BISAP、 Ranson's、APACHEⅡ和CTSI评分系统在急性胰腺炎评估中的价值

摘要

目的 探讨急性胰腺炎床旁指数(BISAP)、Ranson's、APACHEⅡ、CT严重程度指数(CTSI)4种评分系统在急性胰腺炎患者严重程度评估中的价值.方法 回顾性分析2005年至2011年武汉大学中南医院收治的385例急性胰腺炎患者的临床资料,探讨BISAP、Ranson's、APACHEⅡ、CTSI 4种评分系统在急性胰腺炎严重程度评估中的价值.采用x2检验和受试者工作曲线(ROC)评估4种评分系统预测患者发生重症急性胰腺炎、局部并发症和死亡的价值,并计算优势比(OR),用Z检验比较曲线下面积(AUC)的差异.结果 BISAP评分≥3分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为64.4％ (56/87)、16.1％(14/87) 、8.0％(7/87),高于BISAP评分≤2分者的13.4％ (40/298)、6.4％(19/298)、0.3％(1/298),两者比较,差异有统计学意义(,=93.4,8.1,19.7,P＜0.05).Ranson's评分≥3分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为52.7％ (48/91) 、22.0％(20/91) 、7.7％(7/91),高于RanSon's评分≤2分者的16.3％ (48/294)、4.4％ (13/294)、0.3％(1/294),两者比较,差异有统计学意义(x2=49.2,27.3,18.5,P＜0.05).APACHEⅡ评分≥8分者的重症急性胰腺炎发生率、局部并发症发生率、病死率分别为46.6％(27/58)、20.7％(12/58)、8.6％(5/58),高于APACHEⅡ评分≤7分者的21.1％(69/327)、6.4％(21/327) 、0.9％(3/327),两者比较,差异有统计学意义(x2=17.0,12.8,14.4,P＜0.05).CTSI评分≥4分者的重症急性胰腺炎发生率、局部并发症发生率、病死率均分别为51.4％ (19/37)、51.4％(19/37)、16.2％(6/37),高于CTSI评分≤3分者的22.2％(77/347) 、4.0％(14/347)、0.6％(2/347),两者比较,差异有统计学意义(x2=15.1,95.3,40.1,P＜0.05).BISAP评分预测重症急性胰腺炎的灵敏度、特异度、阳性预测值、阴性预测值分别为58％、89％、64％、86％,AUC为0.848,高于其余3种评分系统(Z=2.02,4.22,4.78,P＜0.05).CTSI评分预测局部并发症的灵敏度、特异度、阳性预测值、阴性预测值分别为58％、95％、51％、96％,AUC为0.926,高于其余3种评分系统(Z =3.99,3.24,4.06,P＜0.05).BISAP评分预测急性胰腺炎患者死亡的灵敏度、特异度、阳性预测值、阴性预测值分别为88％、79％、8％、100％,AUC为0.855,与其余3种评分系统比较,差异无统计学意义(Z=0.81,0.03,0.14,P＞0.05).结论 BISAP评分预测重症急性胰腺炎准确度高于Ranson's、APACHEⅡ、CTSI 3种评分系统,CTSI评分预测局部并发症准确度高于其余3种评分系统,4种评分系统预测死亡的效能差异无统计学意义.BISAP评分有助于重症急性胰腺炎早期诊断并制订个体化治疗措施,改善患者预后.%Objective To investigate the value of the bedside index for severity in acute pancreatitis (BISAP),Ranson's,APACHE Ⅱ and computed tomography severity index (CTSI) scoring system in evaluating the severity of acute pancreatitis.Methods The clinical data of 385 patients with acute pancreatitis who were admitted to the Zhongnan Hospital of Wuhan University from 2005 to 2011 were retrospectively analyzed.The values of 4 scoring systems including BISAP,Ranson's,APACHE Ⅱ and CTSI in predicting the incidences of severe acute pancreatitis,local complications and death were investigated by Chi-square test and receiver operating characteristic curv e.Odds ratio (OR) was calculated.The differences of areas under the curves (AUC) were analyzed using the Z test.Results The incidences of severe acute pancreatitis,local complications and mortality of patients with BISAP score ≥ 3 were 64.4％ (56/87),16.1％ (14/87) and 8.0％ (7/87),which were significantly higher than 13.4％ (40/298),6.4％ (19/298) and 0.3 ％ (1/298) of patients with BISAP score ≤ 2 (x2 =93.4,8.1,19.7,P ＜ 0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with Ranson's score≥3 were 52.7％ (48/91),22.0％ (20/91) and 7.7％ (7/91),which were significantly higher than 16.3％ (48/294),4.4％ (13/294) and 0.3％ (1/294) of patients with Ranson's score ≤2 (x2 =49.2,27.3,18.5,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with APACHE Ⅱ score ≥ 8 were 46.6％ (27/58),20.7％ (12/58) and 8.6％ (5/58),which were significantly higher than 21.1％ (69/327),6.4％ (21/327) and 0.9％ (3/327) of patients with APACHE Ⅱ score≤7 (x2 =17.0,12.8,14.4,P ＜0.05).The incidences of severe acute pancreatitis,local complications and mortality of patients with CTSI score ≥4 were 51.4％ (19/37),51.4％ (19/37),16.2％ (6/37),which were significantly higher than 22.2％ (77/347),4.0％ (14/347),0.6％ (2/347) of patients with CTSI score≤3 (x2 =15.1,95.3,40.1,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 58％,89％,64％,86％,respectively,and the AUC was 0.848,which were significantly higher than the other 3 systems (Z =2.02,4.22,4.78,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of CTSI were 58％,95％,51％ and 96％,respectively,and the AUC was 0.926,which was significantly higher than the other 3 systems (Z =3.99,3.24,4.06,P ＜ 0.05).The sensitivity,specificity,positive and negative predictive values of BISAP were 88％,79％,8％ and 100％,respectively,and the AUC was 0.855,with no significant difference compared with the other 3 systems (Z =0.81,0.03,0.14,P ＞ 0.05).Conclusions The accurate rate of BISAP in predicting the severe acute pancreatitis is higher than Ranson's,APACHE Ⅱ and CTSI.The accurate rate of CTSI in predicting the incidence of local complications is higher than the other 3 systems.There is no significant difference of the 4 systems in predicting the mortality.The BISAP scoring system is helpful in early diagnosis of severe acute pancreatitis,and making the individualized treatment plan,thus improving the prognosis of patients.