血清白蛋白及EPIC评分在中至重症急性胰腺炎中的应用价值

The value of serum albumin and EPIC score in moderate to severe acute pancreatitis

目的:旨在采用修订版急性胰腺炎Altanta分类标准,重新评价各临床生化指标、临床评分及影像学评分对急性胰腺炎严重程度的预测价值。方法:回顾性收集2015-03—2018-03期间于我院急诊内科住院的中重症急性胰腺炎(MSAP)及重症急性胰腺炎(SAP)患者资料;通过单因素分析比较MSAP及SAP患者组间差异;采用多因素Logistic回归分析评价各指标对SAP患者的预测价值,对有统计学意义的临床指标及评分应用ROC曲线分析敏感度及特异度。结果:本研究共纳入患者124例,其中MSAP组患者100例(80.65%),SAP组患者24例(19.35%)。SAP组患者CRP、Scr、BUN、AST、LDH、BG、Ranson评分、BISAP评分、EPIC评分及入院时合并SIRS的比例均高于MSAP组,而ALB、血Ca、FT3水平均低于MSAP组(P<0.05)。单因素Logistic回归分析结果显示,CRP、Scr、ALB、FT3、Ranson评分、BISAP评分、EPIC评分和入院时合并SIRS对SAP患者均有一定预测价值;多因素Logistic回归分析结果表明,ALB、Ranson评分及BISAP评分可作为预测SAP患者的独立因素(P <0.05),AUC(95%CI)分别为0.906(0.848~0.964)、0.919(0.863~0.975)和0.908(0.850~0.966)。结论:在修订版急性胰腺炎Altanta分类下,ALB可作为预测中至重症急性胰腺炎患者疾病严重程度的重要指标,其对SAP患者的预测作用与Ranson评分及BISAP评分相当。

Objective：Reevaluate the early predictive value of serum albumin（ALB）,Ranson score,BISAP and EPIC in the severity of acute pancreatitis using revised Atlanta classification standard.Method：We retrospectively studied patients with moderately severe acute pancreatitis（MSAP）or severe acute pancreatitis（SAP）between Mar.2015 to Mar.2018.The diagnosis and severity of acute pancreatitis were defined according to 2012 revised Atlanta classification.Uni-and multi-variate logistic regression were performed to determine the independent risk factors associated with SAP.The diagnostic performance of the factors was evaluated by the area under Receiver Operating Characteristic（ROC）curves.Result：In 124 acute pancreatitis patients,100（80.65%）patients had MSAP and 24（19.35%）patients had SAP.The CRP,Scr,BUN,AST,LDH,BG,Ranson score,BISAP score,EPIC score and proportion of combined with SIRS on admission of SAP group were higher than that of MSAP group.The ALB,Ca and FT3 of SAP group were distinctly lower than MSAP group（P〈0.05）.In uni-variate analysis,ALB,CRP,Scr,FT3,Ranson score,BISAP score,EPIC score and proportion of combined with SIRS on admission were significantly associated with SAP.After multi-variate regression,ALB,Ranson score and BISAP score were independent prognostic factors for SAP（P〈0.05）.The area under ROC curves of ALB to predict SAP was 0.906（0.848~0.963）,similar to Ranson score,0.919（0.863~0.975）and BISAP,0.908（0.850~0.966）.Conclusion：Serum albumin is a promising,easy-to-measure,repeatable,non-invasive biochemical parameter for the prediction of the severity of acute pancreatitis.