BISAP评分在重症急性胰腺炎预后评估中的应用价值
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摘要
目的探究重症急性胰腺炎应用BISAP评分(Bedside Index for Severity in AP,BISAP)的预后价值。方法此次实验对象全部选自2016年7月—2018年10月期间接收的198例重症急性胰腺炎患者,用BISAP评分对其胸膜渗出、血尿素氮、全身炎症反应综合征、意识障碍以及年龄五项指标进行综合评估,并对比该评分和APACHE II评分对预测胰腺坏死、机体脏器功能衰竭、死亡的价值,以及对预后的影响。结果 198例患者中,34. 34%器官功能衰竭,胰腺坏死为48. 99%。对器官功能衰竭、胰腺坏死患者的BISAP评分、APACHE II评分进行AUC预测,以3分为最佳截点,BISAP评分的阴性预测值、阳性预测值、敏感性、特异性均优于APACHE II评分,差异有统计学意义(P <0. 05)。BISAP评分的预计死亡率为12. 12%,实际死亡率为11. 62%,差异无统计学意义(P> 0. 05); APACHE II评分的预计死亡率为9. 09%,实际死亡率为11. 62%,差异有统计学意义(P <0. 05); BISAP评分的预计死亡率和APACHE II评分差异有统计学意义(P <0. 05)。结论对重症急性胰腺炎患者应用BISAP评分进行评估的效果显著优于APACHE II评分,能够有效预测胰腺坏死和器官功能衰竭现象,可对患者预后进行有效评估,其临床应用价值较高。
Objective To investigate the prognostic value of bedside index for severity in AP in severe acute pancreatitis. Methods All of the subjects were selected from 198 patients with severe acute pancreatitis who were admitted to our hospital from July 2016 to October 2018. The BISAP score was used for pleural effusion,blood urea nitrogen,systemic inflammatory response syndrome,and disturbance of consciousness. Five indicators of age were comprehensively evaluated,and the score and APACHE II score were compared to predict pancreatic necrosis,organ dysfunction,death,and prognosis.Results Of the 198 patients,34. 34% had organ failure and pancreatic necrosis was 48. 99%. The AUC prediction was performed on the BISAP score and APACHE II score of patients with organ failure and pancreatic necrosis. The scores were divided into 3 best cut-off points. The negative predictive value,positive predictive value,sensitivity and specificity of BISAP score were better than APACHE II score. The difference was statistically significant( P < 0. 05). The estimated mortality rate of BISAP score was 12. 12%,and the actual mortality rate was 11. 62%. The difference was not statistically significant( P >0. 05). The predicted mortality rate of APACHE II score was 9. 09%,and the actual mortality rate was 11. 62%. The difference was statistically significant( P < 0. 05). There was a statistically significant difference between the predicted mortality rate of the BISAP score and the APACHE II score( P < 0. 05). Conclusion The application of BISAP score in patients with severe acute pancreatitis is significantly better than APACHE II score,which can effectively predict pancreatic necrosis and organ failure,and can effectively evaluate the prognosis of patients,and its clinical application value is higher.
Objective To investigate the prognostic value of bedside index for severity in AP in severe acute pancreatitis. Methods All of the subjects were selected from 198 patients with severe acute pancreatitis who were admitted to our hospital from July 2016 to October 2018. The BISAP score was used for pleural effusion,blood urea nitrogen,systemic inflammatory response syndrome,and disturbance of consciousness. Five indicators of age were comprehensively evaluated,and the score and APACHE II score were compared to predict pancreatic necrosis,organ dysfunction,death,and prognosis.Results Of the 198 patients,34. 34% had organ failure and pancreatic necrosis was 48. 99%. The AUC prediction was performed on the BISAP score and APACHE II score of patients with organ failure and pancreatic necrosis. The scores were divided into 3 best cut-off points. The negative predictive value,positive predictive value,sensitivity and specificity of BISAP score were better than APACHE II score. The difference was statistically significant( P < 0. 05). The estimated mortality rate of BISAP score was 12. 12%,and the actual mortality rate was 11. 62%. The difference was not statistically significant( P >0. 05). The predicted mortality rate of APACHE II score was 9. 09%,and the actual mortality rate was 11. 62%. The difference was statistically significant( P < 0. 05). There was a statistically significant difference between the predicted mortality rate of the BISAP score and the APACHE II score( P < 0. 05). Conclusion The application of BISAP score in patients with severe acute pancreatitis is significantly better than APACHE II score,which can effectively predict pancreatic necrosis and organ failure,and can effectively evaluate the prognosis of patients,and its clinical application value is higher.
