急性胰腺炎修正亚特兰大分类和基于决定因素分类的比较研究

A comparison between the revision of Atlanta classification and determinant-based classification in acute pancreatitis

目的比较急性胰腺炎修正亚特兰大分类（RAC）和基于决定因素分类（DBC）的临床应用价值。方法回顾性分析2001年1月至2015年1月我院收治的急性胰腺炎患者资料，按RAC分为轻症、中度重症和重症3个亚组，按DBC分为轻症、中度重症、重症和危重4个亚组，比较各亚组之间的病情及预后。采用ROC曲线比较RAC和DBC的分类效力。结果共纳入急性胰腺炎患者1120例，其中343例（30．6％）合并器官衰竭，74例（6．6％）发生感染性坏死，63例（5．6％）死亡。RAC和DBC各亚组病情严重度和预后的差异均有统计学意义（P〈0．001），DBC的危重亚组（同时存在持续性器官衰竭和感染性坏死）病情严重度和病死率（19／31，61.3％）最高。在判断住院时间有无延长方面，DBC的ROC曲线下面积（0．73，95％C10．69～0．78）大于RAC（0．68，95％C10．65～0．73）（P=0．031）。在判断病死率（P=0．372）和ICU住院时间延长（P=0.266）方面，二者的差异无统计学意义。结论RAC和DBC对急性胰腺炎的分类效力总体相仿，在判断住院时间延长方面DBC略优。持续性器官衰竭和感染性坏死与急性胰腺炎不良预后相关，两者同时存在时预后最差。

Objective To compare the performance of the revision of Atlanta classification （RAC） and determinant-based classification （DBC） in acute pancreatitis. Methods Consecutive patients with acute pancreatitis admitted to a single center from January 2001 to January 2015 were retrospectively analyzed. Patients were classified into mild, moderately severe and severe categories based on RAC and were simultaneously classified into mild, moderate, severe and critical grades according to DBC. Disease severity and clinical outcomes were compared between subgroups. The receiver operating curve （ROC） was used to compare the utility of RAC and DBC by calculating the area under curve （AUC）. Results Among 1 120 patients enrolled, organ failure occurred in 343 patients （30.6%） and infected necrosis in 74 patients （6,6%）. A total of 63 patients （5.6%） died. Statistically significant difference of disease severity and outcomes was observed between all the subgroups in RAC and DBC （P〈0.001）. The category of critical acute pancreatitis （with both persistent organ failure and infected necrosis） had the most severe clinical course and the highest mortality （19/31, 61.3%）. DBC had a larger AUC （0.73, 95%CI0.69-0.78） than RAC （0.68, 95%CI 0.65-0.73） in classifying ICU admissions （P=0.031）, but both were similar in predicting mortality（P=0.372） and prolonged ICU stay （P=0,266）. Conclusions DBC and RAC perform comparably well in categorizing patients with acute pancreatitis regarding disease severity and clinical outcome. DBC is slightly better than RAC in predicting prolonged hospital stay. Persistent organ failure and infected necrosis are risk factors for poor prognosis and presence of both is associated with the most dismal outcome.