CAJ | 학술논문

目的将急性胃肠损伤(acute gastrointestinal injury,AGI)分级系统引入序贯器官衰竭评价(sequential organ failure assessment,SOFA)评分,探讨对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的预测价值,为临床提供更可靠的评估SAP预后的工具.方法选择2012年7月至2014年7月吉林大学第一医院ICU收治的SAP患者为研究对象,排除年龄＜18岁,入院时间＜24 h,家属放弃治疗的患者.共计入选63例,其中男37例,女26例,年龄为(47±15.3)岁,统计所有患者入科时急性生理和慢性健康状况(acute physiology and chronic health evaluation,APACHE)Ⅱ评分,一周内最高SOFA评分和AGI分级,以及28 d病死率.将AGI分级系统中无AGI定义为0分,AGI Ⅰ级-Ⅳ级分别定义为14分.利用受试者工作特征曲线(receiver operator characteristic curve,ROC)评价APACHEⅡ评分,SOFA评分,以及SOFA+ AGI评分对SAP患者预后的预测价值.应用MedCalc软件比较各评分的ROC曲线下面积(area under roc curve,AUC)之间差异是否具有统计学意义,以P＜0.05为差异具有统计学意义.结果 (1) 63例SAP患者28 d病死率为20.6％ (13/63),其中存活组50例,死亡组13例.比较存活与死亡两组患者的APACHEⅡ评分、SOFA评分及SOFA+ AGI评分,分别为(15.62 ±4.33 VS 12.10 ±3.74,P=0.0048)、(14.77±3.09 vs9.24±2.88,P＜0.01)、(18.77 ±3.09 vs.10.74±3.17,P＜0.01).(2) APACHEⅡ评分的AUC为0.748±0.084(95％ CI:0.622 ～0.849)、SOFA评分的AUC为0.902±0.059 (95％ CI:0.801 ～0.962)、SOFA+AGI评分的AUC为0.963±0.037 (95％ CI:0.882 ～0.994).APACHEⅡ评分和SOFA评分的AUC比较差异无统计学意义(P=0.10),而APACHEⅡ评分与SOFA+ AGI评分的AUC比较差异具有统计学意义(P=0.013),SOFA评分与SOFA+ AGI评分的AUC比较差异具有统计学意义(P=0.008).3种评分系统比较以SOFA+ AGI的Youden指数和阳性似然比最大,分别为0.863和15.38.结论 SOFA评分对重症急性胰腺炎患者预后有较好的预测价值,而将AGI分级系统引入SOFA评分,可以获得更好的预测能力. 目的將急性胃腸損傷(acute gastrointestinal injury,AGI)分級繫統引入序貫器官衰竭評價(sequential organ failure assessment,SOFA)評分,探討對重癥急性胰腺炎(severe acute pancreatitis,SAP)患者預後的預測價值,為臨床提供更可靠的評估SAP預後的工具.方法選擇2012年7月至2014年7月吉林大學第一醫院ICU收治的SAP患者為研究對象,排除年齡＜18歲,入院時間＜24 h,傢屬放棄治療的患者.共計入選63例,其中男37例,女26例,年齡為(47±15.3)歲,統計所有患者入科時急性生理和慢性健康狀況(acute physiology and chronic health evaluation,APACHE)Ⅱ評分,一週內最高SOFA評分和AGI分級,以及28 d病死率.將AGI分級繫統中無AGI定義為0分,AGI Ⅰ級-Ⅳ級分彆定義為14分.利用受試者工作特徵麯線(receiver operator characteristic curve,ROC)評價APACHEⅡ評分,SOFA評分,以及SOFA+ AGI評分對SAP患者預後的預測價值.應用MedCalc軟件比較各評分的ROC麯線下麵積(area under roc curve,AUC)之間差異是否具有統計學意義,以P＜0.05為差異具有統計學意義.結果 (1) 63例SAP患者28 d病死率為20.6％ (13/63),其中存活組50例,死亡組13例.比較存活與死亡兩組患者的APACHEⅡ評分、SOFA評分及SOFA+ AGI評分,分彆為(15.62 ±4.33 VS 12.10 ±3.74,P=0.0048)、(14.77±3.09 vs9.24±2.88,P＜0.01)、(18.77 ±3.09 vs.10.74±3.17,P＜0.01).(2) APACHEⅡ評分的AUC為0.748±0.084(95％ CI:0.622 ～0.849)、SOFA評分的AUC為0.902±0.059 (95％ CI:0.801 ～0.962)、SOFA+AGI評分的AUC為0.963±0.037 (95％ CI:0.882 ～0.994).APACHEⅡ評分和SOFA評分的AUC比較差異無統計學意義(P=0.10),而APACHEⅡ評分與SOFA+ AGI評分的AUC比較差異具有統計學意義(P=0.013),SOFA評分與SOFA+ AGI評分的AUC比較差異具有統計學意義(P=0.008).3種評分繫統比較以SOFA+ AGI的Youden指數和暘性似然比最大,分彆為0.863和15.38.結論 SOFA評分對重癥急性胰腺炎患者預後有較好的預測價值,而將AGI分級繫統引入SOFA評分,可以穫得更好的預測能力.
