老年急性胰腺炎的临床特征以及严重程度评分系统的对比优化

Clinical characteristics of elderly patients with acute pancreatitis and comparative optimization of acute pancreatitis severity scoring system

目的分析老年患者急性胰腺炎临床特征,并对急性胰腺炎严重程度评分系统预测模型进行对比优化。方法收集2011.01.01—2021.12.31入住复旦大学附属华东医院并确诊为急性胰腺炎的患者的临床资料及检验检查结果,将患者分为老年组和非老年组,总结分析老年急性胰腺炎的临床特征。比较4种临床常用评分系统在预测老年急性胰腺炎严重程度,局部及全身并发症等方面的准确性,并对评分系统进行组合优化。结果本研究共纳入急性胰腺炎患者437例,其中老年组224例。老年组最常见病因为胆源性胰腺炎,其次是特发性急性胰腺炎,占27.68%。急性胰周液体积聚和胸腔积液分别是老年急性胰腺炎最常见的局部并发症和全身并发症。在临床常用评分系统方面,老年组的Ranson标准、APACHEⅡ评分以及BISAP评分得分高于非老年组(p<0.05)。在评估急性胰腺炎严重程度,局部及全身并发症等方面MCTSI评分优于其他评分系统。APACHEⅡ评分和MCTSI评分组合能够更准确的预测急性胰腺炎严重程度(AUC=0.797,95%CI 0.7350.858)。结论老年AP患者较非老年患者有其特殊性,应加强对老年急性胰腺炎患者的重视。MCTSI评分在评估急性胰腺炎严重程度,局部及全身并发症等方面都显示出一定优势。联合多种评分系统对老年AP患者进行病情评估和预测更有积极意义。

Objective To analyze the clinical characteristics of elderly patients with acute pancreatitis(AP)and compare and optimize the predictive models of acute pancreatitis severity scoring system.Methods The clinical data and laboratory examination results of patients diagnosed with AP who were admitted to Huadong Hospital Affiliated to Fudan University from January 1,2011 to December 31,2021 were collected.They were divided into elderly group and non-elderly group,and the clinical features of elderly patients with acute pancreatitis were summarized and analyzed.The accuracy of four commonly used clinical scoring systems in predicting the severity of AP,local and systemic complications in the elderly AP patients were compared,and the scoring systems were combined and optimized.Results A total of 437 patients with AP were enrolled,including 224 in the elderly group(72.04±8.33).There were 134 cases(59.82%)of biliary AP in the elderly group,which was the most common cause of AP in the elderly.Acute peripancreatic fluid accumulation and pleural effusion were the most common local and systemic complications of AP in elderly patients,respectively.In terms of commonly used clinical scoring systems,the scores of Ranson standard,APACHE II,and BISAP of the elderly group were higher than those of the non-elderly group(P<0.05).The MCTSI score was superior to other scoring systems in evaluating the severity of AP and local and systemic complications,etc.The combination of APACHE II score and MCTSI score could more accurately predict the severity of AP(AUC=0.797,95%CI 0.735-0.858).Conclusion Elderly AP patients have their unique characteristics compared to the non-elderly patients,and more attention should be paid to elderly AP patients.The MCTSI score shows certain advantages in evaluating the severity of AP,as well as local and systemic complications.It is of positive significance to evaluate and predict the condition of elderly AP patients by combining multiple scoring systems.