改良早期预警评分对重症胰腺炎患者预后的预测价值研究

目的探讨改良早期预警评分(MEWS)应用于重症胰腺炎(SAP)患者预后预测的价值和可行性。方法 63例患者按临床结果分为存活组42例和死亡组21例。以确诊为SAP时作为观察起点,同时采集相关数据,对每位患者分别进行MEWS及APACHE-O评分;以1个月后作为观察终点,比较2种评分系统对预后的预测价值。结果 存活组MEWS和APACHE-O评分均低于死亡组,差异均有统计学意义(P<0.05和P<0.01)。2种评分系统均以死亡为预测指标,MEWS评分界值为7分,灵敏度(Sen)为76.19%,特异度(Spe)为85.71%,ROC曲线下面积Az=0.8741,U=8.3958,P=0.0000,均有较强的预测价值。APACHE-O评分界值为21分,Sen为85.71%,Spe为88.10%;ROC曲线下面积Az=0.9138,U=11.2608,P=0.0000。结论 MEWS和APACHE-O评分对SAP患者预后具有同等预测价值,但MEWS评分系统结构简单,获取数据方便,既省时又节省费用,可用于对SAP患者预后的预测。

Study on predicating value of MEWS for the prognosis of patients with severe acute pancreatitis

Objective To explore the value and feasibility of MEWS in predicating the prognosis of SAP.Methods 63 cases were divided into survival group of 42 and death group of 21 according to the clinical results.Took the time that SAP was diagnosed as the starting point of the observation,at the same time,the correlative data was collected,and each patient was made MEWS and APACHE-O score;Took the time that 1 month later as the ending point of the observation.The predicating value for the prognosis of 2 score systems were compared.Resullts The MEWS and APACHE-O score of the survival group was respectively lower than those of the death group,and the differences were statistically significant（P0.05,P0.01）.Both groups took death as the forecast index.The cut-off of MEWS was 7,Sen=76.19%,Spe=85.71%,area of ROC curve（Az）=0.8741,U=8.3958,P=0.0000,and all above were of strong predicating value.The cut-off of APACHE-O score was 21,Sen=85.71%,Spe=88.10%,Az=0.9138,U=11.2608,P=0.0000.Conclusion It is proved that the APACHE-O score and MEWS show equal forecast value,but MEWS has more simple score structure,which can get data more conveniently.MEWS is time-saving and money-saving,and can be used for the prognosis forecast for SAP.