摘要目的 通过与传统的急性胰腺炎(AP)病情评分系统比较,了解急性胰腺炎严重程度床边指数(BISAP)评分对AP严重程度及预后评估的临床价值.方法 回顾性分析2005年1月至2010年12月间收治的497例AP患者资料,分别进行BISAP、APACHEⅡ、Ranson及Balthazar CT( CTSI)评分,评估病情严重程度.应用受试者工作曲线下面积(AUC)比较BISAP评分与其他各评分系统对AP严重程度及胰腺坏死、器官功能衰竭、患者病死发生的预测能力.结果 497例患者中重症急性胰腺炎(SAP) 101例,轻症急性胰腺炎(MAP) 396例,MAP组和SAP组患者的年龄、性别、病因分布差异无统计学意义.497例患者的BISAP评分、APACHEⅡ评分、Ranson评分的平均分值分别为(1.08±1.01)、(5.79±4.00)、(1.69±1.59)分,两两相关(r值分别为0.612、0.568、0.577,P值均＜0.001).此外,SAP患者的BISAP评分、APACHEⅡ评分、Ranson评分的分值均显著大于MAP患者(P值均＜0.01).BISAP评分预测SAP的AUC值为0.762( 95％ CI 0.722～0.799),阳性截止(cutoff)值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为63.4％、83.1％、48.1％、89.4％；预测胰腺坏死的AUC值为0.711(95％CI0.612～0.797),cutoff值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为84.6％、46.7％、35.5％、89.7％；预测器官衰竭的AUC值为0.777(95％ CI0.683 ～0.854),cutoff值为2分,敏感性、特异性、阳性预测值、阴性预测值分别为93.1％、51.4％、43.5％、94.9％；预测患者病死的AUC值为0.808(95％ CI 0.718 ～0.880),cutoff值为3分,敏感性、特异性、阳性预测值、阴性预测值分别为83.3％、67.4％、25.6％、96.8％.BISAP评分与其他评分系统预测SAP各预后指标的差异均无统计学意义.结论 BISAP评分对AP严重程度及预后的评估价值与其他传统的评分系统相同,但其只有5项指标,且均可在入院24h内采集,可以早期、简便地预测SAP,值得在临床推广应用.

abstractsObjective To evaluate the value of bedside index for severity in acute pancreatitis (BISAP) in predicting the severity and prognosis of acute pancreatitis (AP) by comparison with traditional scoring systems.Methods Four hundred ninety-seven patients of AP admitted into Wuxi People's Hospital from January 2005 to December 2010 were studied retrospectively.BISAP,APACHE Ⅱ,Ranson and Balthazar CT (CTSI) scores were calculated,respectively,in order to evaluate the severity.The AUC of ROC was used to evaluate the ability of BISAP and the other scoring systems in predicting the severity of AP and the occurrence of pancreatic necrosis,organ failure and mortality.Results Among 497 patients,mild acute pancreatitis (MAP) was identified in 396 patients and severe acute pancreatitis (SAP) in 101 patients.The gender,age and etiological factors between MAP and SAP were not statistical different.The BISAP,APACHE Ⅱ,Ranson scores of the 4 9 7 patients were 1.08 ± 1.01,5.79 ± 4.00,1.69 ± 1.59,and the scores were intercorrelated(r =0.612,0.568,0.577,P ＜0.001).In addition,the BISAP,APACHE Ⅱ,Ranson scores of SAP patients were significantly higher than those in MAP patients.The AUC of BISAP for SAP was 0.762(95％ CI 0.722 ～0.799),when the cutoff value was 2,the sensitivity,specificity,positive predictive value (PPV),negative predictive value ( NPV ) were 63.39％,83.08％,48.1％,89.4％ ; the AUC of BISAP for pancreatic necrosis was 0.711 (95％ CI 0.612 ～ 0.797),when the cutoff value was 2,the sensitivity,specificity,PPV,NPV were 84.6％,46.7％,35.5％,89.7％ ; the AUC of BISAP for organ failure was 0.777( 95％ CI0.683 ～ 0.854),when the cutoff value was 2,the sensitivity,specificity,PPV,NPV were 93.1％,51.4％,43.5％,94.9％ ; the AUC of BISAP for mortality was 0.808(95％ CI 0.718 ～0.880),when the cutoff value was 3,the sensitivity,specificity,PPV,NPV were 83.3％,67.4％,25.6％,96.8％.In the cases of SAP,the ability of BISAP and the other scoring systems in predicting the prognosis showed no statistical difference.Conclusions The BISAP has the prediction ability for AP severity and prognosis similar to other scoring systems,and it consists of only 5 parameters and can be completed in the fast 24 h of admission,therefore it can be used for early predication of SAP,which is worth of clinical application.