血清脂肪酶联合Ranson或BISAP评分系统诊断急性胰腺炎严重程度的效果分析

Diagnostic value of serum lipase combined with Ranson or BISAP scoring system in assessment of severity of acute pancreatitis

目的探讨血清脂肪酶联合Ranson或BISAP评分系统在急性胰腺炎严重程度中的诊断意义。方法选取2012年2月-2015年2月惠东县第二人民医院收治的急性胰腺炎患者314例,分为轻症急性胰腺炎(MAP)组(n=202)和重症急性胰腺炎(SAP)组(n=112)。对所有患者分别进行血清脂肪酶检测、Ranson评分、BISAP评分、脂肪酶联合Ranson或BISAP评分。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,不同评估方法间曲线下面积(AUC)、约登指数比较采用Z检验。结果 SAP患者的血清脂肪酶水平、Ranson评分值、BISAP评分值均显著高于MAP患者,差异均有统计学意义(t值分别为14.89、11.89、5.12,P值分别为0.003、0.007、0.037)。预测器官功能衰竭、胰腺坏死和病死率的AUC中,脂肪酶联合BISAP评分系统均高于BISAP评分,差异均有统计学意义(Z值分别为7.54、7.11、7.57,P值分别为0.033、0.031、0.030);脂肪酶联合Ranson评分系统均高于Ranson评分,差异均有统计学意义(Z值分别为5.23、5.78、6.18,P值分别为0.037、0.034、0.032);脂肪酶联合BISAP评分系统均高于脂肪酶联合Ranson评分系统,差异均有统计学意义(Z值分别为13.55、8.33、7.66,P值分别为0.005、0.029、0.031)。脂肪酶联合Ranson评分系统预测器官功能衰竭、胰腺坏死和病死率的约登指数均高于Ranson评分,差异均有统计学意义(Z值分别为5.17、6.89、7.35,P值分别为0.038、0.032、0.027);脂肪酶联合BISAP评分系统的约登指数均高于BISAP评分,差异均有统计学意义(Z值分别为7.54、7.22、9.57,P值分别为0.030、0.031、0.025),脂肪酶联合BISAP评分系统的约登指数均高于脂肪酶联合Ranson评分系统,差异均有统计学意义(Z值分别为10.11、10.23、13.24,P值分别为0.020、0.019、0.010)。结论脂肪酶联合Ranson或BISAP评分系统在诊断急性胰腺炎严重程度时较单独采用Ranson评分系统、BISAP评分系统准确性高,其中脂肪酶联合BISAP评分系统敏感性更高,更具有临床诊断价值。

combined with the Ranson scoring system had significantly higher AUCs than the Ranson scoring system （Z = 5.23, 5.78, and 6.18, P = O. 037, 0.034, and 0.032） , and serum lipase determination combined with the BISAP scoring system had significantly higher AUCs than serum lipase determination combined with the Ranson scoring system （Z = 13.55, 8.33, and 7.66, P = 0. 005, O. 029, and 0.031 ）. As for Youden index for the prediction of organ failure, pancreatic necrosis, and death, serum lipase determination combined with the Ranson scoring system had a significantly higher Youden index than the Ranson scoring system （Z = 5.17, 6.89, and 7.35, P = 0. 038, 0. 032, and 0. 027 ）, serum lipase determination combined with the BISAP scoring system had a significantly higher Youden index than the BISAP scoring system （Z =7.54, 7.22, and 9.57, P =0. 030, 0. 031, and 0. 025）, and serum lipase determination combined with the BISAP scoring system had a significantly higher Youden index than serum lipase determination combined with the Ranson scoring system （ Z = 10.11, 10.23, and 13.24, P=0.020,0.019, and0.010）. Conclusion Compared with the Ranson scoring system or BISAPscoringsys- tern alone, serum lipase determination combined with the Ranson or BISAP scoring system is more accurate in the assessment of severity of a- cute pancreatitis, and serum fipase determination combined with the BISAP scoring system has a higher sensitivity and a greater diagnostic value in clinical practice.