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目的:比较联合胰腺外炎症CT评分(extropancreatic inflammation on abdominal computed tomography,EPIC)及中性粒细胞与淋巴细胞比值(neutropil-lymphocyte rate,NLR)与急性胰腺炎床旁严重指数(bedside index for severity in acute pancreatitis,BISAP)早期预测急性胰腺炎(acute pancreatitis,AP)严重性的价值.方法:对2010-01/2014-04住院的358例AP患者资料进行分析.对所有患者进行EPIC、NLR、BISAP、改良Marshall及联合指标评分.联合指标评分为EPIC分数加上NLR得分(其中NLR≥7.345为1分,<7.345为0分).轻度AP划入轻症组,中度AP重度AP划入重症组.两组的EPIC、NLR、BISAP及联合指标评分进行t检验,采用Spearman检验评价各类指标评分与重症的相关性.对各类指标早期预测AP严重性的曲线下面积(area under curve,AUC)及敏感性、特殊性、准确性、阳性预测值、阴性预测值、约登指数进行了研究.结果:358例AP中,重症55例(占15.363%,55/358),轻症303例(占84.637%,303/358).重症组的EPIC、NLR、BISAP及联合指标评分比轻症组的评分高,分别为4.200±1.393 vs 1.373±1.333,14.358±5.908 vs 7.929±4.514,2.655±0.985 vs 0.993±0.843,5.164±1.385 vs 1.819±1.493,所有P=0.000.EPIC、NLR、BISAP及联合指标评分与重症的相关系数分别为0.529、0.406、0.546及0.554,所有P=0.000.EPIC、NLR、BISAP及联合指标评分早期预测AP严重性的AUC分别为0.914(95%CI:0.867-0.961),0.825(95%CI:0.778-0.872),0.911(95%CI:0.863-0.960)及0.938(95%CI:0.900-0.975),所有P=0.000.BISAP及联合指标评分预测重症的敏感性、特异性、准确性、阳性预测值、阴性预测值及约登指数分别为90.909%、80.528%、82.123%、45.872%、97.992%、0.714及85.455%、86.469%、86.313%、53.409%、97.037%、0.719.结论:联合EPIC及NLR指标简便易于获得,其早期预测AP严重性的曲线下面积较BISAP的预测面积大,与其他指标相比,其预测的重症AP的特异性及准确性较高.
OBJECTIVE: To compare the association between EPCP and neutropil-lymphocyte rate (NLR) and bedside index for severity in acute pancreatitis (APIS) in early stage.Methods: The data of 358 AP patients hospitalized from January 2010 to April 2014 were analyzed.The EPIC, NLR, BISAP , Improved Marshall and joint index score.The joint index score was EPIC score plus NLR score (NLR≥7.345 was 1, <7.345 was 0) .Mild AP were classified as mild and moderate AP AP Severe group.The EPIC, NLR, BISAP and joint index scores of two groups were analyzed by t-test.The Spearman test was used to evaluate the correlation between the scores of various indexes and the severity of the disease.The area under curve , AUC) and sensitivity, specificity, accuracy, positive predictive value, negative predictive value, Youden index were studied.Results: Among 358 AP patients, 55 were severe (15.363%, 55/358) 303 cases (84.637%, 303/358) .The score of EPIC, NLR, BISAP and joint index of severe group were higher than those of mild group (4.200 ± 1.393 vs 1.373 ± 1.333, 14.358 ± 5.908 vs 7.929 ± 4.514, 2.655 ± 0.985 vs 0.993 ± 0.843, 5.164 ± 1.385 vs 1.819 ± 1.493, all P = 0.000.EPIC, NLR, BISAP and the correlation coefficient of the joint index score and severe disease were 0.529,0.406,0.546 and 0.554 respectively, all P = 0.000.EPIC, The AUC of NLR, BISAP and the combined index score for early prediction of AP severity were 0.914 (95% CI: 0.867-0.961), 0.825 (95% CI: 0.778-0.872), 0.911 (95% CI: 0.863-0.960) and 0.938 (95% CI: 0.900-0.975), all P = 0.000. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Youden index of predicting critical illness were 90.909% and 90.528% , 82.123%, 45.872%, 97.992%, 0.714 and 85.455%, 86.469%, 86.313%, 53.409%, 97.037% and 0.719, respectively.Conclusions: The combined EPIC and NLR indexes are easy to obtain and the area under the curve of early prediction of AP severity Compared with the predicted area of BISAP, compared with other indicators, the prediction of severe AP is more specific and accurate.