CAJ | 학술논문

目的探讨APACHE-Ⅱ+肥胖指标(APACHE-O)、APACHE-Ⅱ、Ranson、Balthazar CT评分系统(CTSI)对急性胰腺炎(AP)预后的评估价值.方法收集2005年1月1日至2011年1月1日321例AP患者临床资料,分别计算入院48 h内APACHE-O、APACHEⅡ、Ranson及CTSI 评分.用受试者工作曲线(ROC)和曲线下面积(AUC)分析比较上述评分系统判断重症AP的预测价值,并分析它们对局部并发症、全身并发症及病死的预测能力.结果取诊断阈值为7时,APACHE-O评分对重症AP预测的敏感性、特异性和准确性分别为95.4％、76.6％和79.4％,约登指数和AUC分别为0.720和0.736；取诊断阈值为8时,APACHE-Ⅱ评分对重症AP预测的敏感性、特异性和准确性分别为90.4％、81.0％和82.6％,约登指数和AUC分别为0.714和0.699；取诊断阈值为3时,Ranson评分对重症AP预测的敏感性、特异性和准确性分别为75.0％、78.1％和77.6％,约登指数和AUC分别为0.531和0.703；取诊断阈值为5时,CTSI评分对重症AP预测的敏感性、特异性和准确性分别为82.7％、91.4％和90％,约登指数和AUC分别为0.741和0.778.结果提示评分系统的准确性:CTSI＞ APACHE-O＞ Ranson和APACHE-Ⅱ.CTSI对AP局部并发症预测能力最高,约登指数和AUC分别为0.766和0.777;取诊断阈值为5时,敏感性、特异性和准确性为85.4％、91.2％和90.3％.APACHE-O对AP全身并发症预测能力最高,约登指数和AUC分别为0.789和0.779;取诊断阈值为8时,诊断的敏感性、特异性和准确性为91.1％、87.8％和88.2％.CTSI对AP死亡发生的预测能力最高,约登指数和AUC分别为0.952和0.847；取诊断阈值为8时,敏感性、特异性和准确性为100％、95.2％和95.3％.结论 CTSI评分系统判断重症AP有较高预测能力,CTSI评分对AP局部并发症和死亡预测能力最高,APACHE-O对AP全身并发症预测能力最高.
목적 탐토APACHE-Ⅱ+비반지표(APACHE-O)、APACHE-Ⅱ、Ranson、Balthazar CT평분계통(CTSI)대급성이선염(AP)예후적평고개치.방법 수집2005년1월1일지2011년1월1일321례AP환자림상자료,분별계산입원48 h내APACHE-O、APACHEⅡ、Ranson급CTSI 평분.용수시자공작곡선(ROC)화곡선하면적(AUC)분석비교상술평분계통판단중증AP적예측개치,병분석타문대국부병발증、전신병발증급병사적예측능력.결과 취진단역치위7시,APACHE-O평분대중증AP예측적민감성、특이성화준학성분별위95.4％、76.6％화79.4％,약등지수화AUC분별위0.720화0.736；취진단역치위8시,APACHE-Ⅱ평분대중증AP예측적민감성、특이성화준학성분별위90.4％、81.0％화82.6％,약등지수화AUC분별위0.714화0.699；취진단역치위3시,Ranson평분대중증AP예측적민감성、특이성화준학성분별위75.0％、78.1％화77.6％,약등지수화AUC분별위0.531화0.703；취진단역치위5시,CTSI평분대중증AP예측적민감성、특이성화준학성분별위82.7％、91.4％화90％,약등지수화AUC분별위0.741화0.778.결과 제시평분계통적준학성:CTSI＞ APACHE-O＞ Ranson화APACHE-Ⅱ.CTSI대AP국부병발증예측능력최고,약등지수화AUC분별위0.766화0.777;취진단역치위5시,민감성、특이성화준학성위85.4％、91.2％화90.3％.APACHE-O대AP전신병발증예측능력최고,약등지수화AUC분별위0.789화0.779;취진단역치위8시,진단적민감성、특이성화준학성위91.1％、87.8％화88.2％.CTSI대AP사망발생적예측능력최고,약등지수화AUC분별위0.952화0.847；취진단역치위8시,민감성、특이성화준학성위100％、95.2％화95.3％.결론 CTSI평분계통판단중증AP유교고예측능력,CTSI평분대AP국부병발증화사망예측능력최고,APACHE-O대AP전신병발증예측능력최고.
Objective To investigate the values of the APACHE O,APACHE-Ⅲ,Ranson and Balthazar CT(CTSI) scoring systems in predicting prognosis of severe acute pancreatitis.Methods Data were collected prospectively from 321 consecutive patients who were admitted into our hospital from 2005-01-01 to 2011-01-01 with acute pancreatitis (AP).The sensitivity,specificity and accuracy of the APACHE-O,APACHE-Ⅱ,Ranson,Balthazar CT scoring systems at different cut-off levels were calculated.The receiver-operating curves (ROC) for the prediction of severe AP in the early period were calculated using the APACHE-O,APACHE-Ⅱ,Ranson and Balthazar CT scores in different cut-off levels on hospital admission.The area under the curve (AUC) was used to compare the predictive accuracy.Using ROC curves,the values in predicting systemic complications,local complications and morbidities were also compared.Results At a cut-off point of 7,the APACHE O had a sensitivity of 95.4％,a specificity of 76.6％ and an overall accuracy of 79.4％.The Youden's index and the AUC of the APACHE-O score were 0.720 and 0.736,respectively.At a cut-off point of 8,the APACHE-Ⅱ had a sensitivity of 90.4％,a specificity of 81.0％ and an overall accuracy of 842.6％.The Youden's index and the AUC of the APACHE-Ⅱ were 0.714 and 0.699,respectively.At a cut-off point of 3,the Ranson had a sensitivity of 75.0％,a specificity of 78.1％ and an overall accuracy of 77.6％,respectively.The Youden’s index and the AUC of the Ranson were 0.531 and 0.703,respectively.At a cut-off point of 5,the CTSI had a sensitivity of 82.7％,a specificity of 91.4％ and an overall accuracy of 90.0％,respectively.The Youden's index and the AUC of the CTSI were 0.741 and 0.777,respectively.The CTSI system was the best in predicting local complications with a Youden’s index of 0.766,and an AUC of 0.777,respectively. At a cut-off point of 5,the CTSI had a sensitivity of 85.4％,a specificity of 91.2％ and an overall accuracy of 90.3％,respectively.The APACHE-O system was the best in predicting systematic complications with a Youden’s index of 0.789 and an AUC of 0.779,respectively.At a cut -off point of 8,the CTSI had a sensitivity of 91.1 ％,a specificity of 87.8％ and an overall accuracy of 88.2％,respectively.The CTSI system was the best in predicting local complications with a Youden’s index 0.952 and an AUC of 0.847,respectively.At a cut-off point of 8,the CTSI had a sensitivity of 100％,a specificity of 95.2％,and an overall accuracy of 95.3％,respectively.Conclusions The results suggested that the CTSI is the most useful system in predicting local complications and morbidities of severe AP in the early period.The APACHE-O is most useful in predicting systemic complications of severe AP.