急性胰腺炎床边指数评分对疾病程度及预后的预测价值

目的与急性胰腺炎（acute pancreatitis,AP）传统评分系统进行比较,探讨急性胰腺炎严重程度床边指数（bedside index for severity in acute pancreatitis,BISAP）评分对疾病程度及预后的预测价值。方法 202例AP患者分别行BISAP、急性生理和慢性健康状况评分（Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ）及Ranson评分,比较分析3种评分系统预测AP严重程度、局部并发症、器官功能衰竭的价值。结果 202例AP患者,轻症急性胰腺炎（mild acute pancreatitis,MAP）103例,重症急性胰腺炎（severe acute pancreatitis,SAP）99例;SAP患者发生局部并发症62例,器官功能衰竭60例,23例二类并发症均存在;BISAP评分预测SAP的AUC为0.881（95%CI：0.836-0.927）,最佳cutoff值为2,其预测SAP敏感性、特异性、阳性预测值及阴性预测值分别为88.89%、71.84%、75.21%和87.06%;预测SAP患者局部并发症的AUC为0.715（95%CI：0.644-0.785）,最佳cutoff值为3,预测SAP局部并发症的敏感性、特异性、阳性预测值及阴性预测值分别为77.42%、75.00%、57.83%和88.24%;预测SAP患者器官功能衰竭的AUC为0.884（95%CI：0.837-0.931）,最佳cutoff值为3,预测SAP患者器官功能衰竭的敏感性、特异性、阳性预测值及阴性预测值分别为76.67%、85.21%、68.66%和89.63%。BISAP评分预测AP严重程度、局部并发症、器官功能衰竭的能力与APACHEⅡ和Ranson评分比较差异无统计学意义（P〉0.05）。结论 BISAP评分对AP严重程度及预后预测价值与传统评分相同,但构成简单,主观偏倚小,可动态监测变化。

Clinical value of bedside index for severity in acute pancreatitis scoring system to predicting severity and prognosis of acute pancreatitis

Objective To evaluate the clinical value of bedside index for severity in acute pancreatitis （BISAP） scoring system to predicting the severity and prognosis of acute pancreatitis （AP） by comparing with the traditional scoring systems. Methods A total of 202 patients with AP were evaluated the severity of AP, the occurrence of local complication and organ failure by BISAP, Acute Physiology and Chronic Health Evaluation II （APACHE II ） and Ranson scoring system. Results Among 202 patients, there were 103 cases of mild AP and 99 cases of severe AP. Local complications developed in 62 patients, organ failure developed in 60 patients, and both of the above complications developed in 23 patients. When the AUC of BISAP for severe AP was 0. 881 （95%CI： 0. 836 to 0. 927） and the cutoff value was 2, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） were 88.89%, 71.84%, 75.21% and 87.06% respectively. When theAUC for local complications was 0. 715 （95%CI： 0. 644 to 0. 785） and the cutoff value was 3, the sensitivity, specificity, PPV and NPV were 77.42%, 75.00%, 57.83% and 88.24% respectively. When the AUC for organ failure was 0. 884 （95% CI： 0. 837 to 0. 931） and the cutoff value was 3, the sensitivity, specificity, PPV and NPV were 76. 67%, 85. 21%, 68. 660/00 and 89. 63% respectively. BISAP, APACHE II and Ranson scoring systems showed no significant differences in predicting the severity and prognosis of AP （P〉0.05）. Conclusions BISAP has the similar ability in predicting AP severity and prognosis with the traditional scoring systems. It is simple and easily acquired, has low subjective bias, and can dynamically monitor disease progression.