重症急性胰腺炎早期5因素体系与分级评分对患者死亡的评估价值研究

The assessment value of early 5 factors system with APACHE Ⅱ, Ranson and CT grading in death of patients with severe acute pancreatitis

目的探讨重症急性胰腺炎（SAP）早期5因素体系（年龄60岁、BMI28、人院Glu10．0mmol／L、TG11.3mmol／L以及通便时间48h）与APACHEⅡ、Ranson以及CT分级评分系统对患者死亡风险的评估价值。方法对122例SAP患者临床资料进行回顾性分析，将患者四种评分体系按照临界值分为不同的分段：APACHEⅡ评分≤20分为低分段，〉20分为高分段；Ranson评分≤3分为低分段，〉3分为高分段；CT分级≤c级为低分段，〉c级为高分段；5因素体系分为A型（评分〈2分）、B型（评分2～3分）和c型（〉3分）三型。比较不同分段患者的死亡率。考察早期5因素体系与另外3种评分体系联合后对患者死亡率的预测价值。结果四种评分体系下SAP患者死亡率差异较大，5因素体系、APACHEⅡ评分和Ranson评分高分段患者死亡率显著高于低分段患者（P〈0．05）。将早期5因素体系与上述三种体系结合考察发现，APACHEⅡ〉20分的B型SAP患者死亡率达到63．2％，C型死亡率达到90．0％，死亡率均明显高于APACHEⅡ≤20分的患者组；与Ranson评分以及cT分级评分结合后虽然二者高分段患者病死率均有所提高，但是和低分段患者比较差异没有统计学意义（P〉0．05）。结论SAP早期5因素体系指标少，获取方便，可以动态观察，不同的临床分型能够较好地反映患者病情的严重程度，与APACHEⅡ评分结合能够进一步提高对患者死亡风险的预测水平，但是该体系可能需要进一步完善、提高和研究证实。

Objective To explore the assessment value for the early 5 factors systemage of 60 years, BMI 28, Glul0.0 mmol/L, TG11.3 mmol/L, and admission defecation time 48 hours, with APACHE Ⅱ, Ranson and CT grading in death risk of patients with severe acute pancreatitis （SAP）. Methods A retrospective analysis was conducted on a total of 122 cases of SAP. The cases carried with four scoring system were divided into different sublevel according to the critical value： low sublevel - APACHE score ≤ 20 and high sublevel - APACHE score 〉20; low sublevel - Ranson score ≤3 and high sublevel - Ranson score 〉3; low sublevel - CT grading ≤C and high sublevel - CT grading 〉 C. 5 factors system was divided into type A - score 〈2, type B - score 2-3, and type C - score 〉3. The mortality of different sublevels were compared, and the prediction value of combination early 5 factors system with other 3 kinds of scoring system on mortality of SAP was explored. Results The difference of SAP mortality in 4 score systems was significant. The mortality of high sublevel patients in 5 factors system, APACHE score and Ranson score was significantly higher than that of Low Sublevel with a significant difference （P 〈0.05）. By combined the early 5 factor system with above three system, the mortality of type B within APACHE II 〉20 patient reached at 63.2%, and type C reached at 90%, and the mortality was significantly higher than that of APACHE II low sublevel; by combined with Ranson score and CT grading, although the mortality of high sublevel improved, compared with low sublevel, the difference was not statistically significant （P 〉0.05）. Conclusion SAP early 5 factor system carries the feature of less indexes which can be easily accessed and observed dynamically. The different clinical types of the system can reflect the severity of disease condition in a better position, and it can further improve the prediction level of death risk by combination with the APACHE II score However, the system needs to be further studied, improved, and confirmed.