不同评分系统对重症急性胰腺炎预后评估的临床价值

Evaluation of different scoring systems as prognostic predictor in severe acute pancreatitis

目的探讨评估重症急性胰腺炎(SAP)的不同方法对SAP预后的判断效果。方法回顾性分析10年间收治168例SAP患者的临床资料。运用受试者工作特征曲线(ROC曲线)下面积,单因素和多因素分析评价序贯器官衰竭评分(SOFA)、急性生理和慢性健康评估(APACHEⅡ)及CT严重性指数(CTSI)对SAP预后结果的预测能力。结果ROC曲线面积比较:SOFA,APACHEII,CTSI的ROC曲线下面积分别为0.846,0.809和0.779;SOFA与CTSI评分比较,差异有统计学意义(Z=2.68,P<0.01);APACHEII与SOFA,CTSI比较,差异无统计学意义(Z=1.079,P>0.05和Z=0.693,P>0.05)。单因素分析显示,住院期最大SOFA计分、最大APACHEⅡ评分、最大CT计分指数、年龄、胰腺感染等与SAP预后相关;多因素分析表明,最大SOFA计分、最大APACHEⅡ评分、最大CT计分指数为SAP预后判别预测的独立相关因素。联合评价表明,三者阳性与二者阳性或一个阳性的SAP患者病死率比较,有统计学意义(P<0.05)。结论动态观测SAP患者住院期间的SOFA,APACHEⅡ和CTSI对SAP预后有较强的判别预测能力,联合三者建立的判别方程具有更佳的SAP预后判别效果。

Objective To evaluate different scoring systems in predicting outcome of severe acute pancreatitis （ SAP ）. Methods A retrospective study was carried out in 168 SAP patients treated in our hospital within the past 10 years. We evaluated the prognostic value of the Sequential Organ Function Assessment （ SOFA ） , Acute Physiology and Chronic Health Evaluation Ⅱ （APACHEII） , and Computed Tomography Severity Index （CTSI）. The area under a receiver operating characteristic （ROC） curve and univariate and multivariate analysis methods were used. Results The area under the ROC curve of SOFA, APACHEⅡ, CTSI was 0.846,0. 809 and 0. 779, respectively. The difference between SOFA and CTSI had statistical significance （Z = 2. 68, P 〈 0. 01 ） , but the ones between APACHEⅡ and SOFA, CTSI did not have statistical significance （Z = 1. 079, P 〉 0. 05; Z = 0. 693, P 〉 0. 05）. Univariate analysis showed SOFA, APACHEII, CTSI, age and pancreatic infection were related to prognosis of SAP. Multivariate analysis revealed that only SOFA, APACHEII, CTSI were independent prognosis-related factors of SAP. Conclusions SOFA,APACHEⅡ, CTSI all have good predictive ability for prognosis of SAP during dynamic in-hospital observation, and combination of the three factors has greater ability for prognosis of outcome of SAP.