预测急性胰腺炎患者疾病进展的相关参数研究

Research on parameters related to predicting disease progression in patients with acute pancreatitis

目的 评价预测急性胰腺炎（AP）患者疾病进展、死亡与转入重症监护病房（intensive care unit， ICU）的相关参数。 方法 选取在我院消化内科急诊室就诊的317例AP患者，根据疾病程度，将患者分为重度急性胰腺炎组（SAP组）与轻、中度胰腺炎组（MAP-MSAP组）。比较两组患者入院和入院48 h的临床特征和实验室指标，评价影响患者疾病进展的相关参数。采用受试者工作特征曲线（ROC）评价这些参数对患者发生SAP、死亡及转入ICU的准确度、灵敏度和特异度。 结果 共有57例（18.0%）患者发生SAP，16例（5.0%）患者死亡，23例（7.3%）患者转入ICU治疗。ROC曲线分析表明，BISAP评分、RANSON评分、血乳酸（Lac）、血清肌酐（Cr）、尿素氮（BUN）、48 h血清肌酐、48 h BUN、48 h C-反应蛋白（CRP）对SAP、死亡和转入ICU具有独立预测能力（均P＜0.05）。BISAP评分对预测SAP（AUC=0.965）、死亡（AUC=0.978）与转入ICU （AUC=0.936）均有较高的准确性。在治疗48 h时测得的参数中，48 h BUN对预测SAP（AUC=0.968）、死亡（AUC=0.978）与转入ICU （AUC=0.952）均有较高的准确性。血乳酸对于预测SAP、死亡与转入ICU有一定的准确性。 结论 BISAP评分对预测SAP（AUC=0.965）、死亡（AUC=0.978）和转入ICU（AUC=0.936）有较高的准确性，有助于对患者进行ICU急救管理，血乳酸可以用于开发新的AP评分系统。

Objective To evaluate the parameters of predicting disease progression, death and transfer to ICU in patients with acute pancreatitis （AP）. Methods A total of 317 AP patients were enrolled in the department of gastroenterology emergency of our hospital. The patients were divided into severe pancreatitis group （ SAP group） and mild to moderate pancreatitis group （ MAP - MSAP group） according to the degree of disease. The clinical characteristics and laboratory parameters of the two groups of patients admitted to hospital and admitted for 48 hours were compared. Relevant parameters affecting patient disease progression were evaluated. The receiver operating curve （ROC） was used to evaluate the accuracy, sensitivity, and specificity of these parameters for SAP, death, and transfer to ICU. Results A total of 57 （18.0%） patients developed SAP. 16 （5%） patients died. 23 （7.3%） patients were transferred to the ICU. ROC curve analysis showed that BISAP score, RANSON score, blood lactate, serum creatinine, BUN, 48 h serum creatinine, 48 h BUN, 48 h CRP had independent predictive power for SAP, death and transfer to ICU （ all P 〈 0.05）. BISAP scores have higher accuracy for predicting SAP （ AUC = O. 965 ）, death （ AUC = 0. 978 ）, and transfer to ICU （ AUC = 0. 936 ）.Among the parameters measured at 48 h, 48 h BUN had higher accuracy for predicting SAP （ AUC = 0.968）, death （ AUC = 0. 978） and transfer to ICU （ AUC = 0. 952）. Serum lactic acid has certain accuracy in predicting SAP, death and transfer to ICU. Conclusion BISAP score has a high accuracy in predicting SAP, death and transfer to the ICU, and is helpful for ICU emergency management. Serum lactic acid can be used to develop a new acute pancreatitis scoring system.