目的 探讨急性胰腺炎床旁指数(BISAP)、Ranson's、APACHEⅡ、CT严重程度指数(CTSI)4种评分系统在急性胰腺炎患者严重程度评估中的价值.方法 回顾性分析2005年至2011年武汉大学中南医院收治的385例急性胰腺炎患者的临床资料,探讨BISAP、Ranson's、APACHEⅡ、CTSI 4种评分系统在急性胰腺炎严重程度评估中的价值.采用x2检验和受试者工作曲线(ROC)评估4种评分系统预测患者发生重症急性胰腺炎、局部并发症和死亡的价值,并计算优势比(OR),用Z检验比较曲线下面积(AUC)的差异.结果 BISAP评分≥3分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为64.4％ (56/87)、16.1％(14/87) 、8.0％(7/87),高于BISAP评分≤2分者的13.4％ (40/298)、6.4％(19/298)、0.3％(1/298),两者比较,差异有统计学意义(,=93.4,8.1,19.7,P＜0.05).Ranson's评分≥3分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为52.7％ (48/91) 、22.0％(20/91) 、7.7％(7/91),高于RanSon's评分≤2分者的16.3％ (48/294)、4.4％ (13/294)、0.3％(1/294),两者比较,差异有统计学意义(x2=49.2,27.3,18.5,P＜0.05).APACHEⅡ评分≥8分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为46.6％(27/58)、20.7％(12/58)、8.6％(5/58),高于APACHEⅡ评分≤7分者的21.1％(69/327)、6.4％(21/327) 、0.9％(3/327),两者比较,差异有统计学意义(x2=17.0,12.8,14.4,P＜0.05).CTSI评分≥4分者的重症急性胰腺炎发生率、局部并发症发生率、病死率均分别为51.4％ (19/37)、51.4％(19/37)、16.2％(6/37),高于CTSI评分≤3分者的22.2％(77/347) 、4.0％(14/347)、0.6％(2/347),两者比较,差异有统计学意义(x2=15.1,95.3,40.1,P＜0.05).BISAP评分预测重症急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值分别为58％、89％、64％、86％,AUC为0.848,高于其余3种评分系统(Z=2.02,4.22,4.78,P＜0.05).CTSI评分预测局部并发症的灵敏度、特异度、阳性预测值、阴性预测值分别为58％、95％、51％、96％,AUC为0.926,高于其余3种评分系统(Z =3.99,3.24,4.06,P＜0.05).BISAP评分预测急性胰腺炎患者死亡的灵敏度、特异度、阳性预测值、阴性预测值分别为88％、79％、8％、100％,AUC为0.855,与其余3种评分系统比较,差异无统计学意义(Z=0.81,0.03,0.14,P＞0.05).结论 BISAP评分预测重症急性胰腺炎准确度高于Ranson's、APACHEⅡ、CTSI 3种评分系统,CTSI评分预测局部并发症准确度高于其余3种评分系统,4种评分系统预测死亡的效能差异无统计学意义.BISAP评分有助于重症急性胰腺炎早期诊断并制订个体化治疗措施,改善患者预后.
目的 探討急性胰腺炎床徬指數(BISAP)、Ranson's、APACHEⅡ、CT嚴重程度指數(CTSI)4種評分繫統在急性胰腺炎患者嚴重程度評估中的價值.方法 迴顧性分析2005年至2011年武漢大學中南醫院收治的385例急性胰腺炎患者的臨床資料,探討BISAP、Ranson's、APACHEⅡ、CTSI 4種評分繫統在急性胰腺炎嚴重程度評估中的價值.採用x2檢驗和受試者工作麯線(ROC)評估4種評分繫統預測患者髮生重癥急性胰腺炎、跼部併髮癥和死亡的價值,併計算優勢比(OR),用Z檢驗比較麯線下麵積(AUC)的差異.結果 BISAP評分≥3分者的重癥急性胰腺炎髮生率、跼部併髮癥髮生率、病死率分彆為64.4％ (56/87)、16.1％(14/87) 、8.0％(7/87),高于BISAP評分≤2分者的13.4％ (40/298)、6.4％(19/298)、0.3％(1/298),兩者比較,差異有統計學意義(,=93.4,8.1,19.7,P＜0.05).Ranson's評分≥3分者的重癥急性胰腺炎髮生率、跼部併髮癥髮生率、病死率分彆為52.7％ (48/91) 、22.0％(20/91) 、7.7％(7/91),高于RanSon's評分≤2分者的16.3％ (48/294)、4.4％ (13/294)、0.3％(1/294),兩者比較,差異有統計學意義(x2=49.2,27.3,18.5,P＜0.05).APACHEⅡ評分≥8分者的重癥急性胰腺炎髮生率、跼部併髮癥髮生率、病死率分彆為46.6％(27/58)、20.7％(12/58)、8.6％(5/58),高于APACHEⅡ評分≤7分者的21.1％(69/327)、6.4％(21/327) 