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急性胰腺炎评分系统的研究进展
DOI: 10.3969/j.issn.1001-5256.2022.09.046
利益冲突声明：所有作者均声明不存在利益冲突。
作者贡献声明：罗秀平负责收集、分析资料及撰写文章；王洁参与分析解释过程及修改文章；吴青、刘诗权、覃蒙斌、黄杰安参与修改文章。
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摘要: 急性胰腺炎(AP)是临床常见的危重疾病, 发病率不断升高。虽然大多数患者是轻症胰腺炎, 但重症胰腺炎的病死率仍偏高, 因此亟需一些早期、简便、精确的临床评分系统来判断AP严重程度, 以此便于进行有效的疾病管理和对症治疗而降低患者病死率。目前有大量研究证实, Ranson评分、APACHEⅡ评分、BISAP评分、CTSI评分、某些血清学指标等评分系统已用于评估AP的严重程度及预后, 但均有一定的局限性。本文对现有的评分系统、单一血清学指标及其相关的改良评分系统近年来的研究进展作一概述。通过文献复习认为目前尚无任何单一评分系统或某一指标能够覆盖AP诊治的全过程, 对AP严重程度作出准确的判断，需要开发新的评分系统或联合各项指标综合评定。Abstract: Acute pancreatitis (AP) is a severe disease with an increasing incidence rate in clinical practice. Although most patients have mild pancreatitis, the fatality rate of severe pancreatitis remains at a relatively high level, and therefore, early-stage, simple, and accurate clinical scoring systems are urgently needed to determine the severity of AP, so as to facilitate effective disease management and symptomatic treatment and reduce the fatality rate of patients. At present, a large number of studies have demonstrated that the scoring systems such as Ranson score, APACHE Ⅱ score, BISAP score, CTSI score, and some serological markers have been used to evaluate the severity and prognosis of AP, but all of them have certain limitations. This article reviews the research advances in the existing scoring systems, single serological markers, and related modified scoring systems in recent years. Through a literature review, it is concluded that there is no a single scoring system or a single indicator that can cover the whole process of AP diagnosis and treatment and accurately judge the severity of AP, and therefore, it is necessary to develop a new scoring system or combine various indicators for comprehensive evaluation.
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Key words:
- Pancreatitis /
- Score /
- Prognosis
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表 1 各评分系统的评价
Table 1. Evaluation of various scoring system
评分系统 优点 缺点 Ranson Ranson评分中的48 h变量允许对患者进行延迟重估，这可反映患者病情的动态变化，更可靠地预测多器官功能障碍的持久性和严重程度 变量相对较多，耗时长，预测并发症和病死率的敏感度、特异度相对较低 BISAP 变量少；易统计；将生化指标与影像学相结合 在BISAP评分中，精神状态的评估是主观的；胸腔积液是SAP随时间发展的并发症，在入院时可能不存在，因此，这可能会导致由于评分偏低而错漏部分重症胰腺炎患者 APACHE Ⅱ 可在病程的任何时间点使用 变量多，评分系统繁杂 CTSI/MCTSI 直接、客观地反映胰腺的炎症、坏死程度及并发症 未能结合生化指标全面评估胰腺炎的严重程度；胰周坏死和假性囊肿形成多数不在AP发病初期，评估需要在入院后2~3 d，这不利于SAP的早期判断 单一参数 检测简便、简单易得、计算快捷 单一片面；单一指标大多是回顾性的队列研究及病例对照研究，样本量较小，且现有研究结果之间尚存在争议 
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[1] PETROV MS, YADAV D. Global epidemiology and holistic prevention of pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(3): 175-184. DOI: 10.1038/s41575-018-0087-5. [2] VEGE SS, GARDNER TB, CHARI ST, et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include "moderately severe acute pancreatitis"[J]. Am J Gastroenterol, 2009, 104(3): 710-715. DOI: 10.1038/ajg.2008.77. [3] GUDA NM, TRIKUDANATHAN G, FREEMAN ML. Idiopathic recurrent acute pancreatitis[J]. Lancet Gastroenterol Hepatol, 2018, 3(10): 720-728. DOI: 10.1016/S2468-1253(18)30211-5. [4] Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shenyang, 2019) [J]. J Clin Hepatol, 2019, 35(12): 2706-2711. DOI: 10.3969/j.issn.1001-5256.2019.12.013.