三种评分系统对急性胰腺炎病情及预后的评估价值
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摘要
目的:探讨APACHEⅡ、Ranson、BISAP 3种评分系统在急性胰腺炎病情评估及预后评价中的应用价值。方法:回顾性分析我院收治的128例急性胰腺炎患者的临床资料,分别采用APACHEⅡ、Ranson、BISAP 3种评分系统对患者进行评分,对比其工作特征曲线,分析其评估能力与禁食时间、住院时间的相关性。结果:3种评分系统与禁食时间及住院时间均呈显著的相关性。APACHEⅡ评分系统在评估病情和全身并发症方面具有优势;Ranson评分>5分可作为局部并发症的预测标准;BISAP评分>3分可作为患者死亡的预测指标。结论:3种评分系统均具有评估病情及预后的能力,其中APACHEⅡ可评估病情及全身并发症情况,但对局部并发症情况评估效果不佳;Ranson对局部并发症情况的预测效果良好,但对全身并发症情况和死亡结局评估效果不佳;BISAP可评估患者的死亡结局且效果较佳,但对评估病情及预后无明显优势。
Objective: To investigate the application value of three scoring system,namely APACHEⅡ,Ranson and BISAP in the assessment of the severity and prognosis of acute pancreatitis. Methods: The clinical data of 128 patients with acute pancreatitis in our hospital were retrospectively analyzed and graded respectively by using APACHEⅡ,Ranson,and BISAP systems. Concerning the three different systems,their working characteristics( ROC curve) were compared. The correlation between the evaluation and fasting time and hospitalization time was analyzed. Results: All of the three scoring systems showed a significant correlation with fasting time and length of hospital stay. APACHE Ⅱ score system had advantages in evaluating the degree of illness and systemic complications. A higher Ranson score than 5 points could be used as an ideal prediction of local complications. A higher BISAP score than 3 points could be used as a reasonable prediction of mortality. Conclusion: All of the three scoring systems are able to evaluate the condition and prognosis of AP. APACHEⅡ system can better evaluate the degree of AP and systemic complications,but has faults in the prognosis of local complications; Ranson system shows a good effect on the prediction of the local complications but fails to assess the systemic complications and mortality. As for BISAP system,it has an advantage in evaluating the mortality of patients but not in assessing the degree and prognosis of AP.
Objective: To investigate the application value of three scoring system,namely APACHEⅡ,Ranson and BISAP in the assessment of the severity and prognosis of acute pancreatitis. Methods: The clinical data of 128 patients with acute pancreatitis in our hospital were retrospectively analyzed and graded respectively by using APACHEⅡ,Ranson,and BISAP systems. Concerning the three different systems,their working characteristics( ROC curve) were compared. The correlation between the evaluation and fasting time and hospitalization time was analyzed. Results: All of the three scoring systems showed a significant correlation with fasting time and length of hospital stay. APACHE Ⅱ score system had advantages in evaluating the degree of illness and systemic complications. A higher Ranson score than 5 points could be used as an ideal prediction of local complications. A higher BISAP score than 3 points could be used as a reasonable prediction of mortality. Conclusion: All of the three scoring systems are able to evaluate the condition and prognosis of AP. APACHEⅡ system can better evaluate the degree of AP and systemic complications,but has faults in the prognosis of local complications; Ranson system shows a good effect on the prediction of the local complications but fails to assess the systemic complications and mortality. As for BISAP system,it has an advantage in evaluating the mortality of patients but not in assessing the degree and prognosis of AP.
引文
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[11]黄玲,徐萍,史先芳,等.三种评分标准对急性胰腺炎病情和预后的评估作用[J].中华消化杂志,2012,32(6):400-403.
[12]徐思.BISAP、APACHEII、Ranson评分标准对急性胰腺炎预后预测价值比较的前瞻性研究[D].南昌:南昌大学,2012.
[13]贾俊英.BISAP评分对急性胰腺炎严重程度及预后的评估价值[D].济南:山东大学,2012.
[14]HAYDOCK M D,MITTAL A,van den HEEVER M,et al.National survey of fluid therapy in acute pancreatitis:current practice lacks a sound evidence base[J].World J Surg,2013,37(10):2428-2435.
[15]郭小燕,万荣,徐萍等.BISAP评分对急性胰腺炎患者病情严重度及预后评估价值的研究[J].胃肠病学和肝病学杂志,2012,21(12):1097-1101,1104.
[16]PETROV M S,VEGE S S,WINDSOR J A.Global survey of controversies in classifying the severity of acute pancreatitis[J].Eur J Gastroenterol Hepatol,2012,24(6):715-721.
[17]陈丽芬,陆国民,周群燕,等.BISAP评分对急性胰腺炎严重程度及预后评估的临床价值[J].中华胰腺病杂志,2012,12(4):219-222.
[2]SATOH K,SHIMOSEGAWA T,MASAMUNE A,et al.Nationwide epidemiological survey of acute pancreatitis in Japan[J].Pancreas,2011,40(4):503-507.
[3]于科楠.三种评分对早期预测急性胰腺炎严重程度的评估比较[D].长沙:中南大学,2012.
[4]DELLINGER E P,FORSMARK C E,LAYER P,et al.Determinant-based classification of acute pancreatitis severity:an international multidisciplinary consultation[J].Ann Surg,2012,256(6):875-880.
[5]庄丹丹,欧希龙.巨噬细胞在急性胰腺炎全身炎症反应中的作用[J].东南大学学报:医学版,2013,32(4):501-505.
[6]石双任,陈宏伟.CT与MRI对沟槽状胰腺炎的诊断价值[J].东南大学学报:医学版,2011,30(2):370-373.
[7]YOKOE M.Does higher hospital volume improve the patient outcome in acute pancreatitis[J].J Gastroenterol,2014,49(2):371-372.
[8]OTSUKI M,TAKEDA K,MATSUNO S,et al.Criteria for the diagnosis and severity stratification of acute pancreatitis[J].World J Gastroenterol,2013,19(35):5798.
[9]李素清,马小彬,滑立伟,等.BISAP评分对急性胰腺炎严重程度及预后评估的临床价值[J].中国老年学杂志,2013,33(19):4873-4874.
[10]成刚,李思俊,朱春祥,等.急性胰腺炎4种评分标准价值的比较[J].医学信息:上旬刊,2010,23(9):3355-3356.
[11]黄玲,徐萍,史先芳,等.三种评分标准对急性胰腺炎病情和预后的评估作用[J].中华消化杂志,2012,32(6):400-403.
[12]徐思.BISAP、APACHEII、Ranson评分标准对急性胰腺炎预后预测价值比较的前瞻性研究[D].南昌:南昌大学,2012.
[13]贾俊英.BISAP评分对急性胰腺炎严重程度及预后的评估价值[D].济南:山东大学,2012.
[14]HAYDOCK M D,MITTAL A,van den HEEVER M,et al.National survey of fluid therapy in acute pancreatitis:current practice lacks a sound evidence base[J].World J Surg,2013,37(10):2428-2435.
[15]郭小燕,万荣,徐萍等.BISAP评分对急性胰腺炎患者病情严重度及预后评估价值的研究[J].胃肠病学和肝病学杂志,2012,21(12):1097-1101,1104.
[16]PETROV M S,VEGE S S,WINDSOR J A.Global survey of controversies in classifying the severity of acute pancreatitis[J].Eur J Gastroenterol Hepatol,2012,24(6):715-721.
[17]陈丽芬,陆国民,周群燕,等.BISAP评分对急性胰腺炎严重程度及预后评估的临床价值[J].中华胰腺病杂志,2012,12(4):219-222.