Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值

Predictive value of Ranson score in the classification of moderate to severe hyperlipidemia acute pancreatitis

目的探讨Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值。方法回顾性选取2016年2月至2021年2月北京中医医院怀柔医院中重度高脂血症性急性胰腺炎患者100例,依据病情严重程度分为中度组(全身或局部并发症2d以上无持续性器官衰竭或短暂性器官衰竭2d内消退,n=40)、重度组(2d以上持续性器官衰竭可能对肾脏、心血管、呼吸等系统至少一个器官造成累及,n=60)两组。统计分析两组患者的临床资料、Ranson评分,并统计分析不同Ranson评分患者的多脏器功能衰竭综合征、感染、局部并发症发生情况、死亡情况。结果两组患者的性别构成比、年龄、血脂最高水平之间的差异均无统计学意义(P>0.05),重度组患者血糖>11mmol/L、血钙≤2mmol/L、LDH>350U/L、白细胞数计数>16×10^(9)/L、Hct降低>16×10^(9)/L、碱缺乏>6mmol/L、液体需要量>6L的患者比率、Ranson评分均高于中度组,差异均有统计学意义(P<0.05)。重度组患者的Ranson评分3~4分患者比率低于中度组,5~10分患者比率高于中度组,差异有统计学意义(P<0.05)。100例患者中,多脏器功能衰竭综合征59例,死亡30例,多脏器功能衰竭综合征发病率、病死率分别为29.00%、12.00%,其中Ranson评分3~4分、5~6分、7~8分、9~10分患者的多脏器功能衰竭综合征发病率、病死率均逐渐升高(P<0.05)。死亡患者的Ranson评分高于多脏器功能衰竭综合征、感染、局部并发症患者(P<0.05),多脏器功能衰竭综合征、感染患者的Ranson评分均高于局部并发症患者(P<0.05),但多脏器功能衰竭综合征、感染患者的Ranson评分之间的差异无统计学意义(P>0.05);Ranson评分与多脏器功能衰竭综合征发病率、感染率、病死率均呈正相关关系但无线性关系(r=0.875,P<0.05),与局部并发症发生率无相关性(r=0.190,P>0.05)。结论Ranson评分对高脂血症性急性胰腺炎病情严重程度的评估有较高应用价值。

Objective To investigate the value of Ranson score in the classification and prediction of moderate and severe hyperlipidemia acute pancreatitis.Methods One hundred patients with moderate and severe hyperlipidemia acute pancreatitis in Huairou Hospital,Beijing Hospital of Traditional Chinese Medicine from February 2016 to February 2021 were retrospectively selected and divided into moderate group according to the severity of the disease(systemic or local complications of more than 2 days without persistent organ failure or transient organ failure resolved within 2 days;n=40)and the severe group(more than 2 days of persistent organ failure may involve at least one organ in the kidney,cardiovascular and respiratory systems,n=60).The clinical data and Ranson score of patients in the two groups were statistically analyzed,and the multiple organ failure syndrome,infection,occurrence of local complications and death of patients with different Ranson scores were statistically analyzed.Results There was no significant difference between the two groups in gender,age and maximum lipid level(P>0.05),the ratio of blood glucose>11 mmol/L,blood calcium≤2 mmol/L,LDH>350 U/L,white blood cell count>16×10^(9)/L,Hct decreased>16×10^(9)/L,alkali deficiency>6 mmol/L,liquid requirement>6 L and Ranson score in severe group were higher than those in moderate group,the differences were statistically significant(P<0.05).The proportion of Ranson score 3-4 in severe group was lower than that in moderate group,and the proportion of Ranson score 5-10 was higher than that in moderate group,the differences were statistically significant(P<0.05).Among the 100 patients,there were 59 cases of multiple organ failure syndrome and 30 cases died.The incidence and mortality of multiple organ failure syndrome were 29.00%and 12.00%respectively.The incidence and mortality of multiple organ failure syndrome in patients with Ranson scores of 3-4,5-6,7-8 and 9-10 were gradually increased(P<0.05).The Ranson score of death patients was higher than that of patients with multiple organ failure syndrome,infection and local complications(P<0.05),Ranson scores in patients with multiple organ failure syndrome and infection were higher than those in patients with local complications(P<0.05),but there was no significant difference in Ranson scores between patients with multiple organ failure syndrome and infection(P>0.05);Ranson score was positively correlated with the incidence of MULTIPLE organ failure syndrome,infection rate and mortality,but the wireless relationship(r=0.875,P<0.05)and had no correlation with the incidence of local complications(r=0.190,P>0.05).Conclusion Ranson score is of high value in the classification of moderate and severe hyperlipidemia acute pancreatitis.