不同評分系統(tǒng)預(yù)測高脂血癥性急性胰腺炎嚴(yán)重程度的比較研究
發(fā)布時間：2018-12-15 10:07
【摘要】：目的：研究高脂血癥性急性胰腺炎的臨床特點，比較BISAP、Ranson評分、CTSI、SIRS、HAPS五種評分系統(tǒng)對早期預(yù)測高脂血癥性急性胰腺炎患者的病情嚴(yán)重程度、局部并發(fā)癥、器官衰竭、死亡的能力，探討B(tài)ISAP、Ranson、CTSI、SIRS、HAPS評分系統(tǒng)在早期預(yù)測高脂血癥性急性胰腺炎患者病情嚴(yán)重程度的優(yōu)缺點。 方法：收集2008年9月至2014年3月收治于上海市第一人民醫(yī)院南院和上海市第十人民醫(yī)院的909例急性胰腺炎患者的臨床資料，應(yīng)用回顧性分析研究方法，比較高脂血癥性急性胰腺炎、非高脂血癥性急性胰腺炎的臨床特點；利用BISAP、Ranson、CTSI、SIRS、HAPS對所有急性胰腺炎患者進行評分，，比較各評分在輕度、中度、重度急性胰腺炎的分布差異；通過受試者工作特征曲線（receiver operating characteristiccurve，ROC curve）分析BISAP、Ranson、CTSI、SIRS對高脂血癥性急性胰腺炎及非高脂血癥性急性胰腺炎組預(yù)測重度胰腺炎、局部并發(fā)癥、器官衰竭、死亡的能力。對比BISAP、Ranson、CTSI評分系統(tǒng)在高脂血癥性急性胰腺炎組及非高脂血癥性急性胰腺炎組預(yù)測重度急性胰腺炎的能力；通過一致性檢驗，評估無害性胰腺炎預(yù)測高脂血癥性急性胰腺炎組及非高脂血癥性急性胰腺炎組輕癥胰腺炎的能力。 結(jié)果：909例次急性胰腺炎患者中，高脂血癥性急性胰腺炎129例（14.2%），其中輕度急性胰腺炎68例，中度急性胰腺炎41例，重度急性胰腺炎20例，并發(fā)假性囊腫8例，胰腺包裹性壞死9例，胸腔積液30例，全身炎癥反應(yīng)綜合征33例，持續(xù)性器官衰竭14例，死亡1例。高脂血癥性急性胰腺炎患者中五種評分系統(tǒng)的評分分值在輕度、中度、重度急性胰腺炎三組中存在統(tǒng)計學(xué)差異（P0.05）。BISAP、Ranson、SIRS、CTSI在預(yù)測重度急性胰腺炎時的ROC曲線下面積（the area under receiveroperating characteristic curve，AUC）分別為0.905、0.938、0.812、0.834，兩兩比較差異無統(tǒng)計學(xué)差異（P0.05），最佳閾值（cutoff）分別為1、2、2、4，約登指數(shù)分別為0.604、0.608、0.640、0.668；在預(yù)測局部并發(fā)癥時AUC分別為0.874、0.726、0.668、0.848，AUC兩兩比較時僅BISAP、Ranson與SIRS之間AUC差異存在統(tǒng)計學(xué)差異(P0.05)，約登指數(shù)分別為0.631、0.402、0.294、0.540；在預(yù)測器官衰竭時分別為AUC分別為0.904、0.917、0.758、0.849，AUC兩兩比較時，Ranson、SIRS兩組的AUC差異具有統(tǒng)計學(xué)意義(P0.05)，約登指數(shù)分別為0.634、0.661、0.509、0.616；在預(yù)測死亡時四種評分系統(tǒng)無統(tǒng)計學(xué)意義(P0.05)。無害性胰腺性胰腺炎與高脂血癥性急性胰腺炎組按亞特蘭大分級的輕度急性胰腺炎一致性檢驗中，一致性差(P0.05)。 結(jié)論：高脂血癥性急性胰腺炎具有發(fā)病年齡輕，復(fù)發(fā)率高的特點，并發(fā)胰腺壞死、SIRS、器官衰竭的發(fā)病率較非高脂血癥性急性胰腺炎組高。BISAP、Ranson、SIRS、CTSI對預(yù)測重度急性胰腺炎均具有較好的準(zhǔn)確性，且能力相似；BISAP、Ranson、CTSI預(yù)測局部并發(fā)癥的能力相似，優(yōu)于SIRS；SIRS評分在預(yù)測器官衰竭方面不如BISAP、Ranson、CTSI；四種評分預(yù)測死亡率無明顯意義。HAPS并不適用預(yù)測輕度高脂血癥性急性胰腺炎。
[Abstract]:Objective: To study the clinical characteristics of acute pancreatitis with hyperlipidemia, compare the five scoring systems of BISAP, Ranson, CTSI, SIRS and HAPS to the early prediction of the severity, local complications, organ failure and death of the patients with acute pancreatitis. The advantages and disadvantages of the CTSI, SIRS and HAPS scoring system in the early prediction of the severity of the patients with hyperlipidemic acute pancreatitis. Methods: The clinical data of 909 patients with acute pancreatitis in the first People's Hospital of Shanghai and the 10th People's Hospital of Shanghai were collected from September 2008 to March 2014. The clinical data of 909 patients with acute pancreatitis were analyzed retrospectively. The clinical characteristics of acute pancreatitis associated with inflammation and non-hyperlipoidemia were assessed by using BSAP, Ranson, CTSI, SIRS, and HAPS in all patients with acute pancreatitis. The distribution of each score in mild, moderate and severe acute pancreatitis was compared. e. ROC curve analysis of the ability of BSAP, Ranson, CTSI, SIRS to predict severe pancreatitis, local complications, organ failure, and death in patients with acute pancreatitis and non-hyperlipidemia acute pancreatitis The ability of the BSAP, Ranson, and CTSI scoring systems to predict severe acute pancreatitis in the group of hyperlipidemic acute pancreatitis and the non-hyperlipidemic acute pancreatitis group; and by consistency test The effects of acute pancreatitis in the treatment of hyperlipidemic acute pancreatitis and non-hyperlipidemic acute pancreatitis Results: Of the 909 patients with acute pancreatitis, 129 (14. 