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不同评分系统预测高脂血症性急性胰腺炎严重程度及预后的价值分析

金秋 杨婧 马红琳 李苹菊 胡绍山 刘清清

引用本文:
Citation:

不同评分系统预测高脂血症性急性胰腺炎严重程度及预后的价值分析

DOI: 10.3969/j.issn.1001-5256.2022.11.022
基金项目: 

昆明医科大学第二附属医院院内临床研究项目 2020ynlc013

伦理学声明:本研究方案于2022年3月18日经由昆明医科大学第二附属医院医学伦理委员会审批,批号:审-PJ-科-2022-103。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:杨婧、金秋负责课题设计,资料分析,修改论文并最后定稿;金秋负责收集数据,撰写论文;马红琳、李苹菊、胡绍山负责数据采集,统计学处理;刘清清负责协助论文修改。
详细信息
    通信作者:

    杨婧,yangjing_dl@163.com

Value of different scoring systems in predicting the severity and prognosis of hyperlipidemic acute pancreatitis

Research funding: 

Hospital Clinical Research Project of The Second Affiliated Hospital of Kunming Medical University 2020ynlc013

More Information
  • 摘要:   目的  通过对比APACHEⅡ、BISAP、MCTSI、MEWS、POP、SPS、PANC3评分,筛选出预测高脂血症性急性胰腺炎(HLAP)疾病严重程度及预后的最佳评分系统。  方法  回顾性收集昆明医科大学第二附属医院2017年10月—2022年1月住院治疗的123例HLAP患者资料,将患者分为轻症急性胰腺炎(MAP)组(n=24)、中度重症急性胰腺炎(MSAP)组(n=56)和重症急性胰腺炎(SAP)组(n=43),比较3组患者的基本资料和评分系统差异。非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。使用MedCalc软件绘制受试者工作特征(ROC)曲线,ROC曲线下面积(AUC)分析比较各评分系统对HLAP患者疾病严重程度、局部及全身并发症的预测价值。  结果  3组患者在糖尿病(χ2=6.880,P<0.05)、住院天数(H=26.494,P<0.001)、局部并发症、急性肾损伤(AKI)、急性呼吸窘迫综合征(ARDS)和多器官功能障碍综合征(MODS)之间存在明显差异(χ2值分别为52.211、38.247、79.201、45.032,P值均<0.001)。评分系统比较,3组患者的APACHEⅡ、BISAP、MCTSI、MEWS、POP、SPS、PANC3评分均有统计学差异(H值分别为47.525、42.662、53.545、31.664、49.233、48.543、9.443,P值均<0.05)。预测SAP发生,APACHEⅡ评分的预测价值高于MEWS评分(Z=2.090,P<0.05),余评分预测价值相同,其中POP评分的AUC最高为0.883。MCTSI评分对局部并发症的预测价值最高(AUC=0.886),当cut-off值为5分时,灵敏度为84.7%、特异度为74.5%。预测AKI发生,APACHEⅡ、POP评分AUC分别为0.911(95%CI:0.835~0.986,P<0.001)、0.920(95%CI:0.866~0.974,P<0.001),预测价值APACHEⅡ评分>MCTSI、MEWS评分,POP评分>MCTSI、MEWS、BISAP评分,SPS评分>MCTSI评分;预测ARDS发生,APACHEⅡ评分的AUC为0.914(95%CI: 0.854~0.973,P<0.001),预测价值大于BISAP、MEWS评分(Z值分别为2.152、3.015, P值均<0.05);预测MODS发生,APACHEⅡ、POP评分的AUC分别为0.969(95%CI:0.941~0.996,P<0.001)、0.932(95%CI:0.880~0.984,P<0.001),预测价值APACHEⅡ评分>SPS、BISAP、MEWS、MCTSI评分。  结论  POP评分预测SAP价值最高,但与除MEWS评分以外的各评分系统预测能力相当;MCTSI评分预测局部并发症能力良好;预测全身并发症,APACHEⅡ、POP评分是值得关注的,两者预测AKI、MODS具有高度准确性,APACHEⅡ评分预测ARDS具有高度准确性。

     