中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编委会, 《中华消化杂志》编委会. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 临床肝胆病杂志, 2019, 35(12): 2706-2711. DOI: 10.3969/j.issn.1001-5256.2019.12.013. [5] LIU SZ, YAO JR, MO SJ, et al. Research progress of nutrition support for severe acute pancreatitis[J/CD]. Chin J Hepat Surg(Electronic Edition), 2021, 10(5): 533-535. DOI: 10.3969/j.issn.1006-2084.2017.20.021.刘世洲, 姚佳柔, 莫绍剑, 等. 重症急性胰腺炎营养支持研究进展[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(5): 533-535. DOI: 10.3969/j.issn.1006-2084.2017.20.021. [6] SUN B, LI GQ. Surgical intervention strategies for local complications of severe acute pancreatitis[J]. Chin J Dig Surg, 2020, 4(4): 379-383. DOI: 10.3760/cma.j.cn115610-20200121-00040.孙备, 李冠群. 重症急性胰腺炎局部并发症外科干预策略[J]. 中华消化外科杂志, 2020, 4(4): 379-383. DOI: 10.3760/cma.j.cn115610-20200121-00040. [7] RANSON JH, RIFKIND KM, ROSES DF, et al. Prognostic signs and the role of operative management in acute pancreatitis[J]. Surg Gynecol Obstet, 1974, 139(1): 69-81. [8] RANSON JH, PASTERNACK BS. Statistical methods for quantifying the severity of clinical acute pancreatitis[J]. J Surg Res, 1977, 22(2): 79-91. DOI: 10.1016/0022-4804(77)90045-2. [9] ONG Y, SHELAT VG. Ranson score to stratify severity in acute pancreatitis remains valid-old is gold[J]. Expert Rev Gastroenterol Hepatol, 2021, 15(8): 865-877. DOI: 10.1080/17474124.2021.1924058. [10] YANG CJ, CHEN J, PHILLIPS AR, et al. Predictors of severe and critical acute pancreatitis: a systematic review[J]. Dig Liver Dis, 2014, 46(5): 446-451. DOI: 10.1016/j.dld.2014.01.158. [11] MIKÓ A, VIGHÉ, MÁTRAI P, et al. Computed tomography severity index vs. other indices in the prediction of severity and mortality in acute pancreatitis: a predictive accuracy meta-analysis[J]. Front Physiol, 2019, 10: 1002. DOI: 10.3389/fphys.2019.01002. [12] GAO W, YANG HX, MA CE. The value of BISAP score for predicting mortality and severity in acute pancreatitis: a systematic review and meta-analysis[J]. PLoS One, 2015, 10(6): e0130412. DOI: 10.1371/journal.pone.0130412. [13] WU BU, JOHANNES RS, SUN X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study[J]. Gut, 2008, 57(12): 1698-1703. DOI: 10.1136/gut.2008.152702. [14] TANG HY, LIU S, HU CJ, et al. Value of modified objective Bedside Index for Severity in Acute Pancreatitis score in predicting the severity and prognosis of acute pancreatitis[J]. J Clin Hepatol, 2021, 37(6): 1386-1391. DOI: 10.3969/j.issn.1001-5256.2021.06.032.唐豪佑, 刘胜, 胡程俊, 等. 