목적 장급성위장손상(acute gastrointestinal injury,AGI)분급계통인입서관기관쇠갈평개(sequential organ failure assessment,SOFA)평분,탐토대중증급성이선염(severe acute pancreatitis,SAP)환자예후적예측개치,위림상제공경가고적평고SAP예후적공구.방법 선택2012년7월지2014년7월길림대학제일의원ICU수치적SAP환자위연구대상,배제년령＜18세,입원시간＜24 h,가속방기치료적환자.공계입선63례,기중남37례,녀26례,년령위(47±15.3)세,통계소유환자입과시급성생리화만성건강상황(acute physiology and chronic health evaluation,APACHE)Ⅱ평분,일주내최고SOFA평분화AGI분급,이급28 d병사솔.장AGI분급계통중무AGI정의위0분,AGI Ⅰ급-Ⅳ급분별정의위14분.이용수시자공작특정곡선(receiver operator characteristic curve,ROC)평개APACHEⅡ평분,SOFA평분,이급SOFA+ AGI평분대SAP환자예후적예측개치.응용MedCalc연건비교각평분적ROC곡선하면적(area under roc curve,AUC)지간차이시부구유통계학의의,이P＜0.05위차이구유통계학의의.결과 (1) 63례SAP환자28 d병사솔위20.6％ (13/63),기중존활조50례,사망조13례.비교존활여사망량조환자적APACHEⅡ평분、SOFA평분급SOFA+ AGI평분,분별위(15.62 ±4.33 VS 12.10 ±3.74,P=0.0048)、(14.77±3.09 vs9.24±2.88,P＜0.01)、(18.77 ±3.09 vs.10.74±3.17,P＜0.01).(2) APACHEⅡ평분적AUC위0.748±0.084(95％ CI:0.622 ～0.849)、SOFA평분적AUC위0.902±0.059 (95％ CI:0.801 ～0.962)、SOFA+AGI평분적AUC위0.963±0.037 (95％ CI:0.882 ～0.994).APACHEⅡ평분화SOFA평분적AUC비교차이무통계학의의(P=0.10),이APACHEⅡ평분여SOFA+ AGI평분적AUC비교차이구유통계학의의(P=0.013),SOFA평분여SOFA+ AGI평분적AUC비교차이구유통계학의의(P=0.008).3충평분계통비교이SOFA+ AGI적Youden지수화양성사연비최대,분별위0.863화15.38.결론 SOFA평분대중증급성이선염환자예후유교호적예측개치,이장AGI분급계통인입SOFA평분,가이획득경호적예측능력.
Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP.Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study.The criteria of exclusion were the age below 18 years old,pregnancy,or patients without consent to the treatment.A total of 63 patients with 37 males and 26 females aged (47 ± 15.3) years were included.The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score,the highest SOFA score and AGI grade within the first week,and the 28-day mortality rate were collected.Patients without AGI were defined as zero point,and AGI grade Ⅰ-Ⅳ were defined as 1-4 points.The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHE Ⅱ score,SOFA score,and SOFA + AGI score in predicting the prognosis of SAP.The areas under ROC curve (AUC) of the APACHE Ⅱ score,SOFA score,and SOFA + AGI score were compared with MedCalc software,and P value less than 0.01 was considered to be statistical significance.Results (1) The 28-day mortality of the 63 patients with SAP was 20.6％ (13/63),in which 50 patients in the survival group,13 patients in the death group.The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs.12.10 ± 3.74,P=0.0048),the SOFA scores were (14.77 ± 3.09 vs.9.24 ± 2.88,P ＜0.01),and the SOFA + AGI scores were (18.77 ±3.09 vs.10.74 ± 3.17,P＜0.01).(2) The AUC of APACHEⅡ score was0.748 ± 0.084 (95％ CI:0.622-0.849),the AUC of SOFA score was 0.902 ± 0.059 (95％ CI:0.801-0.962),and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95％ CI,0.882-0.994);There was no significant difference in AUC between APACHE Ⅱ score and SOFA score (P =0.10),and there was statistical significance between the AUC of APACHE Ⅱ score and that of SOFA + AGI score (P =0.013),and the difference in AUC between SOFA score and SOFA + AGI score was statistically significant (P =0.008).The Youden index and the positive likelihood ratio of SOFA + AGI score system were the greatest to be 0.863 and 15.38,respectively.Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it.