急性胰腺炎严重程度床边指数与血清钙比值对急性胰腺炎严重程度的预测价值  

Predictive value of the ratio of bedside index of severity in acute pancreatitis to serum calcium in the degree of severity in acute pancreatitis

作　　者：冯子钦 陈卫昌[1] Feng Ziqin;Chen Weichang(Department of Gastroenterology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院消化内科,苏州215006

出　　处：《中华消化杂志》2023年第12期800-805,共6页Chinese Journal of Digestion

摘　　要：目的评估入院24 h内急性胰腺炎严重程度床边指数(BISAP)与血清钙比值(BISAP/Ca)在急性胰腺炎(AP)严重程度中的预测价值。方法纳入2020年1月1日至2022年12月31日就诊于苏州大学附属第一医院的AP患者711例。根据AP严重程度将711例患者分为轻症AP组(586例)和重症AP组(包括中度重症、重症AP患者,125例),根据是否发生呼吸系统功能障碍分为无呼吸系统功能障碍组(594例)和呼吸系统功能障碍组(117例)。根据患者入院24 h内指标最差值(最高值或最低值)计算急性生理和慢性健康状况Ⅱ(APACHE-Ⅱ)评分,根据患者入院24 h内指标检测值计算BISAP评分,根据患者入院72 h内增强计算机断层扫描结果计算改良计算机断层扫描严重指数(MCTSI)评分。统计学分析采用Mann-Whitney U检验和卡方检验。使用受试者操作特征曲线(ROC)评估BISAP/Ca对AP严重程度的预测价值,并根据灵敏度和特异度计算最佳截断值。采用单因素和多因素logistic回归分析AP患者发生呼吸系统功能障碍的危险因素。结果重症AP组住院天数、全身炎症反应综合征患者占比、胸腔积液患者占比,以及APACHE-Ⅱ、BISAP、MCTSI评分和BISAP/Ca均高于轻症AP组[18.00 d(12.00 d,29.00 d)比9.00 d(6.00 d,12.00 d)、74.4%(93/125)比22.5%(132/586)、90.4%(113/125)比42.3%(248/586)、9.00分(6.00分,13.50分)比4.00分(2.00分,7.00分)、2.00分(2.00分,3.00分)比1.00分(0.00分,1.00分)、4.00分(4.00分,6.00分)比4.00分(2.00分,4.00分)、1.05(0.92,1.54)比0.47(0.00,0.55)],差异均有统计学意义(Z=-12.39,χ^(2)=128.16、95.28,Z=-10.83、-12.50、-11.54、-13.27;均P<0.001)。ROC分析显示,BISAP/Ca、BISAP、血清钙、MCTSI、APACHE-Ⅱ评分预测AP患者严重程度ROC的曲线下面积(95%置信区间)分别为0.873(0.842~0.904)、0.839(0.804~0.875)、0.797(0.752~0.843)、0.802(0.762~0.842)、0.807(0.762~0.852),差异均有统计学意义(均P<0.001)。根据约登指数确定BISAP/Ca区分轻症AP和重症AObjective To evaluate the predictive value of the ratio of bedside index of severity in acute pancreatitis(BISAP)to serum calcium(BISAP/Ca)within 24 hours of admission in the severity of acute pancreatitis(AP).Methods From January 1,2020,to December 31,2022,711 AP patients visited the First Affiliated Hospital of Soochow University were enrolled.According to the severity of AP,the 711 patients were divided into mild AP group(586 cases)and severe AP group(including moderately severe and severe AP patients,125 cases).According to the occurrence of respiratory dysfunction,the 711 patients were divided into a group without respiratory dysfunction(594 cases)and a group with respiratory dysfunction(117 cases).Acute physiology and chronic health evaluation-Ⅱ(APACHE-Ⅱ)score was calculated based on the worst indicators(highest or lowest values)within 24 hours of admission.BISAP score was calculated based on the indicator values of the patients within 24 hours of admission.And modified computed tomography(CT)severity index(MCTSI)score was calculated based on the results of enhanced CT within 72 hours of admission.Mann-Whitney U test and chi-square test were used for statistical comparison.The predictive value of BISAP/Ca for the severity of AP was assessed by receiver operating characteristic curve(ROC),and the optimal cut-off value was calculated based on sensitivity and specificity.Univariate and multivariate logistic regression analyses were used to analyze the risk factors of developing respiratory dysfunction in AP patients.Results The hospital stay,proportion of patients with systemic inflammatory response syndrome,proportion of patients with pleural effusion,and scores of APACHE-II,BISAP,MCTSI,and BISAP/Ca of the severe AP group were higher than those of the mild AP group(18.00 d(12.00 d,29.00 d)vs.9.00 d(6.00 d,12.00 d),74.4%(93/125)vs.22.5%(132/586),90.4%(113/125)vs.42.3%(248/586),9.00(6.00,13.50)vs.4.00(2.00,7.00),2.00(2.00,3.00)vs.1.00(0.00,1.00),4.00(4.00,6.00)vs.4.00(2.00,4.00),1.05(0.92,1.54)vs.0.47(0.00,

关 键 词：急性胰腺炎 严重程度 急性胰腺炎严重程度床边指数 血清钙 呼吸系统功能障碍 

分 类 号：R576[医药卫生—消化系统]