三种评分标准对急性胰腺炎病情及预后评估的比较

A comparative study on three clinical scoring systems in the prediction of severity and prognosis of acute pancreatitis

目的分析入院时床边严重指数(BISAP)、APACHEII及Ranson三种评分系统预测急性胰腺炎(AP)病情严重程度和预后的应用价值。方法回顾性分析我院2007年1月至2010年10月共161例AP患者,包括MAP110例,SAP51例,均进行BISAP、APACHEII、Ranson评分,通过受试者工作特征(ROC)曲线,比较三种方法对AP严重程度及预后的预测能力。结果 SAP组和MAP组的BISAP、APACHEII及Ranson评分分值差异均有统计学意义(2.71±1.8vs1.41±1.4,8.61±6.1vs3.27±2.4,4.55±2.3vs1.67±0.9,均P<0.001);分析ROC曲线下的面积(the area under receiver operator characteristic curve,AUC)显示:APACHEII评分在评估AP病情严重程度及全身并发症上具优势,预测病情严重程度及全身并发症的AUC分别为0.897、0.899,与其它两种评分标准相比有统计学差异(P<0.05)。Ranson评分≥5分时预测局部并发症的发生占优势。BISAP评分≥3分时预测死亡结局的敏感性(0.953)较其它评分标准高。结论三种评分标准预测能力各有侧重。APACHEII评分预测疾病严重性及全身并发症具有优势,Ranson评分预测局部并发症的效果较好,BISAP评分简单有效,预测AP患者死亡结局优于APACHEII、Ranson评分。

Objective To evalute and compare the value of Bedside Index for Severity in Acute Pancreatitis(BISAP),Acute Physiology And Chronic HealthEvaluationII(APACH EII),Ranson scoring systems in predicting the severtity and prognosis of acute pancreatitis(AP).Methods One hundred and sixty-one patients with acute pancreatitis admitted into Fujian Provincial Hospital from January 2007 to October 2010, Including 110 mild acute pancreatitis(MAP)cases and51 severe acute pancreatitis(SAP)cases,were retrospectively studied with BISAP, APACHEII and Ranson scoring systems. Receiver operator characteristic curve was used to compare the values of APACHEII,BISAP and Ranson socring systems in predicting severity and prognosis of acute pancreatitis.Results There was significant differences between MAP group and SAP group with BISAP, APACHEII and Ranson score(2.71±1.8vs1.41±1.4, 8.61±6.1vs3.27±2.4, 4.55±2.3vs1.67±0.9, both P < 0.001).Through the comparison of the area under receiver operator characteristic curve(AUC): APACHEII had a higher ability in predicting severity and systemic complications compared to other two scoring systems(P < 0.05),the AUC values of APACHEII in predicting severity and systemic complications were 0.897 and 0.899, respectively. Ranson scoring systems had a higher ability in predicting local complications as the cut-piont was no less than 5. The sensitivty of BISAP which was better than other two scoring systems in predicting mortality was 0.953 as the cut-piont was no less than 3.Conclusions The predictive ability of the three scoring systems is not the same.APACHEII scoring system had a higher ability in predicting severity and multiple organ dysfunction syndrome while Ranson scoring system had a higher ability in predicting local complications;BISAP is a simple and useful scoring system, and had a higher ability in predicting mortality of patients with acute pancreatitis.