改良客观性BISAP评分对急性胰腺炎严重程度及预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(6): 1386-1391. DOI: 10.3969/j.issn.1001-5256.2021.06.032. [15] ZANWAR S, MOHAN AT, PARAMSIVAN P, et al. A novel "BISSHOAP" score for predicting severe and moderately severe acute pancreatitis in emergency room[J]. Gastroenterol Hepatol Endosc Pract, 2021, 1: 111-115. DOI: 10.4103/ghep.ghep-40-20. [16] KNAUS WA, DRAPER EA, WAGNER DP, et al. APACHE Ⅱ: a severity of disease classification system[J]. Crit Care Med, 1985, 13(10): 818-829. DOI: 10.1097/00003246-198510000-00009 [17] GVRLEYIK G, ZAHIDULLAHOǦLU CIRPICI O, AKTEKIN A, et al. The value of Ranson and APACHE Ⅱ scoring systems, and serum levels of interleukin-6 and C-reactive protein in the early diagnosis of the severity of acute pancreatitis[J]. Ulus Travma Acil Cerrahi Derg, 2004, 10(2): 83-88. http://www.ncbi.nlm.nih.gov/pubmed/15103565 [18] CHATZICOSTAS C, ROUSSOMOUSTAKAKI M, VLACHONIKOLIS IG, et al. Comparison of Ranson, APACHE Ⅱ and APACHE Ⅲ scoring systems in acute pancreatitis[J]. Pancreas, 2002, 25(4): 331-335. DOI: 10.1097/00006676-200211000-00002. [19] ALBERTI P, PANDO E, MATA R, et al. Evaluation of the modified computed tomography severity index (MCTSI) and computed tomography severity index (CTSI) in predicting severity and clinical outcomes in acute pancreatitis[J]. J Dig Dis, 2021, 22(1): 41-48. DOI: 10.1111/1751-2980.12961. [20] BAI L, WANG HY, XU WL, et al. Correlation between PTX-3, SIL-2R and APACHE Ⅱ score in patients with severe acute pancreatitis[J]. Chin J Public Health Eng, 2021, 20(4): 639-641. DOI: 10.19937/j.issn.1671-4199.2021.04.040.白翎, 王宏宇, 许卫利, 等. PTX-3、SIL-2R血清水平变化与重症急性胰腺炎患者APACHEⅡ评分的相关性[J]. 中国卫生工程学, 2021, 20(4): 639-641. DOI: 10.19937/j.issn.1671-4199.2021.04.040. [21] MORTELE KJ, WIESNER W, INTRIERE L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome[J]. AJR Am J Roentgenol, 2004, 183(5): 1261-1265. DOI: 10.2214/ajr.183.5.1831261. [22] LANKISCH PG, APTE M, BANKS PA. Acute pancreatitis[J]. Lancet, 2015, 386(9988): 85-96. DOI: 10.1016/S0140-6736(14)60649-8. [23] MACHIN SJ, BRIGGS C. Mean platelet volume: a quick, easy determinant of thrombotic risk?[J]. J Thromb Haemost, 2010, 8(1): 146-147. DOI: 10.1111/j.1538-7836.2009.03673.x. [24] COBAN E, AFACAN B. The effect of rosuvastatin treatment on the mean platelet volume in patients with uncontrolled primary dyslipidemia with hypolipidemic diet treatment[J]. Platelets, 2008, 19(2): 111-114. DOI: 10.1080/09537100701230444. [25] GASPARYAN AY, AYVAZYAN L, MIKHAILIDIS DP, et al. Mean platelet volume: a link between thrombosis and inflammation?[J]. Curr Pharm Des, 2011, 17(1): 47-58. DOI: 10.2174/138161211795049804. [26] KAUSHANSKY K. The molecular mechanisms that control thrombopoiesis[J]. J Clin Invest, 2005, 115(12): 3339-3347. DOI: 10.1172/JCI26674. [27] CHU SG, BECKER RC, BERGER PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis[J]. J Thromb Haemost, 2010, 8(1): 148-156. DOI: 10.1111/j.1538-7836.2009.03584.x. [28] AKBAL E, DEMIRCI S, KOÇAK E, et al. Alterations of platelet function and coagulation parameters during acute pancreatitis[J]. Blood Coagul Fibrinolysis, 2013, 24(3): 243-246. DOI: 10.1097/MBC.0b013e32835aef51. [29] JIN L, ZHOU SP, CAO ZJ, et al. Correlation of platelet related parameters in predicting severity of acute pancreatitis [J]. J Clin Emerg, 2021, 20(2): 111-116. DOI: 10.13201/j.issn.1009-5918.2021.02.006.