2%) of the patients with severe acute pancreatitis, including 68 cases of mild acute pancreatitis, 41 with moderate acute pancreatitis, 20 cases of severe acute pancreatitis, 8 cases of concurrent pseudocyst, 9 cases of pancreatic inclusion necrosis, and pleural effusion 30 cases, 33 cases of systemic inflammatory response syndrome, 14 cases of persistent organ failure, and death The scores of the five scoring systems in the patients with hyperlipidemic acute pancreatitis had a statistical difference in the three groups of mild, moderate and severe acute pancreatitis (P0.05). The area under the ROC curve of the BSAP, Ranson, SIRS and CTSI in the prediction of severe acute pancreatitis was 0.905, 0.938, 0.812, and 0, respectively. There was no statistical difference between the two groups (P0.05). The best threshold (coutoff) was 1, 2, 2, 4, and the ~ (n) index was 0.604, 0.608, 0.640, and 0.668 respectively. The AUC in the predicted local complications was 0. 874, 0. 726, 0. 668, 0. 848, and the AUC was 0.631, 0.402, 0.294, 0, respectively. The AUC of the two groups was 0.904, 0.917, 0.758, 0.849 and AUC, respectively. The difference of AUC in the two groups was 0.634, 0.661, 0.509, and 0.616, respectively. 05). The consistency of the non-benign pancreatic pancreatitis and the acute pancreatitis group of the hyperlipidemic acute pancreatitis in the consistency test of the mild acute pancreatitis in Atlanta (P0. Conclusion: Hyperlipidemic acute pancreatitis has the characteristics of light weight and high recurrence rate, and the incidence of pancreatic necrosis, SIRS and organ failure is higher than that of non-hyperlipidemic acute pancreatitis. The high. BSAP, Ranson, SIRS and CTSI in the group with severe acute pancreatitis had good accuracy in predicting the severe acute pancreatitis, and the ability was similar; the ability of the BSAP, Ranson, CTSI to predict local complications was similar to that of the SIRS; the SIRS score was inferior to that of the BSAP, Ranson, and CTSI in predicting organ failure; and the death rate was predicted by four scores. There is no significant difference. HPS does not apply to the prediction of mild hyperlipoidemia
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R589.2;R576
本文編號：2380457
[Abstract]:Objective: To study the clinical characteristics of acute pancreatitis with hyperlipidemia, compare the five scoring systems of BISAP, Ranson, CTSI, SIRS and HAPS to the early prediction of the severity, local complications, organ failure and death of the patients with acute pancreatitis. The advantages and disadvantages of the CTSI, SIRS and HAPS scoring system in the early prediction of the severity of the patients with hyperlipidemic acute pancreatitis. Methods: The clinical data of 909 patients with acute pancreatitis in the first People's Hospital of Shanghai and the 10th People's Hospital of Shanghai were collected from September 2008 to March 2014. The clinical data of 909 patients with acute pancreatitis were analyzed retrospectively. The clinical characteristics of acute pancreatitis associated with inflammation and non-hyperlipoidemia were assessed by using BSAP, Ranson, CTSI, SIRS, and HAPS in all patients with acute pancreatitis. The distribution of each score in mild, moderate and severe acute pancreatitis was compared. e. ROC curve analysis of the