不同评分系统评估Fournier坏疽预后的比较

Different scoring systems to evaluate the prognosis of Fournier's gangrene: A comparative study

目的:总结诊疗Fournier坏疽的经验,对评估其预后的常用评分系统进行比较,寻找最佳的评估工具。方法:回顾性分析2004年至2014年间在我院确诊为Fournier坏疽并进行手术治疗患者16名。使用不同评分系统对入组病例进行预后评分,并用统计学方法对评分结果进行比较。结果:临床采用的评分系统包括FGSI、UFGSI、ACCI、s APGAR等,本研究中ACCI与UFGSI评分在死亡组与生存组中有显著差异,FGSI、s APGAR评分差异不明显,ACCI评分的ROC曲线下面积最大,标准误最小。结论:评估Fournier疽预后的评分工具ACCI、UFGSI均能对FG患者的预后做出评价,其中ACCI的敏感性、特异性更高,且容易在临床采集,是最佳的评价工具。

Objective： To sum up the experience in diagnosis and treatment of Fournier~ gangrene and find an optimal evalua- tion tool for its prognosis by comparing currently used prognostic scoring systems. Methods： We retrospectively analyzed 16 cases of Fournierg gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier＇s Gangrene Severity Index （FGSI）, Uludag Fournier＇s Gangrene Severity Index （UFGSI）, Age-Adjusted Charlson Comorbidity Index （ACCI）, and Surgical Apgar Score （sAPGAR） , we obtained the prognostic scores of the patients and made comparisons among different scoring systems. Results： FGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score. Conclusion ： Both ACCI and UFGSI are useful for evaluating the prognosis of Fournier＇s gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.