四种评分系统对中重度高脂血症性急性胰腺炎的预测价值

The predictive value of four scoring systems for typing moderately severe and severe hyperlipidemic acute pancreatitis

目的探讨急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、急性胰腺炎严重程度床旁指数(BISAP)、Ranson评分、改良CT严重指数(MCTSI)四种评分系统对中重度高脂血症性急性胰腺炎(HLAP)的预测价值。方法收集2016年2月—2020年2月本院收治的116例HLAP患者的临床资料,根据病情严重程度分轻症、中度重症、重症,计算患者各评分的分值,采用卡方检验和ROC曲线评估四种评分系统预测患者发生中度重症、重症急性胰腺炎和并发症的价值。结果APACHEⅡ评分≥8分、BISAP评分≥3分、Ranson评分≥3分及MCTSI评分≥4分者中度重症、重症急性胰腺炎的发生率、并发症发生率分别高于APACHEⅡ评分≤7分、BISAP评分≤2分、Ranson评分≤2分及MCTSI评分≤3分者,差异均有统计学意义(P均<0.05)。APACHEⅡ评分预测中度重症、重症急性胰腺炎的敏感度(52%)和AUC值(0.752)高于其他三种评分系统,MCTSI评分预测并发症的敏感度(75%)和AUC值(0.779)高于其他三种评分系统。结论四种评分系统均可用于HLAP病情严重程度、并发症发生率的评估和预测。与其他三种评分系统相比,APACHEⅡ评分在准确性上具有一定的优势,但项目繁多、可行性差,BISAP评分简便、易行,但预测的准确性有待于进一步提高。

Objective The aim of this study was to evaluate the predictive value of the four scoring systems for typing hyperlipidemic acute pancreatitis(HLAP),including acute physiology and chronic health evaluation scoring system(APACHEⅡ),bedside index for severity in acute pancreatitis(BISAP),Ranson score and modified CT severity index(MCTSI).Methods The clinical data of 116 patients with HLAP those admitted to our hospital from February 2016 to February 2020 were retrospectively collected.According to the severity of the disease,the patients were divided into mild cases,moderately severe cases,severe cases,and the scores were calculated.Chi-square test and receiver operating characteristic curve were used to evaluate the value of the four scoring systems in predicting severity and complications.Results The incidences of moderately severe acute pancreatitis,severe acute pancreatitis and complications among patients with BISAP score≥3,Ranson score≥3,APACHEⅡscore≥8 and MCTSI score≥4 were significantly higher than those patients with APACHEⅡscore≤7,BISAP score≤2,Ranson score≤2 and MCTSI score≤3 respectively(all P<0.05).The sensitivity and AUC of APACHEⅡin predicting moderately severe acute pancreatitis,severe acute pancreatitis were 52%and 0.752,which were higher than the other three systems.In assessment of complications,the sensitivity and AUC of MCTSI were 75%and 0.779,which were higher than the other three systems.Conclusions All the four scoring systems can be used to determine the severity,and incidence of complications.Compared with the other three scoring systems,APACHEⅡhas certain advantages in accuracy,but there are many projects with poor feasibility.BISAP is simple and easy to practice,but the accuracy needs to be further improved.