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目的重新评价BISAP、APACHEⅡ、CTSI等评分体系对急性胰腺炎(acute pancreatitis,AP)新分类内重度急性胰腺炎(severe acute pancreatitis,SAP)的评价价值。方法收集2013年9月至2014年10月北京协和医院收治的136例AP患者临床资料及入院BISAP、CTSI、APACHEⅡ、SIRS、Glasgow、Ranson评分,评估各评分体系与新分类的相关性,用ROC曲线分析各评分预测病情严重程度的准确性,并评价其对预后的判断价值。结果 (1)136例AP患者中,轻度急性胰腺炎组50例(36.8%),中度重症胰腺炎组61例(44.9%),重症胰腺炎组25例(18.4%)。(2)BISAP、APACHEⅡ、CTSI评分与疾病严重程度相关(P<0.05)。(3)BISAP、APACHEⅡ和CTSI评分对新分类中SAP预测准确性AUC值分别为0.904、0.942和0.823,最佳预测值分别为3分(敏感度84%,特异度86.5%,阳性似然比6.216,阴性似然比0.185)、10分(敏感度96%,特异度86.5%,阳性似然比7.104,阴性似然比0.046)和4分(敏感度96%,特异度56.8%,阳性似然比2.220,阴性似然比0.070)。(4)BISAP评分与疾病复发相关(P<0.05)。结论 BISAP、APACHEⅡ、CTSI评分与新分类相关性较好,其中BISAP、APACHEⅡ评分对SAP的预测最为准确,BISAP≥3分或APACHEⅡ≥10分提示SAP。
Objective To evaluate the evaluation value of BISAP, APACHEⅡ and CTSI in the new classification of acute pancreatitis (AP) in severe acute pancreatitis (SAP). Methods The clinical data of 136 AP patients admitted to Peking Union Medical College Hospital and the BISAP, CTSI, APACHEⅡ, SIRS, Glasgow and Ranson scores admitted from September 2013 to October 2014 in Peking Union Medical College Hospital were collected. The correlation between each score system and the new classification was evaluated. Curves were used to analyze the accuracy of each score in predicting the severity of the disease and evaluating its value in predicting prognosis. Results (1) In 136 AP patients, 50 cases (36.8%) were mild acute pancreatitis group, 61 cases (44.9%) in severe severe pancreatitis group and 25 cases (18.4%) in severe pancreatitis group. (2) The BISAP, APACHEⅡ, CTSI scores correlated with the severity of the disease (P <0.05). (3) The AUC values of BISAP, APACHEⅡ and CTSI score for the new classification of SAP prediction accuracy were 0.904,0.942 and 0.823 respectively, the best prediction value was 3 points (sensitivity 84%, specificity 86.5%, positive likelihood ratio 6.216, negative likelihood ratio 0.185), 10 points (sensitivity 96%, specificity 86.5%, positive likelihood ratio 7.104, negative likelihood ratio 0.046) and 4 points (sensitivity 96%, specificity 56.8%, positive Then than 2.220, the negative likelihood ratio of 0.070). (4) BISAP score correlated with disease recurrence (P <0.05). Conclusion The correlation between BISAP, APACHEⅡ and CTSI scores is better than the new classification. Among them, BISAP and APACHEⅡscores the most accurate prediction of SAP. BISAP≥3 or APACHEⅡ≥10 points suggest SAP.