ability of BSAP, Ranson, CTSI, SIRS to predict severe pancreatitis, local complications, organ failure, and death in patients with acute pancreatitis and non-hyperlipidemia acute pancreatitis The ability of the BSAP, Ranson, and CTSI scoring systems to predict severe acute pancreatitis in the group of hyperlipidemic acute pancreatitis and the non-hyperlipidemic acute pancreatitis group; and by consistency test The effects of acute pancreatitis in the treatment of hyperlipidemic acute pancreatitis and non-hyperlipidemic acute pancreatitis Results: Of the 909 patients with acute pancreatitis, 129 (14. 2%) of the patients with severe acute pancreatitis, including 68 cases of mild acute pancreatitis, 41 with moderate acute pancreatitis, 20 cases of severe acute pancreatitis, 8 cases of concurrent pseudocyst, 9 cases of pancreatic inclusion necrosis, and pleural effusion 30 cases, 33 cases of systemic inflammatory response syndrome, 14 cases of persistent organ failure, and death The scores of the five scoring systems in the patients with hyperlipidemic acute pancreatitis had a statistical difference in the three groups of mild, moderate and severe acute pancreatitis (P0.05). The area under the ROC curve of the BSAP, Ranson, SIRS and CTSI in the prediction of severe acute pancreatitis was 0.905, 0.938, 0.812, and 0, respectively. There was no statistical difference between the two groups (P0.05). The best threshold (coutoff) was 1, 2, 2, 4, and the ~ (n) index was 0.604, 0.608, 0.640, and 0.668 respectively. The AUC in the predicted local complications was 0. 874, 0. 726, 0. 668, 0. 848, and the AUC was 0.631, 0.402, 0.294, 0, respectively. The AUC of the two groups was 0.904, 0.917, 0.758, 0.849 and AUC, respectively. The difference of AUC in the two groups was 0.634, 0.661, 0.509, and 0.616, respectively. 05). The consistency of the non-benign pancreatic pancreatitis and the acute pancreatitis group of the hyperlipidemic acute pancreatitis in the consistency test of the mild acute pancreatitis in Atlanta (P0. Conclusion: Hyperlipidemic acute pancreatitis has the characteristics of light weight and high recurrence rate, and the incidence of pancreatic necrosis, SIRS and organ failure is higher than that of non-hyperlipidemic acute pancreatitis. The high. BSAP, Ranson, SIRS and CTSI in the group with severe acute pancreatitis had good accuracy in predicting the severe acute pancreatitis, and the ability was similar; the ability of the BSAP, Ranson, CTSI to predict local complications was similar to that of the SIRS; the SIRS score was inferior to that of the BSAP, Ranson, and CTSI in predicting organ failure; and the death rate was predicted by four scores. There is no significant difference. HPS does not apply to the prediction of mild hyperlipoidemia
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R589.2;R576
【參考文獻】
相關(guān)期刊論文 前3條
1 Radka Ivanova;Susana Puerta;Alfonso Garrido;Ignacio Cueto;Ana Ferro;María José Ariza;Andrés Cobos;Pedro González-Santos;Pedro Valdivielso;;Triglyceride levels and apolipoprotein E polymorphism in patients with acute pancreatitis[J];Hepatobiliary & Pancreatic Diseases International;2012年01期
2 吳文治;劉景云;洪萬東;吳金明;;4項臨床評分系統(tǒng)對重癥急性胰腺炎預(yù)后評估的受試者工作特征曲線分析[J];醫(yī)學(xué)研究雜志;2013年02期
3 郭小燕;萬榮;徐萍;黃玲;徐雅萍;王興鵬;;BISAP評分對急性胰腺炎患者病情嚴(yán)重度及預(yù)后評估價值的研究[J];胃腸病學(xué)和肝病學(xué)雜志;2012年12期
本文編號：2380457
本文鏈接：http://www.lk138.cn/yixuelunwen/xiaohjib/2380457.html
最近更新
教材專著
