Ranson和APACHEⅡ评分对重症急性胰腺炎患者死亡风险的评估价值

The value of APACHEⅡand Ranson scoring systems on pridicting death risk of severe acute pancreatitis

目的探讨急性生理学和慢性健康状况评分系统(APACHEⅡ)和Ranson评分系统对重症急性胰腺炎(SAP)患者死亡评估价值。方法收集四川大学华西医院收入的SAP患者185例入院后临床资料,行24 h内Ranson评分和APACHEⅡ评分,分别计算死亡组和生存组的两种评分及存活概率。分析两种评分系统的相关性,采用受试者工作特征曲线(ROC曲线)下面积评价二者对死亡的结果评估。结果185例SAP患者Ranson评分为1～10(4.72±2.18)分;入院24 h内APACHEⅡ评分为2～33(12.36±6.39)分;死亡组Ranson评分为3～10(6.53±1.74)分,APACHEⅡ评分为5～33(19.32±5.86)分;与生存患者的评分比较差异有显著性(P<0.05)。Ranson评分、APACHEⅡ评分进行Spearman等级直线相关分析见2项评分间均呈正相关(r=0.61)(P值均为0.00)。2个评分系统对SAP患者结局为死亡和生存进行ROC曲线分析后可以看出,Ranson评分、APACHEⅡ评分均可以预测SAP的死亡概率(P=0.00),但2项评分差异无特异性(P>0.05)。诊断阈值分别为5和14。结论Ranson评分和APACHEⅡ评分可以很好地预测SAP患者的死亡概率,预测价值相似。临床亟需新的预测评分系统出现。

Objective To evaluate the clinical applied value of Ranson and APACHEⅡ scoring systems on prediction of the severity and prognosis of severe acute pancreatitis（SAP）.Methods One hundred and eighty-five patients with SAP,who were admitted into West China Hospital of Sichuan University from January 2005 to January 2008 were studied retrospectively.Data associated to Ranson and APACHEⅡ scoring systems within 24 hours were recorded.The scores of death and survival patients and the correlation between the two scoring systems were analyzed.The area under the ROC curve（AUC） was compared in assessing the death rate of SAP.Results Ranson score was 1 to 10（4.72±2.18） in 185 SAP patients.APACHEⅡscore within 24 hours was 2 to 33（12.36±6.39）.The Ranson and APACHEⅡscores of death patients were 3~10（6.53±1.74）,5~33（19.32±5.86）.There were significant differences between death and survival patients（P0.05）.The two scoring systems were positively correlated（r=0.61）（P=0.00）.From AUC,Ranson and APACHEⅡ scores could predict the mortality of SAP patients,but there was no significant difference（P0.05）.Their diagnosis thresholds were 5 and 7.Conclusion Ranson and APACHEⅡscoring systems both can predict the death rate of SAP,but their prognosis ability are similar.We really need some ideal prognosis scoring systems in clinics.