、0.9％(3/327),兩者比較,差異有統計學意義(x2=17.0,12.8,14.4,P＜0.05).CTSI評分≥4分者的重癥急性胰腺炎髮生率、跼部併髮癥髮生率、病死率均分彆為51.4％ (19/37)、51.4％(19/37)、16.2％(6/37),高于CTSI評分≤3分者的22.2％(77/347) 、4.0％(14/347)、0.6％(2/347),兩者比較,差異有統計學意義(x2=15.1,95.3,40.1,P＜0.05).BISAP評分預測重癥急性胰腺炎的靈敏度、特異度、暘性預測值、陰性預測值分彆為58％、89％、64％、86％,AUC為0.848,高于其餘3種評分繫統(Z=2.02,4.22,4.78,P＜0.05).CTSI評分預測跼部併髮癥的靈敏度、特異度、暘性預測值、陰性預測值分彆為58％、95％、51％、96％,AUC為0.926,高于其餘3種評分繫統(Z =3.99,3.24,4.06,P＜0.05).BISAP評分預測急性胰腺炎患者死亡的靈敏度、特異度、暘性預測值、陰性預測值分彆為88％、79％、8％、100％,AUC為0.855,與其餘3種評分繫統比較,差異無統計學意義(Z=0.81,0.03,0.14,P＞0.05).結論 BISAP評分預測重癥急性胰腺炎準確度高于Ranson's、APACHEⅡ、CTSI 3種評分繫統,CTSI評分預測跼部併髮癥準確度高于其餘3種評分繫統,4種評分繫統預測死亡的效能差異無統計學意義.BISAP評分有助于重癥急性胰腺炎早期診斷併製訂箇體化治療措施,改善患者預後.
목적 탐토급성이선염상방지수(BISAP)、Ranson's、APACHEⅡ、CT엄중정도지수(CTSI)4충평분계통재급성이선염환자엄중정도평고중적개치.방법 회고성분석2005년지2011년무한대학중남의원수치적385례급성이선염환자적림상자료,탐토BISAP、Ranson's、APACHEⅡ、CTSI 4충평분계통재급성이선염엄중정도평고중적개치.채용x2검험화수시자공작곡선(ROC)평고4충평분계통예측환자발생중증급성이선염、국부병발증화사망적개치,병계산우세비(OR),용Z검험비교곡선하면적(AUC)적차이.결과 BISAP평분≥3분자적중증급성이선염발생솔、국부병발증발생솔、병사솔분별위64.4％ (56/87)、16.1％(14/87) 、8.0％(7/87),고우BISAP평분≤2분자적13.4％ (40/298)、6.4％(19/298)、0.3％(1/298),량자비교,차이유통계학의의(,=93.4,8.1,19.7,P＜0.05).Ranson's평분≥3분자적중증급성이선염발생솔、국부병발증발생솔、병사솔분별위52.7％ (48/91) 、22.0％(20/91) 、7.7％(7/91),고우RanSon's평분≤2분자적16.3％ (48/294)、4.4％ (13/294)、0.3％(1/294),량자비교,차이유통계학의의(x2=49.2,27.3,18.5,P＜0.05).APACHEⅡ평분≥8분자적중증급성이선염발생솔、국부병발증발생솔、병사솔분별위46.6％(27/58)、20.7％(12/58)、8.6％(5/58),고우APACHEⅡ평분≤7분자적21.1％(69/327)、6.4％(21/327) 、0.9％(3/327),량자비교,차이유통계학의의(x2=17.0,12.8,14.4,P＜0.05).CTSI평분≥4분자적중증급성이선염발생솔、국부병발증발생솔、병사솔균분별위51.4％ (19/37)、51.4％(19/37)、16.2％(6/37),고우CTSI평분≤3분자적22.2％(77/347) 、4.0％(14/347)、0.6％(2/347),량자비교,차이유통계학의의(x2=15.1,95.3,40.1,P＜0.05).BISAP평분예측중증급성이선염적령민도、특이도、양성예측치、음성예측치분별위58％、89％、64％、86％,AUC위0.848,고우기여3충평분계통(Z=2.02,4.22,4.78,P＜0.05).CTSI평분예측국부병발증적령민도、특이도、양성예측치、음성예측치분별위58％、95％、51％、96％,AUC위0.926,고우기여3충평분계통(Z =3.99,3.24,4.06,P＜0.05).BISAP평분예측급성이선염환자사망적령민도、특이도、양성예측치、음성예측치분별위88％、79％、8％、100％,AUC위0.855,여기여3충평분계통비교,차이무통계학의의(Z=0.81,0.03,0.14,P＞0.05).결론 BISAP평분예측중증급성이선염준학도고우Ranson's、APACHEⅡ、CTSI 3충평분계통,CTSI평분예측국부병발증준학도고우기여3충평분계통,4충평분계통예측사망적효능차이무통계학의의.BISAP평분유조우중증급성이선염조기진단병제정개체화치료조시,개선환자예후.
Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.
