全身炎症反应综合征标准判断重症急性胰腺炎及预后的研究

Modified Systemic Inflammatory Response Syndrome for Judgement of Severe Acute Pancreatitis and It's Prognosis

目的 探讨全身性炎症反应综合征 (SystemicInflammatoryResponseSyndrome,SIRS)在急性胰腺炎 (AcutePan creatitis,AP)中的发生情况 ,尝试建立修订全身性炎症反应综合征 (ModifiedSystemicInflammatoryResponseSyndrome ,MSIRS)标准 ,应用MSIRS早期判断重症急性胰腺炎 (SevereAcutePancreatitis,SAP)及其预后 .方法 收集我院 1998年 1月～ 2 0 0 2年 2月收治的 2 81例急性胰腺炎的临床资料 ,统计分析轻型急性胰腺炎 (MildAcutePancreatitis,MAP)和SAP患者发病 48小时内的SIRS指标水平 ;修改SIRS标准水平 ,探索MSIRS标准早期判断SAP的优越性以及和SAP预后间的关系 .结果 ①SIRS在AP中总发生率为 41.2 % ,其中MAP发生SIRS为 18.1% ,SAP则 10 0 %发生SIRS ;②建立MSIRS标准 :T >38℃ ,P >110次 /min ,R >2 2次 /min ,WBC >15 .0× 10 9/L ,符合 2项或 2项以上者 ,判断为SAP ;③与临床诊断金标准比较 ,MSIRS标准早期判断出SAP的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为 :91.9%、93.6 %、93.1%、85 0 %和 96 .7% .④SAP患者除胰腺并发症外 ,急性呼吸窘迫综合征 (AcuteRespiratoryDistressSyndrome ,ARDS)、多器官功能不全综合征 (MultipleOrganDysfunctionSydromeMODS)

Objective To explore systemic inflammatory response syndrome(SIRS) occurred in the patients with acute pancreatitis(AP),and try to establish the modified systemic inflammatory response syndrome (MSIRS) to judge the severe acute pancreatitis (SAP) and to predict the prognosis. Methods Two hundreds and eighty-one cases of AP were collected and the recordings of SIRS criteria were analyzed according to the group of mild acute pancreatitis (MAP) and SAP within 48 hr after onset of illness. The criteria of SIRS was modified and the MSIRS criteria was used to judge the SAP and the relationship of MSIRS and outcome was studied. Results The incidence of SIRS was 41.2% in AP, 18.1% in MAP and 100% in SAP.The established MSIRS criteria were as follows: T>38℃,P>110次/min,R>22次/min,WBC>15.0×10 9/L, the patients met at least two of the criteria were determined as SAP. Comparing with the golden standard from the discharged diagnosis, sensibitity,specificity, accurate rate, positive predictive value and nagative predictive value were 91.9%,93.6%,93.1%,85.0% and 96.7% respectively.Except the complication of pancreasd,the incidence of acute respiratory distress syndrome(ARDS),multiple organ dysfunction sydrome(MODS),and fatality rate increase as the increase in number of observed item which met the MSIRS criteria. Conclusions SIRS plays an important role in AP,the SAP could be differentiated by the MSIRS criteria which posses high sensibitity, specificity and accurate rate,and the criteria is related with the incidence of ARDS,MODS and death.