修订亚特兰大分类和基于决定因素分类对急性胰腺炎的评估研究  

Evaluation of Revised Atlanta Classification and Determinant-based Classification for Acute Pancreatitis

作　　者：张东丽[1] 焦晨阳 伏亦伟[1] 杨斌[1] 赵治彬[1] ZHANG Dongli;JIAO Chenyang;FU Yiwei;YANG Bin;ZHAO Zhibin(Department of Gastroenterology, Jiangsu Taizhou People’s Hospital, Taizhou, Jiangsu Province 225300)

机构地区：[1]江苏省泰州市人民医院消化科,225300

出　　处：《胃肠病学》2021年第3期151-154,共4页Chinese Journal of Gastroenterology

摘　　要：背景:修订亚特兰大分类(RAC)和基于决定因素分类(DBC)是临床广泛应用的急性胰腺炎(AP)严重程度分类标准,目前对上述两种分类标准的比较研究较少。目的:探讨RAC和DBC在AP严重程度评估中的准确性。方法:收集2015年9月—2019年9月泰州市人民医院收治的481例AP患者的临床资料,按RAC和DBC标准进行分组,比较各亚组患者的治疗和预后结果。结果:按RAC标准,轻度AP(MAP)、中重度AP(MSAP)、重度AP(SAP)分别为269例(55.9%)、174例(36.2%)、38例(7.9%),各组病死率、入住ICU比例、ICU停留时间、手术率、住院时间相比差异均有统计学意义(P<0.05)。按DBC标准,MAP、MSAP、SAP、危重AP(CAP)分别为319例(66.3%)、117例(24.3%)、34例(7.1%)和11例(2.3%),各组病死率、入住ICU比例、ICU停留时间、手术率、住院时间相比差异均有统计学意义(P<0.05)。DBC的CAP患者的入住ICU比例(100%对63.2%、P=0.014)、中位ICU停留时间(35 d对15 d,P=0.001)、平均住院时间[(50.36±21.54)d对(22.78±14.56)d,P=0.038]均显著高于RAC的SAP患者,而病死率和手术率无明显差异(P=0.136;P=0.202)。结论:RAC和DBC均能准确地评估AP的严重程度,对于合并感染性坏死的SAP(RAC标准)患者应进一步单独归类为CAP。Background:The revised Atlanta classification(RAC)and determinant-based classification(DBC)are widely used in assessing the severity of acute pancreatitis(AP).However,studies on comparison between RAC and DBC are scarce.Aims:To explore the accuracy of RAC and DBC in the assessment of AP severity.Methods:The clinical data of 481 AP patients from September 2015 to September 2019 at Taizhou People’s Hospital were collected and severity were stratified according to RAC and DBC.The treatment and prognosis of each subgroup were compared.Results:On the basis of RAC,269(55.9%),174(36.2%)and 38(7.9%)patients were classified as mild AP(MAP),moderate severe AP(MSAP)and severe AP(SAP),respectively.There were significant differences in mortality,ICU monitoring rate,ICU stay,operation rate and hospital stay among the above groups(P<0.05).On the basis of DBC,319(66.3%),117(24.3%),34(7.1%)and 11(2.3%)patients were classified as MAP,MSAP,SAP and critical AP(CAP),respectively.There were significant differences in mortality,ICU monitoring rate,ICU stay,operation rate and hospital stay among the above groups(P<0.05).The ICU monitoring rate(100%vs.63.2%,P=0.014),median ICU stay(35 days vs.15 days,P=0.001),hospital stay[(50.36±21.54)days vs.(22.78±14.56)days,P=0.038]were significantly increased in CAP patients(classified by DBC)than those in SAP patients(classified by RAC),however,no significant differences in mortality and operation rate were found between the two groups(P=0.136;P=0.202).Conclusions:Both RAC and DBC can accurately stratify the severity of AP.SAP patients(classified by RAC)complicated with infected necrosis should be further classified into CAP.

关 键 词：急性胰腺炎 修订亚特兰大分类 基于决定因素分类 感染性坏死 预后 

分 类 号：R47[医药卫生—护理学]