【摘要】 目的 建立改良BISAP评分系统，比较并分析BISAP评分系统与改良BISAP评分系统对急性胰腺炎（AP）严重程度及病情评估的价值。方法 新系统的建立：回顾性收集2019年1月—2021年12月中南大学湘雅三医院收治的1 033例AP患者的临床资料。根据修订版Atlanta分级将其分为轻症急性胰腺炎（MAP）组（n=827）和重症急性胰腺炎（SAP）组（n=206），比较两组患者临床特征、实验室指标及影像学资料的差异，将差异有统计学意义的指标进行二元Logistic回归分析，筛选出SAP的独立危险因素，利用受试者特征曲线（ROC曲线）得出各独立危险因素的最大约登指数对应的最佳截断值，并根据不同情况分别赋值为0或1分，结合BISAP评分系统，建立改良BISAP评分系统。新系统验证：回顾性收集2017年1月—2018年12月中南大学湘雅三医院收治的473例AP患者的临床资料，对其进行BISAP评分与改良BISAP评分，利用ROC曲线下面积（AUC）分析比较两个评分系统对AP病情严重程度、预后的预测价值。计数资料应用χ2检验或Fisher精确检验进行两组间比较；计量资料两组间比较采用成组t检验和Mann-Whitney U检验。结果 新系统的建立：MAP组与SAP组患者在入院方式、住院天数、是否入住ICU、死亡人数、合并基础疾病、出现并发症方面差异均有统计学意义（P值均<0.05）。二元Logistic回归分析显示，体温、NLR、CRP、Alb、TG、D二聚体、纤维蛋白原、MCTSI评分为SAP的独立危险因素（P值均<0.05）。ROC曲线分析显示CRP(AUC=0.921)、NLR(AUC=0.798)、D二聚体（AUC=0.768）及MCTSI评分（AUC=0.931）对SAP有较好的预测价值，且上述四项指标联合预测的AUC为0.976，与单个指标、两项指标联合及三项指标联合相比，其诊断效能更高，且差异有统计学意义（P值均<0.05）。新评分系统验证：共纳入473例患者，其中MAP组408例，SAP组65例。两组患者在入院方式、住院天数、是否入住ICU、死亡人数、出现并发症方面差异有统计学意义（P值均<0.05）。在预测SAP方面，改良BISAP评分优于BISAP评分（AUC:0.972 vs 0.887,P<0.05），改良BISAP评分>3为最佳临界值。改良BISAP评分在预测AP患者死亡方面也有较高价值（AUC=0.910），但与BISAP评分系统（AUC=0.896）比较差异无统计学意义（P=0.707）。结论 改良BISAP评分在预测AP严重程度方面优于BISAP评分，在预测AP患者死亡方面也有较高的价值，可以比较准确、客观且在早期评估AP患者病情。更多还原

【Abstract】 Objective To establish a modified BISAP scoring system, and to investigate the value of the BISAP scoring system versus the modified BISAP scoring system in assessing the severity and condition of acute pancreatitis(AP).Methods For the establishment of the new scoring system, a retrospective analysis was performed for the clinical data of 1 033 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2019 to December 2021, and according to the revised Atlanta classification, they were divided into mild acute pancreatitis(MAP) group with 827patients and severe acute pancreatitis(SAP) group with 206 patients. The two groups were compared in terms of clinical features, laboratory markers, and imaging data. A binary logistic regression analysis was performed for the statistically significant indicators to screen for the independent risk factors for SAP. The receiver operating characteristic(ROC) curve was used to obtain the optimal cut-off value corresponding to the maximum Youden index for each independent risk factor, and a score of 0 or 1 was assigned depending on different situations, which was integrated into the BISAP scoring system to establish a modified BISAP scoring system. For the validation of the new scoring system, a retrospective analysis was performed for the clinical data of 473 patients with AP who were admitted to Third Xiangya hospital of central South University from January 2017to December 2018. BISAP score and modified BISAP score were determined for each patient, and the area under the ROC curve(AUC) was used to compare the value of the two scoring systems in predicting the severity and prognosis of AP. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups, and the independent-samples t test and the Mann-Whitney U test were used for comparison of continuous data between two groups. Results For the establishment of the new scoring system, there were significant differences between the MAP group and the SAP group in mode of admission, length of hospital stay, ICU admission rate, number of deaths, underlying diseases, and incidence rate of complications(all P<0.05). The binary logistic regression analysis showed that body temperature, neutrophil-to-lymphocyte ratio(NLR), C-reactive protein(CRP), albumin, triglycerides, D-dimer, fibrinogen, and MCTSI score were independent risk factors for SAP(all P<0.05). The ROC curve analysis showed that CRP(AUC=0.921), NLR(AUC=0.798), D-dimer(AUC=0.768), and MCTSI score(AUC=0.931) had a good predictive value for SAP, and the combination of these four indicators had an AUC of 0.976 and showed a significantly higher diagnostic efficiency than each indicator alone or the combination of two or three indicators(all P<0.05). For the validation of the new scoring system, a total of 473 patients were enrolled, with 408 in the MAP group and 65 in the SAP group, and there were significant differences between the two groups in mode of admission, length of hospital stay, ICU admission rate, number of deaths, and incidence rate of complications(all P<0.05). The modified BISAP score was better than the BISAP score in predicting SAP(AUC: 0.972 vs 0.887, P<0.05), with an optimal cut-off value of >3 points. The modified BISAP score also had a relatively high value in predicting the mortality of AP patients(AUC=0.910), but there was no significant difference between the modified BISAP score and the BISAP scoring system(AUC: 0.910 vs 0.896, P=0.707). Conclusion The modified BISAP score is better than the BISAP score in predicting the severity of AP and has a relatively high value in predicting the mortality of AP patients, giving a more accurate, objective, and early assessment of the condition of AP patients.更多还原