BISAP评分联合血清胆碱酯酶对危重型急性胰腺炎的诊断价值

目的:探讨BISAP评分联合血清胆碱酯酶对危重型急性胰腺炎(acute pancreatitis,AP)的诊断价值.方法:选取2014年1月至2016年6月重庆市急救医疗中心收治的164例AP患者,其中轻型52例,中型76例,重型16例,危重型20例.比较不同分类AP的BISAP评分及血清胆碱酯酶水平.同时,利用受试者工作曲线下面积(area under the curve,AUG)预测危重型AP,并比较BISAP评分及血清胆碱酯酶联合诊断与单独应用的差异性.结果:随着AP患者病情严重程度的增加,BISAP评分逐渐升高,血清胆碱酯酶水平逐渐下降.4种AP患者的BISAP评分和血清胆碱酯酶水平比较,差异有统计学意义(均P＜0.05).BISAP评分诊断危重型AP的AUC为0.881(95％ CI:0.795～0.968),最佳截断值为2.5分,此时敏感性为90.0％,特异性为79.2％,准确性为80.5％.血清胆碱酯酶诊断危重型AP的AUC为0.791(95％ CI:0.668～0.914),最佳截断值为3 406 U/L,此时敏感性为85.0％、特异性为74.3％,准确性为75.6％.通过logistic回归得出BISAP评分和血清胆碱酯酶回归模型,预测危重型AP的AUC为0.935(95％ CI:0.892～0.978),敏感性为95.0％,特异性为88.2％,准确性为89.0％.联合诊断的AUC面积大于BISAP评分或血清胆碱酯酶单独诊断的AUC面积,差异有统计学意义(均P＜0.05).结论:BISAP评分和血清胆碱酯酶均能较准确地诊断危重型AP,二者联合诊断时可以进一步提高诊断效能.

Diagnostic value of BISAP scores combined with serum cholinesterase in patients with critical acute pancreatitis

Objective:To explore the diagnostic value of BISAP scores combined with serum cholinesterase in patients with critical acute pancreatitis (AP).Methods:A total of 164 patients with AP from Jan.2014 to Jun.2016 were selected,including 52 patients with mild AP,76 patients with moderate AP,16 patients with severe AP and 20 cases with critical AP.The BISAP scores and level of serum cholinesterase among different kinds of AP were compared.Meanwhile,the area under ROC curve (AUC) was used to predict the presence of critical AP and the difference of diagnostic value between BISAP scores combined with serum cholinesterase and single application were compared.Results:With the degree of severity ofAP,BISAP scores gradually increased and levels of serum cholinesterase declined.The differences of BISAP scores and levels of serum cholinesterase among different kinds of AP were significant (All P＜0.05).The AUC of BISAP scores for critical AP was 0.881 (95％ CI:0.795-0.968),when the cutoff value was 2.5,the sensitivity,specificity and accuracy were 90.0％,79.2％ and 80.5％.The AUC of serum cholinesterase for critical AP was 0.791 (95％ CI:0.668-0.914),when the cutoff value was 3 406 U/L,the sensitivity,specificity and accuracy were 85.0％,74.3％ and 75.6％.Logistic regression was obtained by BISAP scores and serum cholinesterase regression model.The sensitivity,specificity and accuracy of BISAP scores combined with serum cholinesterase were 90.0％,87.8％ and 89.6％.The differences of AUC between BISAP scores combined with serum cholinesterase and single application were significant (All P＜0.05).Conclusion:BISAP scores and serum cholinesterase can accurately diagnose critical AP.When they are combined,the diagnosis efficacy of critical AP can increase.