1992版和2012版亚特兰大分类标准对急性胰腺炎病情严重程度判定的差异

The comparison of the 1992 and 2012 Atlanta classifications for assessing disease severity in patients with acute pancreatitis

目的 比较2012年新亚特兰大分类标准与1992年旧亚特兰大分类标准对急性胰腺炎（AP）的严重度分级、器官衰竭和局部并发症判定的差异.方法 从南昌大学第一附属医院AP数据库选择2005年1月至2013年12月发病3d内入院的2 305例成人AP患者,分别按旧亚特兰大分类标准和新亚特兰大分类标准判断病情严重程度、器官功能衰竭和胰腺局部并发症,比较两者判定情况的差异.结果 入选的2 305例AP患者按旧亚特兰大标准判定为急性呼吸衰竭301例（13.1％）,休克136例（5.9％）,急性肾衰竭105例（4.6％）,消化道出血296例（12.8％）,诊断为轻症AP 900例（39.0％）,重症AP l 405例（61.0％）;以新亚特兰大标准判定为急性呼吸衰竭686例（29.8％）,循环衰竭107例（4.6％）,急性肾衰竭129例（5.6％）,诊断为轻度AP 998例（43.3％）,中度AP 937例（40.7％）,重度AP 370例（16.1％）.结果显示,新亚特兰大标准判定的急性呼吸衰竭发生率高于旧亚特兰大标准（x2=191.09 ,P ＜0.001）.新亚特兰大标准诊断的重度AP患者其病危自动出院率和院内病死率高于中度AP患者（17.0％比4.1％,4.1％比1.5％,P均＜0.001）,也高于旧亚特兰大标准诊断的重症AP患者（17.0％比7.2％,4.1％比2.1％,P均＜0.001）,且住院时间更长,费用更高.结论 新旧亚特兰大标准对器官功能衰竭的判定标准不同,新标准判定的重度AP比旧标准判定的重症AP病情更为严重,预后更差.新标准有利于对危重AP患者的识别,集中医疗资源重点管理.

Objective To compare the discrepancy between the new （2012） and the old （1992） Atlanta classification criteria for defining severity, organ failure and local complications in patients with acute pancreatitis （AP）.Methods Demographic, clinical and laboratory data of 2 305 consecutive AP patients with onset less than 3 days, were collected between January 2005 to December 2013 in the First Affiliated Hospital of Nanchang University.Severity, organ failure and pancreatic local complications were respectively classified by the old Atlanta classification and the new revised Atlanta classification.Multi-factor scoring system and single serum marker were recorded and calculated using the acute pancreatitis database.Results In 2 305 patients with AP, there were 301 cases （13.1%） diagnosed with acute respiratory failure, 136 cases （5.9%） with shock, 105 cases （4.6%） with acute renal failure, 296 cases （12.8%） with gastrointestinal bleeding, based on the old Atlanta classification criteria.According to the severity, 900 cases （39.0%） were classified as mild acute pancreatitis （MAP）, 1 405 cases （61.0%） as severe acute pancreatitis （SAP）.However, based on the new Atlanta classification criteria, there were 686 cases （29.8%） with acute respiratory failure, 129 cases （5.6%） with acute renal failure, 107 cases （4.6%） with circulatory failure.Consequently, 998 cases （43.3%） were classified as MAP, 937 cases （40.7%） as moderately severe acute pancreatitis （MSAP）, 370 cases （16.1%） as SAP.The incidence of respiratory failure was lower than that of the old standard.In SAP patients by new criteria, the discharge rate in critical condition and mortality were not only higher than those in MSAP patients （17.0% vs 4.1%, 4.1% vs 1.5%, respectively , all P 〈 0.001）, but also higher than those in SAP patients by the old classification （17.0% vs 7.2% ,4.1% vs 2.1%, all P 〈 0.001）.Conclusions The diagnostic criteria of organ failure are different between the new and old Atlanta classification.The SAP patients classified by the new standard have worse outcome than those by the old standard.More attention needs to be paid to critical patients stratified by the new standard.