引文
[1]陈芳. APACHEⅡ评分与BISAP评分在急性胰腺炎患者中的临床意义[J].检验医学与临床,2017,14(6):839-841.
[2]林素涵,李耀浙,吴青松,等. BISAP评分联合红细胞比容对急性胰腺炎严重程度的早期评估价值[J].中华胰腺病杂志,2016,16(6):402-404.
[3]陈东来,廖振海,林顺权.血清脂肪酶联合Ranson或BISAP评分系统诊断急性胰腺炎严重程度的效果分析[J].临床肝胆病杂志,2016,32(2):324-328.
[4]周仁伟,刘鹏军. PDW、PLT、MPV及BISAP评分对急性胰腺炎病情程度的预测价值[J].热带医学杂志,2017,17(11):1490-1493.
[5]杨涓,郑盛,张帆,等.不同评分系统早期预测急性胰腺炎病情严重程度的比较研究[J].中国医药导报,2016,13(2):133-137.
[6]杨立新,杜丽川,刘欣,等.四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用[J].中华内科杂志,2016,55(9):695-699.
[7]陈玲. Ranson、CTSI和BISAP评分在判断急性胰腺炎病情和预后中的意义[J].中华胰腺病杂志,2016,16(4):261-264.
[8]区晓鸣,陈丽华.早期康复护理干预对脑卒中偏瘫患者肢体功能恢复的影响[J].按摩与康复医学,2013,22(8):187-188.
[9]卓越,邱小松,薛婷,等. IL-6、IL-10联合BISAP评分在重症急性胰腺炎预后评估中的作用研究[J].现代生物医学进展,2017(29):118-121.
[10]林素涵,李耀浙,吴青松,等. BISAP评分联合红细胞比容对急性胰腺炎严重程度的早期评估价值[J].中华胰腺病杂志,2016,16(6):402-404.
[11]郑吉敏,张建,高俊茶. BISAP评分联合C反应蛋白对急性胰腺炎严重程度的早期评估价值[J].中华医学杂志,2015,95(12):925-928.
[12]王学新,聂晓辉,田亚兰,等.血清降钙素原和C反应蛋白联合检测在急性胰腺炎危重度的早期评估及治疗的价值[J].肝胆外科杂志,2015,23(6):448-450.
[13]张明强,廖芳莲,陈秀仰,等.降钙素原与C反应蛋白联合检测在早期诊断重症急性胰腺炎的价值[J].现代诊断与治疗,2015(8):1821-1822.
[14]魏本尊,沈超,孙克坚. BISAP评分联合血清CRP对急性胰腺炎患者病情与生存状况评估效果[J].中国现代普通外科进展,2015,18(11):905-907.
[15]张爱平.细胞因子联合BISAP评分系统早期预测急性胰腺炎严重程度及预后的前瞻性研究[J].现代消化及介入诊疗,2016,21(1):54-56.
[16]王立娟,查君敬,黄利娟,等. BISAP评分对急性胰腺炎严重度及病死率评估的应用价值[J].安徽医学,2014(10):1362-1366.
[17]汪翊,冷琦,黄子星,等.三种CT评分与急性胰腺炎严重程度床边指数评分评估重症急性胰腺炎的相关性研究[J].中国普外基础与临床杂志,2015(12):1520-1524.
[18]刘移忠.磁共振成像与CT对急性胰腺炎严重程度的分级评估[J].实用医学影像杂志,2017(3):51-53.
[19]谢金华,黎庆权,欧远祥,等.急性胰腺炎CT分级与C反应蛋白测定评估炎症严重程度的对比研究[J].现代医用影像学,2015,24(3):355-358.
[20]姚建辉,范震.急性胰腺炎反应期C反应蛋白测定对病情严重程度的评估[J].昆明医科大学学报,2015,36(10):107-110.
[21]曾维琛,林焕雄.血清同型半胱氨酸、乳酸脱氢酶对急性胰腺炎预后的影响[J].临床医学工程,2017,24(10):1751-1752.1437-1438.
[22]丁俊华,沈雁波,王霆,等.血清s TREM-1和尿CAPAP对急性胰腺炎病情轻重与转归的评估[J].实用医学杂志,2018,34(14):2345-2347.
