不同海拔高度多脏器功能障碍评分系统比较

Comparison of three multi-organ dysfunction scoring systems in predicting the outcome of MODS in flatland and plateau

目的：判别高原地区多脏器功能障碍综合征（multiple organ dysfunction syndrome at high altitude，H—MODS）各项诊断指标参数界值与平原地区的差异；验证新的评分诊断标准的准确性、可操作性。方法：按统一标准将总数为462例MODS患者根据海拔高度分为平原对照组（CG，n=113）、中度高原组（MHG，1517m，n=314）、高原组（HG，2808—3400m，n=35）。分别用平原地区MODS评分诊断标准（庐山会议标准和Marshall诊断标准）以及兰州修订的H—MODS评分标准，绘制ROC曲线（receiver operating characteristic curve），计算约登指数和最佳界值，验证3个标准在不同海拔高度预测MODS结局的准确性。结果：多脏器评分提示兰州标准随海拔梯度升高有进一步提高预测准确性的效果，P=0．034。分层分析还表明，肺、脑、心、肾等单项指标的ROC预测值也以兰州标准的适用度最高（P〈0．05）。结论：通用的MODS诊断标准中某些参数界值不适合中度高原以上地区；海拔高度大于1500m以上地区可能是区分平原和高原MODS诊断标准的一个有意义的分界线，值得进一步实践观察。

Objective： To compare the diagnostic parameters of multiple organ dysfunction syndrome （MODS） at high altitude and on plain. Methods： A total of 462 cases fulfilled the criteria for MODS were divided into three groups： control group （CG, n = 113, on plain）, moderate high altitude group （MHG, n = 314, 1 517m） and high altitude group （ HG, n = 35,2 808m to 3 400m）. The MODS scores of patients in the three groups were carried out according to Lushan conference, Marshall （1995） and Lanzhou criteria drafted. Results： In MHG group, the probability of ROC, the maximal ~ordon index, the optimum cutoff points, the sensitivity and the specificity of Lanzhou criterion were more effective in predicting the outcome of MODS than those of Lushan and Marshall＇s criteria （ P 〈 0.05）, suggesting that the accuracy of Lanzhou criterion in predicting the outcome of MODS had the heightening tendency at moderate high or higher altitude. Further investigation showed that Lanzhou criterion was more adapted to high altitude areas in predicting the ROC probability values of lung, brain, heart and kidney compared with the other two criteria （ P 〈 0.05 ）. Conclusion： The current diagnostic score criteria of MODS could not fit for the moderate high or higher altitude areas. The altitude of 1 517m might be important boundary in distinguishing the applying extension of the diagnostic criteria of MODS on flatland or highland.