床旁严重度指数评分联合血清降钙素原对急性胰腺炎严重程度的早期评估价值

Early evaluations of BISAP combined with serum procalcitionin in predicting the severity of acute pancreatitis

目的：观察床旁严重度指数（BISAP）评分联合血清降钙素原（PCT）对急性胰腺炎（AP）预后的早期预测价值。方法测定230例 AP 患者的24 h 血清淀粉酶、血钙、血糖、PCT 以及D-二聚体水平，并根据相关评分标准对患者进行 BISAP 评分。比较轻症 AP（MAP）、中度重症 AP （MSAP）以及重症 AP（SAP）BISAP 评分各分值人数和所占比例，并比较 BISAP 评分联合 PCT 与其他评分系统对 SAP 的预测价值。结果随着 BISAP 分值的升高，AP 患者病情的严重程度及死亡人数差异均有统计学意义（P ＜0．01）；BISAP 评分与 PCT、D-二聚体、血糖呈正相关（r ＝0．445、0．321、0．269，P 均＜0．01），与血钙呈负相关（r ＝-0．335，P ＜0．01）；PCT 与 APACHE Ⅱ、Ranson 评分、BISAP评分和 CTSI 评分呈正相关（r ＝0．427、0．382、0．451和0．402，P 均＜0．01）；将 PCT 纳入 BISAP 评分，预测 SAP 的 ROC 曲线下面积（AUC）为0．883，预测死亡的 AUC 为0．919。结论 BISAP 评分对 AP患者的病情严重程度和死亡有很好的预测价值，BISAP 联合 PCT 能更好预测 AP 的预后。

Objective To evaluate the early evaluations of bedside index for severity in acute pancreatitis（BISAP）plus serum procalcitionin（PCT）in predicting the severity and prognosis of acute pancreatitis（AP）.Methods A total of 230 cases of AP were prospectively analyzed.The levels of amylase, serum glucose,serum calcium,PCT and D-dimer in 24 hours were measured.According to the evaluation standard,the scores of BISAP were obtained.Mild acute pancreatitis （MAP）,moderately severe acute pancreatitis（MSAP）and severe acute pancreatitis（SAP）,death toll and their proportion were compared in different BISAP score.Correlation analyses were conducted for BISAP scores and laboratory indices,PCT and different scoring systems.The evaluative value of BISAP plus serum PCT and other scoring systems in SAP were compared.Results With rising BISAP scores,both severity and mortality increased in acute pancreatitis（P 〈0.01）.BISAP scores were positively correlated with PCT,D-dimer and serum glucose（r =0.445,0.321,0.269,all P 〈0.01）and negatively correlated with serum calcium（r =-0.335,P 〈0.01）. PCT was positively correlated with APACHEⅡ,Ranson,BISAP and CTSI scores（r =0.427,0.382,0.451, 0.402,all P 〈0.01）.When PCT was included into the BISAP scores,the area under the curve（AUC）of predicting SAP was 0.883 and the AUC of predicting death was 0.919.So BISAP score plus serum PCT had a good predictive value for the severity of AP and death.Conclusion In clinical practice,the simple BISAP scoring system can predict the severity of AP,and BISAP score plus PCT has a better predictive value for AP.