急性胃肠损伤分级在急性胰腺炎患者严重程度评估中的应用

Application of acute gastrointestinal injury grading system in assessing the severity of acute pancreatitis

目的探讨急性胃肠损伤(AGI)分级对中度重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)患者病情严重程度、感染性胰腺坏死及患者死亡的预测价值。方法收集2011年6月至2015年6月间海军军医大学附属长海医院收治的344例MSAP和SAP患者的临床资料,通过受试者工作特征(R0 C)曲线,计算曲线下面积(AUC),分析比较AGI分级与不同临床评分(APACHEII评分、MCTSI、Marshall评分)对AP病情严重程度、胰腺感染性坏死及患者死亡的预测价值。结果344例患者中AGI高级别组(IIKIV级)81例,AGI低级别组(I、n级)263例。高级别组AP患者死亡例数、器官功能衰竭例数均显著高于低级别组(25/81比0/263,36/45比32/231),差异均有统计学意义(P值均<0.001)。高级别AGI预测AP患者死亡、感染性胰腺坏死的AUC分别为0.944(95%C/0.916~0.972)、0.779(95%C/0.723~0.836),高于APACHE II评分、MCTSI、Marshall评分,预测AP病情严重程度的AUC为0.718(95%C/0.644~0.792),低于APACHE I I、Marshall评分。结论AGI分级能较好地评估AP病情严重程度,对死亡和感染性胰腺炎坏死的预测价值高于APACHEII评分、MCTSI、Marshall评分。

Objective To explore the predictive value of acute gastrointestinal injury(AGI)grading system in assessing the severity,infectious pancreatic necrosis and death of patients with moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP).Methods The clinical data of 344 patients with MSAP or SAP admitted in Changhai Hospital Affiliated to Navy Medical University from June 2011 to June 2015 were collected.ROC curve was used and the area under ROC curve(AUC)was calculated.The predictive value of AGI grade for the severity,infectous pancreatic necrosis and death was compared with those of different clinical scores(APACHE H score,MCTSI and Marshal score).Results Of 344 patients,81 patients were classified into high AGI grade group(Grade IH,IV),while 263 patients were in low AGI grade group(Grade I,II)•The mortality and the number of patients with organ failure were obviously higher in high AGI grade group than those in low AGI grade group(25/81 vs 0/263,36/45 vs 32/231),and the difference was statistically significant(all P<values 0.001).AUC of high AGI grade for predicting patientsr death and infectious pancreatic necrosis was 0.944(95%C/0.916-0.972)and 0.779(95%Cl 0.723-0.836),respectively,which was higher than those of APACHE E and Marshall score.Conclusions AGI grading system can be applied to better assess the severity of acute pancreatitis,and its predictive value for death and infectious pancreatic necrosis was higher than that of APACHE D , MCTSI and Marshall score.