摘要目的 探讨强离子隙(SIG)在亚特兰大新分类标准下预测急性胰腺炎严重程度的价值.方法 选择2015年1月至2016年12月在苏州大学附属第一医院诊治的133例急性胰腺炎患者的临床资料,其中轻度急性胰腺炎(MAP)55例、中度急性胰腺炎(MSAP)52例及重度急性胰腺炎(SAP)26例,诊断标准符合2014年急性胰腺炎诊治指南要求,并除外可能影响结果的其他基础疾病,如糖尿病酮症酸中毒,慢性肾功能不全等.观察各组的SIG水平,评估SIG与APACHEⅡ评分、Ranson评分、住院天数的相关性,并采用受试者工作特征(ROC)曲线比较SIG、血肌酐(Scr)、APACHEⅡ评分及Ranson评分预测急性胰腺炎严重程度的有效性.结果 SIG的水平SAP组最高,MSAP组其次,均高于MAP组,各组两两比较差异有统计学意义(P<0.01).SIG水平与APACHEⅡ评分(r=0.567,P<0.01)、Ranson评分(r=0.502,P<0.01)、住院天数(r=0.589,P<0.01)均呈正相关.SIG在预测MSAP+SAP时的ROC曲线下面积与APACHEⅡ评分(0.874±0.029和0.895±0.025,P>0.05)和Ranson评分(0.874±0.029和0.890±0.025,P>0.05)比较,差异均无统计学意义,但大于Scr(0.874±0.029和0.735±0.043,P<0.01);预测SAP时,曲线下面积SIG大于Scr(0.910±0.030和0.755±0.054,P<0.01),但与APACHEⅡ(0.910±0.030和0.867±0.034,P>0.05)及Ranson评分(0.910±0.030和0.871±0.032,P>0.05)比较,差异均无统汁学意义.结论 SIG在预测急性胰腺炎严重程度上具有重要的临床价值.

abstractsObjective To investigate the value of strong ion gap (SIG) in predicting the severity of acute pancreatitis (AP) based on the revised Atlanta classification. Methods A total of 133 patients with AP admitted from January, 2015 to December, 2016 were enrolled. Of them, there were 55 with mild AP (MAP), 52 with moderately severe AP (MSAP) and 26 with severe AP (SAP). All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2014 in China. Patients with other underlying diseases that might influence the clinical outcome were excluded, including those with diabetic ketoacidosis, chronic renal failure and other disorders. The changes in blood SIG levels in each group were observed. The correlations between SIG and acute physiology, chronic health evaluation (APACHE) Ⅱ score, Ranson score and length of hospital stay were analyzed. The receiver operating characteristic curves (ROC) were plotted to determine the efficiency of SIG, Scr, APACHE Ⅱ score, and Ranson score for predicting the severity of acute pancreatitis. Results The level of SIG in the SAP group was the highest, followed by the MSAP group and the lowest in the MAP group.There were significant differences in pairwise comparisons (P<0.01). The correlations between SIG and APACHE Ⅱ score (r=0.567, P<0.01), Ranson score (r=0.502, P<0.01), and length of hospital stay were positive (r=0.589, P<0.01). There was no statistical difference in the area under curve (AUC) between SIG and APACHE Ⅱ score (0.874±0.029 vs.0.895±0.025, P>0.05) and as well as Ranson score (0.874±0.029 vs. 0.890±0.027, P>0.05) for predicting moderately-severe acute pancreatitis, but SIG was superior to Scr (0.874±0.029 vs. 0.735±0.043, P<0.01). There was a significant difference in AUC between SIG and Scr (0.910±0.030 vs. 0.755±0.054, P<0.01), but no statistical differences between SIG and APACHE Ⅱ score (0.910±0.030 vs. 0.867±0.034, P>0.05) and Ranson score (0.910±0.030 vs. 0.871±0.032, P>0.05) for predicting severe acute pancreatitis. Conclusion SIG has important clinical significance for predicting the severity of acute pancreatitis.