APACHE-II评分联合BISAP评分及血清淀粉样蛋白A对高脂血症性急性胰腺炎严重程度的预测价值

Predictive Value of APACHE-II Score Combined with BISAP Score and Serum Amyloid A for the Severity of Hyperlipidemic Acute Pancreatitis

摘要: 目的：评估APACHE-II评分联合BISAP评分及血清淀粉样蛋白A (serum amyloid A, SAA)对高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis, HLAP)严重程度的预测价值。方法：收集2020年1月至2022年12月首诊于安徽医科大学附属合肥医院的192例HLAP患者进行回顾性分析研究。将入组患者按照病情严重程度分为2组：轻症HLAP组(123例)和中重症HLAP组(69例)。比较两组患者的一般资料、APACHE-II评分和BISAP评分以及入院即刻血清淀粉样蛋白A (SAA)等多项实验室指标，采用多因素二元logistic回归分析筛选出中重症HLAP的独立危险因素。采用受试者工作特征(receiver op-erating characteristic, ROC)曲线评价APACHE-II评分联合BISAP评分及SAA的临床预测效果。结果：APACHE-II评分(OR = 1.424, P = 0.002)、BISAP评分(OR = 2.289, P = 0.024)及SAA (OR = 0.042, P = 0.006)均为中重症HLAP的独立危险因素(P < 0.05)。APACHE-II评分预测中重症HLAP的灵敏度及特异度均为79.7%，ROC曲线下面积(AUC)为0.872 (P < 0.05)；SAA预测中重症HLAP的灵敏度及特异度分别为84.6%、82.6%，AUC为0.870 (P < 0.05)；BISAP评分预测中重症HLAP患者的灵敏度及特异度分别为82.9%，62.7%，AUC为0.818 (P < 0.05)。三项指标联合后预测中重症HLAP患者的灵敏度及特异度分别为87.0%、95.7%，AUC为0.962 (P < 0.05)。结论：APACHE-II、BISAP评分及SAA与HLAP患者严重程度呈正相关，且联合该三项指标对中重症HLAP有较高的预测价值。

Abstract: Objective: To evaluate the predictive value of APACHE-II score combined with BISAP score and se-rum amyloid A (SAA) for the severity of hyperlipidemic acute pancreatitis (HLAP). Methods: A total of 192 patients with HLAP who were first diagnosed in Hefei Hospital of Anhui Medical University from January 2020 to December 2022 were retrospectively analyzed. The enrolled patients were divided into 2 groups according to the severity of illness: mild HLAP group (123 patients) and mod-erate to severe HLAP group (69 patients). A number of laboratory parameters such as general data, APACHE-II score and BISAP score, and serum amyloid A (SAA) immediately after admission were compared between the two groups, and multivariate binary logistic regression analysis was used to screen independent risk factors for moderate to severe HLAP. Receiver operating characteristic (ROC) curve was used to evaluate the clinical predictive effect of APACHE-II score combined with BISAP score and SAA. Results: APACHE-II score (OR = 1.424, P = 0.002), BISAP score (OR = 2.289, P = 0.024) and SAA (OR = 0.042, P = 0.006) were independent risk factors for moderate to severe HLAP (P < 0.05). APACHE-II score predicted moderate to severe HLAP with a sensitivity and speci-ficity of 79.7% and an area under the ROC curve (AUC) of 0.872 (P < 0.05); SAA predicted severe HLAP with a sensitivity and specificity of 84.6% and 82.6% and an AUC of 0.870 (P < 0.05); and BISAP score predicted moderate to severe HLAP with a sensitivity and specificity of 82.9% and 62.7% and an AUC of 0.818 (P < 0.05). The sensitivity and specificity of the combination of the three indicators in predicting patients with moderate to severe HLAP were 87.0% and 95.7%, respec-tively, and the AUC was 0.962 (P < 0.05). Conclusion: APACHE-II, BISAP score and SAA are positively correlated with the severity of HLAP, and the combination of these three indicators has a high pre-dictive value for moderate and severe HLAP.