BISAP联合凝血指标对急性胰腺炎严重程度评估的意义

Significance of BISAP combined with coagulation parameters in predicting the severity of acute pancreatitis

目的:研究BISAP(bedside index for severity in AP)评分联合凝血指标对急性胰腺炎(acute pancreatitis,AP)严重程度评估的意义.方法:回顾2008-2012年中国医科大学附属盛京医院收治的166例AP患者的临床资料.对所有患者进行入院24h的BISAP、APACHE-Ⅱ评分,48h的Ranson's及发病72h内CTSI评分,入院24h内抽取静脉血测定部分凝血活酶活化时间、凝血酶原时间、D-二聚体(D-dimer)、纤维蛋白原及血小板水平.分析凝血指标及BISAP评分对AP严重程度判断的意义,并通过ROC曲线分析二者联合对AP严重程度评估的意义.结果:多因素Logistic回归分析发现,D-dimer对AP严重程度评估具有独立预测意义;随着BISAP评分增加,SAP的比率增加;BISAP评分系统评估AP严重程度以2为临界点时Youden指数最大(0.541),ROC曲线下面积为0.836(0.776-0.896),并不逊于传统评分系统;BISAP评分系统联合D-dimer能更好地评估AP患者的严重程度.结论:BISAP是临床判断AP轻重程度的简单有效的指标,将BISAP与D-dimer联合应用使得对AP严重程度的评估更为准确.

AIM： To explore the significance of BISAP （bedside index for severity in AP） combined with coagulation parameters in predicting the severity of acute pancreatitis （AP）. METHODS： One hundred and sixty-six patients with AP who were admitted to Shengjing Hospital of China Medical University from 2008 to 2012 were included in this study. The BISAP and APACHE-Ⅱ scores were calculated using data from the first 24 h from admission and the Ranson＇s score using data from the first 48 h. CTSI was calculated in patients who underwent CECT within 72 h from onset. The activated partial thromboplastic time （APTT）, prothrombin time （PT）, D-dimer, fibrinogen （FIB） and platelet （PLT） were measured within the first 24 h from admission. The area under the receiver operating characteristic （ROC） curve （AUC） was calculated to explore the significance of BISAP combined with coagulation parameters in predicting the severity of AP. RESULTS： Multivariate Logistic regression analysis showed that D-dimer was an independent predictor of the severity of AP. Increased BISAP score is associated with an increased risk of severe AP （SAP）. Taking 2 as the cutoff value for SAP, we obtained the maximum Youden index. The AUC for BISAP in predicting SAP was 0.836 （95%CI： 0.776-0.896）, and the BISAP score performed similar to the three ＂traditional＂ scoring systems. BISAP score combined with D-dimer （BISAP＋D） could improve the predictive validity. CONCLUSION： BISAP score is an accurate means for predicting the severity of AP, and BISAP＋D score may enhance the accuracy of early prediction of SAP.