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目的评估APACHE-Ⅱ、Balthazar分级及腹部CT胰外炎症评分系统(EPIC)三种临床标准对急性胰腺炎(AP)的预后价值。方法研究2007-07-01—2007-12-31于温州医学院附属第一医院收治的入院24 h内行腹部CT检查的AP患者178例。用受试者工作特征(ROC)曲线分析各临床评分标准预测重症AP的敏感度、特异度、约登指数及曲线下面积(AUROC),分析各评分标准对局部和全身并发症的预见能力。结果178例患者中诊断为重症者46例。轻症和重症AP患者三种临床评分分值差异均有统计学意义(P<0.05)。Cutoff值取4.5时EPIC评分标准判断重症AP的敏感度最高达0.870,特异度最高达0.884,AUROC最大达0.929。EPIC预测局部并发症、全身并发症的AUROC均最大。结论EPIC是入院24 h内预测重症AP有效的指标,对并发症亦有极佳的预测能力。
Objective To evaluate the prognostic value of three clinical criteria of APACHE-Ⅱ, Balthazar classification and abdominal CT pancreatitis score system (EPIC) in acute pancreatitis (AP). Method Study 2007-07-01-2007-12-31 In the First Affiliated Hospital of Wenzhou Medical College admitted to hospital within 24 h of abdominal CT examination of 178 patients with AP. The sensitivity, specificity, Youden index and area under the curve (AUROC) of each clinical grading scale in predicting severe AP were analyzed by receiver operating characteristic (ROC) curve analysis, and the predictive ability of each grading standard on local and systemic complications was analyzed. Results Of the 178 patients diagnosed as severe in 46 cases. The scores of the three clinical scores of patients with mild and severe AP were statistically significant (P <0.05). Cutoff value of 4.5 when the EPIC scoring criteria to determine the sensitivity of critically ill patients up to 0.870, specificity of up to 0.884, AUROC up to 0.929. EPIC predicts local complications and systemic complications with the highest AUROC. Conclusion EPIC is an effective index for predicting severe AP within 24 hours after admission, and has excellent predictive ability for complications.