金磊, 周淑萍, 曹子君, 等. 血小板相关参数在急性胰腺炎病情严重程度预测中的相关性研究[J]. 临床急诊杂志, 2021, 20(2): 111-116. DOI: 10.13201/j.issn.1009-5918.2021.02.006. [30] FU Y, ZHANG Q, LI MY, et al. Correlation analysis between platelet-related parameters and inflammatory indicators in patients with acute pancreatitis[J]. West China Med J, 2020, 35(8): 943-947. DOI: 10.7507/1002-0179.202006249.付阳, 张琦, 李梦雨, 等. 急性胰腺炎患者血小板相关参数与炎性指标的相关性研究[J]. 华西医学, 2020, 35(8): 943-947. DOI: 10.7507/1002-0179.202006249. [31] HU QM, NIU CY. Predictive value of combined measurement of D-dimer, fibrinogen, and peripheral blood leukocyte count for severity of acute pancreatitis[J]. J Clin Hepatol, 2017, 33(8): 1522 -1526. DOI: 10.3969/j.issn.1001-5256.2017.08.023.虎青梅, 牛春燕. D-二聚体、纤维蛋白原、外周血白细胞计数联合检测对急性胰腺炎严重程度的预测价值[J]. 临床肝胆病杂志, 2017, 33(8): 1522-1526. DOI: 10.3969/j.issn.1001-5256.2017.08.023. [32] YU SS, JIN K, FU YY, et al. Predictive value of D-dimer combination-related indicators in the severity of acute pancreatitis[J]. J Clin Emerg, 2019, 20(12): 925-930. DOI: 10.13201/j.issn.1009-5918.2019.12.003.余姗姗, 金魁, 付阳阳, 等. D-二聚体联合相关指标在急性胰腺炎严重程度预测中的价值研究[J]. 临床急诊杂志, 2019, 20(12): 925-930. DOI: 10.13201/j.issn.1009-5918.2019.12.003. [33] SINGH AK, DAWRA S, RANA S, et al. Can serum resistin predict severity of acute pancreatitis?[J]. Biomarkers, 2021, 26(1): 31-37. DOI: 10.1080/1354750X.2020.1841295. [34] AL-BAHRANI AZ, AMMORI BJ. Clinical laboratory assessment of acute pancreatitis[J]. Clin Chim Acta, 2005, 362(1-2): 26-48. DOI: 10.1016/j.cccn.2005.06.008. [35] ZHANG FX, LI ZL, ZHANG ZD, et al. Prognostic value of red blood cell distribution width for severe acute pancreatitis[J]. World J Gastroenterol, 2019, 25(32): 4739-4748. DOI: 10.3748/wjg.v25.i32.4739. [36] LEI JJ, ZHOU L, LIU Q, et al. Can mean platelet volume play a role in evaluating the severity of acute pancreatitis?[J]. World J Gastroenterol, 2017, 23(13): 2404-2413. DOI: 10.3748/wjg.v23.i13.2404. [37] WANG F, MENG Z, LI S, et al. Platelet distribution width levels can be a predictor in the diagnosis of persistent organ failure in acute pancreatitis[J]. Gastroenterol Res Pract, 2017, 2017: 8374215. DOI: 10.1155/2017/8374215. [38] ZHOU H, MEI X, HE X, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study[J]. Medicine (Baltimore), 2019, 98(16): e15275. DOI: 10.1097/MD.0000000000015275. [39] KIBAR YI, ALBAYRAK F, ARABUL M, et al. Resistin: New serum marker for predicting severity of acute pancreatitis[J]. J Int Med Res, 2016, 44(2): 328-337. DOI: 10.1177/0300060515605428. -
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