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目的:比较BISAP、APACHE II、Ranson评分系统对发病早期急性胰腺炎(AP)患者的严重程度及预后的评估价值。方法:回顾性分析2009年1月1日—2014年3月收治的AP患者(病程≤48 h)临床资料,根据患者入院时第1次BISAP、APACHE II、Ranson评分,比较各评分系统预测AP患者器官功能衰竭、胰腺坏死、死亡的受试工作者特征曲线(ROC)的曲线下面积(AUC),及其灵敏度和特异度。结果:按纳入与剔除标准,最终共纳入135例患者,其中24例(17.7%)诊断重症胰腺炎(SAP)(19例器官衰竭诊断,5例死亡);20例(14.8%)在入院期间诊断胰腺坏死。BISAP、APACHE II和Ranson评分诊断器官功能衰竭的AUC分别为0.773、0.821、0.897(P<0.001),敏感度与特异度分别为0.880与0.530、0.872与0.642、0.740与0.982;预测胰腺坏死程度的AUC分别为0.819、0.785、0.825(P>0.05),敏感度与特异度分别为0.715与0.885、0.844与0.630、0.833与0.672;预测死亡的AUC分别为0.773、0.786、0.889(P>0.05),敏感度与特异度分别为0.740与0.830、0.843与0.752、0.865与0.886。结论:3种评分系统在预测AP患者胰腺坏死程度与死亡方面价值相似,BISAP在预测AP器官功能衰竭方面不如Ranson与APACHE II,但其评分简单,能够快速评估和动态监测,有利于临床使用。
OBJECTIVE: To compare the diagnostic value of BISAP, APACHE II and Ranson scoring system in evaluating the severity and prognosis of patients with acute pancreatitis (AP) at early onset. Methods: The clinical data of patients with AP (duration ≤ 48 h) admitted to our hospital from January 1, 2009 to March 2014 were retrospectively analyzed. Based on the first BISAP, APACHE II and Ranson scores, Area under the curve (AUC), and sensitivity and specificity of the patient’s organ failure, pancreatic necrosis, and deaths from the test-worker characteristic curve (ROC). Results: According to inclusion and rejection criteria, a total of 135 patients were enrolled. Among them, 24 patients (17.7%) diagnosed severe pancreatitis (SAP) (19 cases of organ failure diagnosis and 5 deaths); 20 patients (14.8% Diagnosis of pancreatic necrosis. The AUC of BISAP, APACHE II and Ranson score in diagnosing organ failure were 0.773,0.821,0.897 (P <0.001), and the sensitivity and specificity were 0.880 and 0.530,0.872 and 0.642,0.740 and 0.982, respectively. The predictive value of pancreatic necrosis AUC were 0.819,0.785,0.825 respectively (P> 0.05). The sensitivity and specificity were 0.715 and 0.885,0.844 and 0.630,0.833 and 0.672, respectively. The predicted AUC of death were 0.773, 0.786 and 0.889, respectively (P> 0.05) Sensitivity and specificity were 0.740 and 0.830, 0.843 and 0.752, 0.865 and 0.886, respectively. CONCLUSION: The three scoring systems are similar in predicting the degree of pancreatic necrosis and death in patients with AP. BISAP is inferior to Ranson and APACHE II in predicting AP organ failure. However, its scoring system is simple, rapid assessment and dynamic monitoring are beneficial to clinical use.