程度进行分级;将住院期间死亡或病重自动出院的患者界定为死亡风险患者。以受试者工作特征(ROC)曲线比较各评分系统预测MSAP、SAP和死亡风险的准确性。结果2 080例患者按亚特兰大新分类标准诊断MAP 857例(41.2%),MSAP 892例(42.9%)和SAP 331例(15.9%);ROC曲线分析显示,APACHEⅡ、Ranson、BISAP评分及CT严重指标(CTSI)评分对于MSAP无预测价值,但对SAP和死亡风险有预测价值。其中在入院第1天和第2天APACHEⅡ评分预测SAP准确性最高,曲线下面积(AUC)分别为0.785和0.746,入院第1天APACHEⅡ评分预测死亡风险准确性也最高(AUC=0.845)。结论各评分系统只对SAP和死亡风险有预测价值,其中APACHEⅡ评分预测SAP和死亡风险的准确性最高。Objective To clarify the accuracy of APACHEⅡ, Ranson, BISAP and CTSI scoring systems for predicting the progression of mild acute pancreatitis (MAP) to moderate acute pancreatitis (MSAP) and severe acute pancreatitis (SAP), and death risk of patients with acute pancreatitis (AP). Methods All data from 2080 consecutive adult patients who were admitted within 3 days of disease onset were selected from AP database between 2014 and 2017. The severity was classified according to the revised Atlanta classification systems. Patients who died during hospitalization or discharged automatically were defined as patients at risk of death. The predictive accuracies for MSAP, SAP and death risk were compared using receiver operating characteristic (ROC) curves. Results The 2080 patients with AP were divided into MAP (n=857, 41.2%), MSAP (n=892, 42.9%), and SAP (n=331, 15.9%) according to the revised Atlanta classification system. ROC curve analysis showed APACHEⅡ score, Ranson score, BISAP score and the CT severity index (CTSI) had no predictive value for MSAP, but have predictive value for SAP and death risk. APACHEⅡ score had the highest accuracy in predicting SAP with area under the curve (AUC) values of 0.785 and 0.746 on the 1st and 2nd day after admission, respectively, and the APACHEⅡ score on admission day 1 had the highest accuracy in predicting death risk (AUC=0.845). Conclusions Various scoring systems had predictive value only for SAP and death risk, and APACHEⅡ score had the highese accuracy in predicting SAP and death risk.

关 键 词：胰腺炎 急性坏死性 死亡风险 预测 数据库 

分 类 号：R576[医药卫生—消化系统]