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改良Ranson评分评估胆源性胰腺炎严重度及预后的价值

陈丽芬,周群燕,陆国民,占强   

  1. 南京医科大学附属无锡市人民医院
  • 收稿日期:2012-01-28 修回日期:2012-08-05 出版日期:2013-01-15 发布日期:2013-01-15
  • 通讯作者: 陈丽芬

Evaluation of The Biliary Ranson Score in Predicting Severity and Prognoses of Gallstone Acute Pancreatitis

  • Received:2012-01-28 Revised:2012-08-05 Published:2013-01-15 Online:2013-01-15
  • Contact: Li-Fen CHEN

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摘要：

【摘要】 目的比较APACHEⅡ评分、Ranson评分及改良Ranson评分对胆源性急性胰腺炎严重程度及其预后评估的临床价值。方法回顾并分析328例胆源性急性胰腺炎患者的病历资料,进行APACHEⅡ评分、改良Ranson评分及Ranson评分。应用ROC曲线分析比较3种评分系统预测胆源性急性胰腺炎严重程度及其评估预后的能力。结果 328例胆源性急性胰腺炎中诊断为重症急性胰腺炎(SAP)72例,轻症急性胰腺炎(MAP)256例,SAP和MAP组的年龄、性别构成差异无统计学意义(P>0.05);各评分系统的分值数据两两相关;改良Ranson评分预测胆源性急性胰腺炎严重程度较APACHEⅡ评分及Ranson评分有优势,在SAP中预测胰腺坏死的发生较APACHEⅡ评分有优势。改良Ranson评分预测胆源性SAP的最佳cut-off值为2,其敏感性为81.94%、特异性为75.78%、阳性预测值为48.8%、阴性预测值为93.7%。结论改良Ranson评分较APACHEII及Ranson评分系统对胆源性急性胰腺炎严重程度的预测有一定的优势。 

关键词: 改良Ranson评分, 评分系统, 胆源性急性胰腺炎, 严重程度, 预后

Abstract: Objective: To evaluate the ability of the Biliary Ranson score in predicting the severity of gallstone acute pancreatitis and its prognosis by comparison with APACHE II score and Ranson score. Methods: 328 patients of gallstone pancreatitis admitted into Wuxi People’s Hospital from January 2005 to December 2010 were studied retrospectively. The APACHEⅡ score were calculated in the first 24 hours after admission, so was the Ranson and the Biliary Ranson score within the 48 hours after admission. Receiver operating characteristic curve analysis was used to evaluate the ability of Biliary Ranson score and other scoring systems in predicting the severity of gallstone pancreatitis and the occurrence of pancreatic necrosis, mortality and organ failure. Results: Among 328 patients，severe acute pancreatitis(SAP) was identified in 72 patients and mild acute pancreatitis(MAP) in 256 patients. The gender and age between MAP and SAP were of no statistical difference. The scores were correlated significantly between every two systems, respectively. The Biliary Ranson score is more useful in predicting SAP than APACHE II score and Ranson score, and can perform better in predicting pancreatic necrosis in the cases of SAP compared to APACHE II score. The cutoff value of Biliary Ranson score in predicting SAP was 2 in which the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) were 81.94%, 75.78%, 48.8% and 93.7%, respectively. Conclusions: The Biliary Ranson score is a more valuable score than other scores in predicting the severity of gallstone pancreatitis.

Key words: Biliary Ranson score, scoring system, gallstone acute pancreatitis, severity, prognosis