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目的探讨各评分系统对急性胰腺炎(acute pancreatitis,AP)疾病严重程度预测价值的差异。方法回顾性分析156例AP患者的临床资料,记录患者入院时的c-反应蛋白(CRP)等实验室检测值,结合中国胰腺炎诊治指南(2007)将患者分为轻症胰腺炎(mild acute pancreatitis,MAP)组、重症胰腺炎(severe acute pancreatitis,SAP)组。按照各评分系统的相应评分标准对患者进行急性生理学和慢性健康状况评分(APACHEⅡ)、Ranson、BISAP、CTSI评分。按照APACHEⅡ≥8分、Ranson≥3分、BISAP≥2分、CTSI≥3分、CRP≥21.4mg/L的标准分别将患者区分为MAP组、SAP组,ROC曲线比较各评分系统对AP疾病严重程度预测价值的差异。结果 156例AP患者,确诊为SAP21例,另135例诊断为MAP。APACHEⅡ≥8分、Ranson≥3分、BISAP≥2分、CTSI≥3分、CRP≥21.4 mg/L预测SAP的AUC分别为0.78(95%CI:0.70~0.84),0.69(95%CI:0.62~0.76),0.74(95%CI:0.66~0.80),0.69(95%CI:0.61~0.76),0.68(95%CI:0.57~0.78),各评分系统间差异无统计学意义。结论各评分系统对SAP的预测价值差异无统计学意义,在临床工作中,SAP的早期预测应参考多种评价体系,临床获取及应用更为简便的单一实验室指标的参考意义,值得进一步深入研究。
Objective To explore the difference of the predictive value of each score system in the severity of acute pancreatitis (AP). Methods The clinical data of 156 patients with AP were retrospectively analyzed. Laboratory tests such as c-reactive protein (CRP) at admission were recorded. The patients were divided into mild acute pancreatitis (2007) pancreatitis, MAP group and severe acute pancreatitis (SAP) group. Acute physiology and chronic health assessment (APACHE II), Ranson, BISAP and CTSI scores were performed according to the corresponding grading system of each scoring system. According to the standard of APACHEⅡ≥8, Ranson≥3, BISAP≥2, CTSI≥3, CRP≥21.4mg / L, the patients were divided into MAP group, SAP group and ROC curve. Differences in the degree of predictive value. Results 156 cases of AP patients, diagnosed as SAP21 cases, and the other 135 cases diagnosed as MAP. APACHEⅡ≥8 points, Ranson≥3 points, BISAP≥2 points, CTSI≥3 points, and CRP≥21.4 mg / L predicted SAP’s AUC were 0.78 (95% CI: 0.70-0.84) and 0.69 ~ 0.76), 0.74 (95% CI: 0.66-0.80), 0.69 (95% CI: 0.61-0.76) and 0.68 (95% CI: 0.57-0.78). There was no significant difference between the three scoring systems. Conclusion There is no significant difference in the predictive value of SAP between the scoring systems. In clinical work, the early prediction of SAP should refer to a variety of evaluation systems, clinical acquisition and application of more simple single laboratory indicators of reference value, it is worth further the study.