改良BISAP评分系统的建立及其在重症急性胰腺炎早期诊断和预后评估中的意义  

Establishment of a modified BISAP scoring system and its clinical significance in the early diagnosis and prognostic evaluation of severe acute pancreatitis

作　　者：李蓉洁 彭依 唐小龙 张德才[1] 刘少俊[1] LI Rongjie;PENG Yi;TANG Xiaolong;ZHANG Decai;LIU Shaojun(Department of Gastroenterology,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院消化内科,长沙410013

出　　处：《临床肝胆病杂志》2023年第10期2432-2442,共11页Journal of Clinical Hepatology

基　　金：湖南省自然科学基金项目(2020JJ8107)。

摘　　要：目的 建立改良BISAP评分系统,比较并分析BISAP评分系统与改良BISAP评分系统对急性胰腺炎(AP)严重程度及病情评估的价值。方法 新系统的建立:回顾性收集2019年1月—2021年12月中南大学湘雅三医院收治的1 033例AP患者的临床资料。根据修订版Atlanta分级将其分为轻症急性胰腺炎(MAP)组(n=827)和重症急性胰腺炎(SAP)组(n=206),比较两组患者临床特征、实验室指标及影像学资料的差异,将差异有统计学意义的指标进行二元Logistic回归分析,筛选出SAP的独立危险因素,利用受试者特征曲线(ROC曲线)得出各独立危险因素的最大约登指数对应的最佳截断值,并根据不同情况分别赋值为0或1分,结合BISAP评分系统,建立改良BISAP评分系统。新系统验证:回顾性收集2017年1月—2018年12月中南大学湘雅三医院收治的473例AP患者的临床资料,对其进行BISAP评分与改良BISAP评分,利用ROC曲线下面积(AUC)分析比较两个评分系统对AP病情严重程度、预后的预测价值。计数资料应用χ^(2)检验或Fisher精确检验进行两组间比较;计量资料两组间比较采用成组t检验和Mann-Whitney U检验。结果 新系统的建立:MAP组与SAP组患者在入院方式、住院天数、是否入住ICU、死亡人数、合并基础疾病、出现并发症方面差异均有统计学意义(P值均<0.05)。二元Logistic回归分析显示,体温、NLR、CRP、Alb、TG、D二聚体、纤维蛋白原、MCTSI评分为SAP的独立危险因素(P值均<0.05)。ROC曲线分析显示CRP(AUC=0.921)、NLR(AUC=0.798)、D二聚体(AUC=0.768)及MCTSI评分(AUC=0.931)对SAP有较好的预测价值,且上述四项指标联合预测的AUC为0.976,与单个指标、两项指标联合及三项指标联合相比,其诊断效能更高,且差异有统计学意义(P值均<0.05)。新评分系统验证:共纳入473例患者,其中MAP组408例,SAP组65例。两组患者在入院方式、住院天数、是否入住ICU、死亡人数、出现并发Objective To establish a modified BISAP scoring system,and to investigate the value of the BISAP scoring system versus the modified BISAP scoring system in assessing the severity and condition of acute pancreatitis(AP).Methods For the establishment of the new scoring system,a retrospective analysis was performed for the clinical data of 1033 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2019 to December 2021,and according to the revised Atlanta classification,they were divided into mild acute pancreatitis(MAP)group with 827 patients and severe acute pancreatitis(SAP)group with 206 patients.The two groups were compared in terms of clinical features,laboratory markers,and imaging data.A binary logistic regression analysis was performed for the statistically significant indicators to screen for the independent risk factors for SAP.The receiver operating characteristic(ROC)curve was used to obtain the optimal cut-off value corresponding to the maximum Youden index for each independent risk factor,and a score of 0 or 1 was assigned depending on different situations,which was integrated into the BISAP scoring system to establish a modified BISAP scoring system.For the validation of the new scoring system,a retrospective analysis was performed for the clinical data of 473 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2017 to December 2018.BISAP score and modified BISAP score were determined for each patient,and the area under the ROC curve(AUC)was used to compare the value of the two scoring systems in predicting the severity and prognosis of AP.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups,and the independent-samples t test and the Mann-Whitney U test were used for comparison of continuous data between two groups.Results For the establishment of the new scoring system,there were significant differences between the MAP group and the SAP group in

关 键 词：急性胰腺炎 BISAP评分 早期诊断 预后 

分 类 号：R576[医药卫生—消化系统]