Ranson评分对中重度高脂血症性急性胰腺炎分型的预测价值

Predictive Value of Ranson Score for Typing Moderately Severe and Severe Hyperlipidemic Acute Pancreatitis

目的探讨Ranson评分对高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)分型的早期预测价值。方法回顾性收集2014年1月至2018年10月在北京协和医院急诊科就诊的中重度HLAP患者资料,包括年龄、性别、血脂水平、血糖、白细胞、乳酸脱氢酶(lactate dehydrogenase,LDH)、谷草转氨酶(aspartate aminotransferase,AST)以及入院48 h后的血细胞比容、尿素氮、血钙、碱缺乏、液体丢失量。按照疾病严重程度分为中度和重度HLAP,并计算每例患者的Ranson评分。采用t检验比较中度和重度HLAP组间Ranson评分的差异,运用受试者工作特征(receiver operating characteristic,ROC)曲线分析得出最佳界值,计算其敏感度和特异度,以卡方检验验证其一致性。结果共计99例符合入选和排除标准的HLAP患者进入本研究,其中中、重度HLAP分别为45例和54例。重度HLAP组的Ranson评分显著高于中度组,差异具有统计学意义(5.19±1.33比3.09±1.35,P<0.01)。ROC曲线分析显示4为最佳临界值,敏感度为75.9%,特异度为84.4%;以4为临界值,Ranson评分3~4者符合中度HLAP的表现,Ranson评分>4符合重度HLAP表现,中度和重度组的Ranson评分与疾病分型一致(P<0.01)。结论Ranson评分可用于中度和重度HLAP分型早期预测,3~4分提示中度HLAP,>4分提示重度HLAP。

Objective The aim of this study was to evaluate the predictive value of Ranson score for typing hyperlipidemic acute pancreatitis(HLAP).Methods The clinical data of HLAP patients in the department of Emergency Medicine of Peking Union Medical College Hospital from January 2014 to October 2018 were retrospectively collected,including age,sex,serum lipid,blood glucose,white blood cells,lactate dehydrogenase,aspartate aminotransferase,and hematocrit,urea nitrogen,blood calcium,alkali deficiency,fluid loss at the 48th hour after the admission.Ranson scores were evaluated and compared between the moderately severe and severe HLAP groups;the optimal cut-off value was obtained using the receiver operating characteristic(ROC)curve analysis,and its sensitivity and specificity were calculated.The chi-square test was used to verify the consistency.Results A total of 99 patients meeting the inclusive and exclusive criteria were enrolled in this study,including 45 with moderately severe HLAP and 54 with severe HLAP.Ranson score of the severe HLAP group was higher than that of the moderately severe group(5.19±1.33 vs.3.09±1.35,P<0.01).ROC curve analysis indicated that 4 was the cut-off value;its sensitivity and specificity were 75.9%and 84.4%,respectively.Using 4 as the cutting line,a Ranson score of 3-4 indicated the moderately severe HLAP,and>4 indicated severe HLAP;Ranson scores of moderately severe and severe HLAP group were consistent with the disease classification(P<0.01).Conclusions The Ranson score might be used to type the moderately severe and severe HLAP,with a score of 3-4 suggesting the moderately severe HLAP and>4 suggesting the severe HLAP.