[23]郑丹,张胜,崔可,等.平均血小板体积联合红细胞分布宽度对重症急性胰腺炎预后的价值[J].实用医学杂志,2018,34(8):1294-1296,1300.
[2]林素涵,李耀浙,吴青松,等. BISAP评分联合红细胞比容对急性胰腺炎严重程度的早期评估价值[J].中华胰腺病杂志,2016,16(6):402-404.
[3]陈东来,廖振海,林顺权.血清脂肪酶联合Ranson或BISAP评分系统诊断急性胰腺炎严重程度的效果分析[J].临床肝胆病杂志,2016,32(2):324-328.
[4]周仁伟,刘鹏军. PDW、PLT、MPV及BISAP评分对急性胰腺炎病情程度的预测价值[J].热带医学杂志,2017,17(11):1490-1493.
[5]杨涓,郑盛,张帆,等.不同评分系统早期预测急性胰腺炎病情严重程度的比较研究[J].中国医药导报,2016,13(2):133-137.
[6]杨立新,杜丽川,刘欣,等.四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用[J].中华内科杂志,2016,55(9):695-699.
[7]陈玲. Ranson、CTSI和BISAP评分在判断急性胰腺炎病情和预后中的意义[J].中华胰腺病杂志,2016,16(4):261-264.
[8]区晓鸣,陈丽华.早期康复护理干预对脑卒中偏瘫患者肢体功能恢复的影响[J].按摩与康复医学,2013,22(8):187-188.
[9]卓越,邱小松,薛婷,等. IL-6、IL-10联合BISAP评分在重症急性胰腺炎预后评估中的作用研究[J].现代生物医学进展,2017(29):118-121.
[10]林素涵,李耀浙,吴青松,等. BISAP评分联合红细胞比容对急性胰腺炎严重程度的早期评估价值[J].中华胰腺病杂志,2016,16(6):402-404.
[11]郑吉敏,张建,高俊茶. BISAP评分联合C反应蛋白对急性胰腺炎严重程度的早期评估价值[J].中华医学杂志,2015,95(12):925-928.
[12]王学新,聂晓辉,田亚兰,等.血清降钙素原和C反应蛋白联合检测在急性胰腺炎危重度的早期评估及治疗的价值[J].肝胆外科杂志,2015,23(6):448-450.
[13]张明强,廖芳莲,陈秀仰,等.降钙素原与C反应蛋白联合检测在早期诊断重症急性胰腺炎的价值[J].现代诊断与治疗,2015(8):1821-1822.
[14]魏本尊,沈超,孙克坚. BISAP评分联合血清CRP对急性胰腺炎患者病情与生存状况评估效果[J].中国现代普通外科进展,2015,18(11):905-907.
[15]张爱平.细胞因子联合BISAP评分系统早期预测急性胰腺炎严重程度及预后的前瞻性研究[J].现代消化及介入诊疗,2016,21(1):54-56.
[16]王立娟,查君敬,黄利娟,等. BISAP评分对急性胰腺炎严重度及病死率评估的应用价值[J].安徽医学,2014(10):1362-1366.
[17]汪翊,冷琦,黄子星,等.三种CT评分与急性胰腺炎严重程度床边指数评分评估重症急性胰腺炎的相关性研究[J].中国普外基础与临床杂志,2015(12):1520-1524.
[18]刘移忠.磁共振成像与CT对急性胰腺炎严重程度的分级评估[J].实用医学影像杂志,2017(3):51-53.
[19]谢金华,黎庆权,欧远祥,等.急性胰腺炎CT分级与C反应蛋白测定评估炎症严重程度的对比研究[J].现代医用影像学,2015,24(3):355-358.
[20]姚建辉,范震.急性胰腺炎反应期C反应蛋白测定对病情严重程度的评估[J].昆明医科大学学报,2015,36(10):107-110.
[21]曾维琛,林焕雄.血清同型半胱氨酸、乳酸脱氢酶对急性胰腺炎预后的影响[J].临床医学工程,2017,24(10):1751-1752.1437-1438.
[22]丁俊华,沈雁波,王霆,等.血清s TREM-1和尿CAPAP对急性胰腺炎病情轻重与转归的评估[J].实用医学杂志,2018,34(14):2345-2347.
[23]郑丹,张胜,崔可,等.平均血小板体积联合红细胞分布宽度对重症急性胰腺炎预后的价值[J].实用医学杂志,2018,34(8):1294-1296,1300.