  • 图  1  各评分预测SAP的ROC曲线

    Figure  1.  ROC curve of scoring systems in predicting SAP

    图  2  各评分预测局部并发症的ROC曲线

    Figure  2.  ROC curve of scoring systems in predicting local complications

    图  3  各评分预测AKI的ROC曲线

    Figure  3.  ROC alrve of scoring in predict AKI

    图  4  各评分预测ARDS的ROC曲线

    Figure  4.  ROC curve of scoring systems in predicting ARDS

    图  5  各评分预测MODS的ROC曲线

    Figure  5.  ROC curve of scoring systems in predicting MODS

    表  1  3组患者一般资料比较

    Table  1.   Comparison of general data between the three groups

    指标 MAP组(n=24) MSAP组(n=56) SAP组(n=43) 统计值 P
    男[例(%)] 17(70.80) 39(69.64) 30(69.77) χ2=0.012 0.994
    年龄(岁) 39 (33.00~52.50) 38(32.00~44.00) 43(32.00~50.00) H=2.267 0.322
    BMI(kg/m2) 26.44(23.54~30.22) 26.36(24.23~28.41) 27.41(24.97~30.44) H=1.945 0.378
    糖尿病[例(%)] 20(83.33) 33(58.92) 22(51.16) χ2=6.880 0.032
    高血压[例(%)] 6(25.00) 15(26.78) 10(23.26) χ2=0.161 0.922
    糖尿病酮症[例(%)] 14(58.33) 32(57.14) 20(46.51) χ2=1.368 0.505
    脂肪肝[例(%)] 19(79.17) 53(94.64) 39(90.70) χ2=4.220 0.113
    住院天数(d) 9(7~11) 12(8~15) 19(14~32) H=26.494 <0.001
    局部并发症[例(%)] 0 33(58.93) 39(90.70) χ2=52.211 <0.001
    AKI[例(%)] 1(4.20) 5(8.93) 25(58.14) χ2=38.247 <0.001
    ARDS[例(%)] 0 3(5.37) 35(81.40) χ2=79.201 <0.001
    MODS[例(%)] 0 2(3.57) 23(53.49) χ2=45.032 <0.001
    死亡[例(%)] 0 1(1.79) 2(4.65) χ2=1.227 0.590
    APACHEⅡ评分 5.50(3.00~8.00) 6.00(4.00~7.75) 15.00(11.00~23.00) H=47.525 <0.001
    BISAP评分 1(0~2) 1(1~2) 2(2~3) H=42.662 <0.001
    MCTSI评分 4(2~4) 6(4~6) 8(6~8) H=53.545 <0.001
    MEWS评分 2(1~4) 2(1~4) 5(3~6) H=31.664 <0.001
    POP评分 6(4~8) 5(2~8) 12(9~17) H=49.233 <0.001
    SPS评分 0(0~1) 1(0~1) 2(1~3) H=48.543 <0.001
    PANC3评分 1(1~2) 1(1~2) 2(1~2) H=9.443 <0.050
    下载: 导出CSV

    表  2  各评分系统预测SAP、局部及全身并发症价值比较

    Table  2.   Comparison of the value of scoring systems in predicting SAP, local and systemic complications

    项目 AUC(95%CI) SE cut-off 约登指数 灵敏度 特异度 P
    SAP
      APACHEⅡ 0.875(0.800~0.951) 0.039 8.5 0.696 0.884 0.813 <0.001
      BISAP 0.825(0.749~0.901) 0.039 1.5 0.496 0.884 0.613 <0.001
      MCTSI 0.849(0.777~0.920) 0.037 7.0 0.619 0.744 0.875 <0.001
      MEWS 0.802(0.720~0.884) 0.042 4.5 0.449 0.512 0.938 <0.001
      POP 0.883(0.822~0.943) 0.031 10.5 0.623 0.698 0.925 <0.001
      SPS 0.860(0.794~0.925) 0.033 0.5 0.514 0.977 0.538 <0.001
    局部并发症
      APACHEⅡ 0.612(0.512~0.711) 0.051 11.5 0.260 0.417 0.843 0.036
      BISAP 0.718(0.628~0.809) 0.046 1.5 0.322 0.694 0.627 <0.001
      MCTSI 0.886(0.829~0.942) 0.029 5.0 0.592 0.847 0.745 <0.001
      MEWS 0.608(0.508~0.707) 0.051 4.5 0.208 0.306 0.902 0.042
      POP 0.642(0.545~0.739) 0.049 9.5 0.301 0.458 0.843 0.008
      SPS 0.732(0.643~0.822) 0.046 0.5 0.394 0.806 0.588 <0.001
    AKI
      APACHEⅡ 0.911(0.835~0.986) 0.039 12.5 0.741 0.839 0.902 <0.001
      BISAP 0.831(0.747~0.915) 0.043 2.5 0.494 0.581 0.913 <0.001
      MCTSI 0.790(0.705~0.875) 0.043 7.0 0.492 0.710 0.783 <0.001
      MEWS 0.822(0.732~0.913) 0.046 4.5 0.569 0.645 0.924 <0.001
      POP 0.920(0.866~0.974) 0.028 10.5 0.687 0.806 0.880 <0.001
      SPS 0.885(0.815~0.955) 0.036 1.5 0.654 0.806 0.848 <0.001
    ARDS
      APACHEⅡ 0.914(0.854~0.973) 0.030 10.5 0.713 0.842 0.871 <0.001
      BISAP 0.828(0.750~0.907) 0.040 1.5 0.483 0.895 0.588 <0.001
      MCTSI 0.835(0.762~0.909) 0.038 7.0 0.572 0.737 0.835 <0.001
      MEWS 0.812(0.727~0.897) 0.043 4.5 0.520 0.579 0.941 <0.001
      POP 0.892(0.832~0.952) 0.031 10.5 0.643 0.737 0.906 <0.001
      SPS 0.874(0.812~0.935) 0.031 1.5 0.531 0.684 0.847 <0.001
    MODS
      APACHEⅡ 0.969(0.941~0.996) 0.014 11.5 0.817 0.960 0.857 <0.001
      BISAP 0.878(0.813~0.943) 0.033 1.5 0.551 1.000 0.551 <0.001
      MCTSI 0.853(0.785~0.921) 0.035 7.0 0.626 0.840 0.786 <0.001
      MEWS 0.854(0.771~0.938) 0.043 4.5 0.628 0.720 0.908 <0.001
      POP 0.932(0.880~0.984) 0.027 10.5 0.787 0.920 0.867 <0.001
      SPS 0.886(0.822~0.950) 0.033 1.5 0.656 0.840 0.816 <0.001
    下载: 导出CSV
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