急性重症胆源性胰腺炎预测模型建立的临床意义  

Clinical significance of establishment of predictive model for severe acute biliary pancreatitis

作　　者：李玉 蔡兆辉[1] 魏国峰[1] 张旗[1] 陈良[1] 陈辉 李海山 LI Yu;CAI Zhao-hui;WEIGuo-feng(Department of Emergency,The Second People's Hospital of Hefei,Hefei Hospital affiliated to Anhui Medical Universiy,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)急诊科,合肥230011 [2]不详

出　　处：《肝胆外科杂志》2023年第2期116-120,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆源性胰腺炎(biliary pancreatitis,BP)的预后风险因素,建立多指标联合预测模型并评估该预测模型的临床意义。方法回顾性分析在2016年1月-2020年12月期间在合肥市第二人民医院就诊的84例中度重症和重症胆源性胰腺炎患者,根据修订版亚特兰大诊断标准,中度重症组病人67例和重症组病人17例。应用单因素分析及二分类Logis-tic回归分析筛选出胆源性胰腺炎早期相关的独立预后风险因素,建立多指标联合预测模型,绘制预测模型的受试者工作特征曲线(ROC),确定截断值、计算曲线下面积(AUC)、灵敏度、特异度、阳性预测值及阴性预测值,评估多指标联合预测模型的临床预测效果。结果单因素分析显示,早期白蛋白、肌酐、APACHEⅡ评分、ARDS发生率在两组间的差异有统计学意义;多因素回归分析显示,APACHEⅡ评分、ARDS发生率为胆源性胰腺炎的预后独立风险因素;预测模型APACHEⅡ评分、ARDS、A-PACHEⅡ评分和ARDS的AUC、灵敏度、特异度、阳性预测值、阴性预测值分别为:0.870、0.727、0.867、66.7%、89.7%;0.768、0.636、0.900、70.0%、87.10.930.0.909、0.867、71.4%、93.6%。结论早期血清白蛋白、肌酐、APACHEⅡ评分、ARDS与胆源性胰腺炎的预后相关,其中APACHEⅡ评分、ARDS为独立的预后风险因素,多指标联合预测模型可更准确的预测胆源性胰腺炎患者预后,指导临床治疗。Objective To investigate the prognostic risk factors of biliary pancreatitis(BP),to establish a multi-index pre-dictive model and to evaluate its clinical significance.Methods A retrospective analysis of 84 patients with moderate to severe and se-vere biliary pancreatitis admitted to Hefei Second People's hospital between January 2016 and December 2020 was performed,there were 67 patients in moderate severe group and 17 patients in severe group.Univariate analysis and binary Logistic regression analysis were used to screen out the independent prognostic risk factors related to the early stage of biliary pancreatitis,and a multi-index com-bined prediction model was established to draw the receiver operating characteristic curve(ROC)of the prediction model,the cut-off value,area under the curve(AUC),sensitivity,specificity,positive and negative predictive values were determined and the clinical predictive effect of the combined multi-index prediction model was evaluated.Results Univariate analysis showed that there were sig-nificant differences in early albumin,creatinine,Apache II score,and incidence of Ards between the two groups,apacheⅡscore and incidence of ARDS were independent risk factors for the prognosis of biliary pancreatitis The AUC,sensitivity,specificity,positive pre-dictive value and negative predictive value of ApacheⅡscore,ARDS,ApacheⅡscore and ARDS were 0.870,0.727,0.867,66.7%and 89.7%,respectively 0.768,0.636,0.900.70.0%,87.1;0.930.0.909,0.867,71.4%,93.6%.Conclusions Early Alb,creatinine,ApacheⅡscore and ARDS are associated with the prognosis of biliary pancreatitis.ApacheⅡscore and ARDS are inde-pendent prognostic risk factors,the multi-index combined prediction model can more accurately predict the prognosis of patients with biliary pancreatitis and guide clinical treatment.

关 键 词：胆源性胰腺炎 APACHEⅡ评分 急性呼吸窘迫综合征 预测模型 

分 类 号：R657.51[医药卫生—外科学]