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入院早期评分系统对急性胰腺炎严重程度及预后的预测价值
Value of early admission scoring systems in predicting the severity and prognosis of acute pancreatitis
文章发布日期:2020年06月01日  来源:  作者:安文慧,何旭昶,杨婧,等  点击次数:181次  下载次数:43次

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【摘要】:目的 通过纳入入院早期(24 h内)即可对急性胰腺炎严重程度及预后进行评估的较全面的评分系统,筛选出早期预测最有价值的评分系统。方法 回顾性收集2016年9月-2019年9月昆明医科大学第二附属医院消化内科收治的254例急性胰腺炎患者资料,分为轻症急性胰腺炎组(MAP组)、中度重症急性胰腺炎组(MSAP组)和重症急性胰腺炎组(SAP组),分析3组患者的一般资料、合并症及入院早期评分系统(包括BISAP评分、SIRS评分、MEWS评分、PANC3评分、HAPS评分、CTSI评分、SPS评分)的差异,并将各早期评分系统进行急性胰腺炎严重程度及预后预测价值的比较。符合正态分布的计量资料多组间比较采用方差分析;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验或Fisher确切概率法。绘制受试者工作特征曲线(ROC曲线),比较ROC曲线下面积 (AUC)。结果3组患者住院天数及住院费用比较,差异有统计学意义(H值分别为48.82、76.93,P值均<0.05);合并症中,3组患者在是否合并肺部感染、胰腺坏死、多器官功能障碍综合征(MODS)及死亡方面差异有统计学意义(H值分别为64.84、98.19、53.09、8.09,P值均<0.05);早期评分系统中,BISAP评分、SIRS评分、MEWS评分、HAPS评分、CTSI评分、SPS评分3组比较均有统计学差异(H值分别为93.19、21.24、23.99、16.57、67.09、33.95,P值均<0.05);通过ROC曲线的绘制将早期评分系统进一步进行胰腺严重程度及并发症的比较,发现BISAP评分在入院24 h预测SAP、肺部感染的预测价值最高,当cut-off值>2分时,灵敏度分别为86.10%、51.20%,特异度分别为81.70%、83.50%;CTSI评分预测胰腺坏死的价值最高,当cut- off值>3分时,灵敏度为82.70%,特异度为89.10%。在MODS方面,HAPS和BISAP评分均有较好的预测价值,灵敏度分别为63.70%、75.00%,特异度分别为90.00%、76.10%。结论 不同评分系统在早期预测胰腺炎严重程度及并发症上各有优势,其中BISAP评分对于SAP、胰腺炎合并肺部感染、MODS,CTSI评分对于胰腺坏死,HAPS对早期MODS的排除有优良的预测价值。
【Abstract】:Objective To screen out the scoring system with the highest predictive value by analyzing the comprehensive scoring systems which can assess the severity and prognosis of acute pancreatitis in the early stage (within 24 hours) after admission. Methods A retrospective analysis was performed for the clinical data of 254 patients with acute pancreatitis who were admitted to Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, from September 2016 to September 2019, and they were divided into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group. The three groups were compared in terms of general data, comorbidities, and scores of early admission scoring systems, including BISAP score, SIRS score, MEWS score, PANC3 score, HAPS score, CTSI score, and SPS score, and these scoring systems were compared in terms of their value in predicting the severity and prognosis of acute pancreatitis. An analysis of variance was used for comparison of normally distributed continuous data between groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was compared. Results The SAP group had a significantly longer length of hospital stay and significantly higher hospital costs than the other two groups (H=48.82 and 76.93, both P<0.05). As for comorbidities, there were significant differences in the presence or absence of pulmonary infection, pancreatic necrosis, multiple organ dysfunction syndrome (MODS), and death between the three groups (H=64.84, 98.19, 53.09, and 8.09, all P<0.05). As for the early scoring systems, there were significant differences between the three groups in BISAP score, SIRS score, MEWS score, HAPS score, CTSI score, and SPS score (H=93.19, 21.24, 23.99, 16.57, 67.09, and 33.95, all P<0.05). The early scoring systems were further compared in terms of the severity of pancreatitis and complications based on the ROC curve, and it was found that BISAP score had the highest value in predicting SAP and pulmonary infection within 24 hours after admission, with sensitivities of 86.10% and 51.20%, respectively, and specificities of 81.70% and 83.50%, respectively, at the cut-off value of >2. CTSI score had the highest value in predicting pancreatic necrosis, with a sensitivity of 82.70% and a specificity of 89.10% at the cut-off value of >3. In terms of MODS, both HAPS and BISAP scores had good predictive value, with sensitivities of 63.70% and 75.00%, respectively, and specificities of 90.00% and 76.10%, respectively. Conclusion Different scoring systems have their own advantages in predicting the severity and complications of pancreatitis in the early stage, among which BISAP score has a high value in predicting SAP, pancreatitis with pulmonary infection, and MODS, CTSI score has a high value in predicting pancreatic necrosis, and HAPS score has a high value in excluding MODS in the early stage.
【关键字】:胰腺炎; 早期评分系统; 预后
【Key words】:pancreatitis; early scoring system; prognosis
【引证本文】:AN WH, HE XC, YANG J, et al. Value of early admission scoring systems in predicting the severity and prognosis of acute pancreatitis[J]. J Clin Hepatol, 2020, 36(6): 1342-1346. (in Chinese)
安文慧, 何旭昶, 杨婧, 等. 入院早期评分系统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, 2020, 36(6): 1342-1346.

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