BISAP、MEWS和常規(guī)檢驗指標的急性胰腺炎嚴重程度預測模型的臨床意義
本文選題:急性胰腺炎 + 急性胰腺炎嚴重程度床邊指數(shù); 參考:《昆明醫(yī)科大學》2017年碩士論文
【摘要】:[目的]探討紅細胞分布寬度(Red Cell Distribution Width,RDW)、血清Ca~(2+)水平、改良早期預警的評分(Modified Early Warning Score,MEWS)、急性胰腺炎嚴重程度床邊指數(shù)(Bedside Index for Severity in Acute Pancreatitis,BISAP)對預測急性胰腺炎嚴重程度的價值,并構建一種更為精確的評分系統(tǒng)在發(fā)病早期來預測急性胰腺炎(Acute Pancreatitis,AP)的嚴重程度指導基層對AP進行分級,從而及時進行干預和轉診,降低病死率及重癥率。[方法]分別統(tǒng)計302例急性胰腺炎患者紅細胞分布寬度和血清Ca~(2+)水平,統(tǒng)計和計算302例AP病例的MEWS、BISAP,使用單因素logistic回歸分析RDW、血清Ca~(2+)水平、MEWS、BISAP是否為AP嚴重程度的預測指標。將單因素logistic回歸中有統(tǒng)計學意義的參數(shù)納入多因素logistic回歸,采用向前逐步回歸,篩選變量,構建多因素預測模型。構建受試者工作特征曲線(receiver operating characteristic curve,ROC),通過曲線下面積,比較多因素預測模型和各單因素模型預測AP嚴重程度的意義,并采用bootstrap法對模型的內部效度進行驗證。[結果]302例患者中MAP 209例,SAP 93例。單因素logistic回歸分析后發(fā)現(xiàn),血清Ca~(2+)水平、MEWS、BISAP均為AP嚴重程度的預測指標(P值均0.001),而RDW不是AP嚴重程度的預測指標(P0.05)。多因素logistic回歸分析后發(fā)現(xiàn),血清Ca~(2+)水平和BISAP是AP嚴重程度的獨立預測指標(P值均0.001),而MEWS不是AP嚴重程度的獨立預測指(P0.05),且血清Ca~(2+)水平和 BISAP 呈負相關(r =-0.330, P0.001)。各模型對SAP的預測能力為:聯(lián)合血清Ca~(2+)水平和BISAP、新構建的預測模型血清Ca~(2+)水平BISAP,血清Ca~(2+)水平和BISAP的預測能力無統(tǒng)計學意義(P0.05);新構建的預測模型分別與單項血清Ca~(2+)水平、BISAP的預測能力有顯著統(tǒng)計學意義(P0.01)。采用bootstrap法對各模型的內部效度進行驗證后發(fā)現(xiàn)3個模型內部效度良好。[結論]血清Ca~(2+)水平和BISAP對AP嚴重程度的預測價值較高,但聯(lián)合血清Ca~(2+)水平和BISAP構建的模型明顯優(yōu)于血清Ca~(2+)水平和BISAP,且簡單易行,值得在臨床推廣。
[Abstract]:[objective] to investigate the value of red cell distribution (RDW2), modified early warning score (MEWS) and bedside Index for severity in Acute pancreatitis (BISAP) in predicting the severity of acute pancreatitis. Furthermore, a more accurate scoring system was established to predict the severity of acute pancreatitis (AP) at the early stage of the disease, to guide the basic units to grade AP, so that timely intervention and referral could be carried out to reduce the mortality rate and the severe rate of acute pancreatitis. [methods] the distribution width of erythrocyte and the level of Cafi2 in serum of 302 patients with acute pancreatitis were counted and calculated. The single factor logistic regression analysis was used to determine whether MEWS BISAP was a predictor of AP severity. The parameters with statistical significance in univariate logistic regression were incorporated into multivariate logistic regression and the multivariate prediction model was constructed by stepwise forward regression and screening of variables. The receiver operating characteristic curve was constructed. The significance of predicting AP severity by multi-factor prediction model and single-factor model was compared by the area under the curve, and the internal validity of the model was verified by bootstrap method. [results] among 302 patients, there were 209 cases with SAP and 93 cases with map. The results of univariate logistic regression analysis showed that the serum Caan2) level was a predictor of AP severity (P = 0.001), while RDW was not a predictor of AP severity (P 0.05). The results of multivariate logistic regression analysis showed that the serum Caan2) level and BISAP were both independent predictors of AP severity (P = 0.001), while Mews was not an independent predictor of AP severity (P 0.05), and the serum Caanzao (2) level was negatively correlated with BISAP (r = -0.330, P 0.001). The predictive ability of each model to SAP is as follows: combined serum Caan2) level and BISAP level, newly constructed prediction model serum Caanzao 2) level BISAP level, serum Caanzao 2) level and BISAP prediction ability have no statistical significance, the new prediction model and single prediction model have no statistical significance (P0.05). The predictive ability of BISAP was statistically significant (P 0.01). Bootstrap method was used to verify the internal validity of each model, and it was found that the internal validity of the three models was good. [conclusion] the level of serum Caanzao 2) and BISAP in predicting the severity of AP were higher, but the combined serum level of Caan2) and the model of BISAP were obviously superior to the level of serum Caan2) and BISAP, and were simple and easy to use, so it was worth popularizing in clinic.
【學位授予單位】:昆明醫(yī)科大學
【學位級別】:碩士
【學位授予年份】:2017
【分類號】:R576
【參考文獻】
相關期刊論文 前10條
1 王艷梅;衛(wèi)婷婷;侯銘;張麗;阿孜古麗·買買提;李萍;;應用改良早期預警評分與APACHEⅡ評估急診內科病人預后能力的對比研究[J];護理研究;2016年13期
2 盧生芳;郭玉剛;李長風;張成人;韓蕓;陳麗芳;艾自勝;;改良早期預警評分和生理評分系統(tǒng)及危險患者評分對急診科搶救室患者預后評估的應用價值研究[J];中國全科醫(yī)學;2016年12期
3 杜坤;鄧琳;張健;張廣慧;;降鈣素原對急性胰腺炎的診斷及預后的臨床價值[J];檢驗醫(yī)學與臨床;2015年22期
4 徐永紅;閆領;邊城;田字彬;荊雪;;降鈣素原在急性胰腺炎中的病情判斷價值[J];世界華人消化雜志;2015年30期
5 許世申;陳達明;程禹帥;;血清降鈣素原在急性胰腺炎病情及預后評估中的價值[J];實用醫(yī)學雜志;2015年16期
6 盧清龍;趙萍;馬增香;王文生;侯運輝;張霞;李春艷;;紅細胞分布寬度對急性胰腺炎嚴重程度及預后判斷的價值[J];山東醫(yī)藥;2015年13期
7 高艷霞;李莉;李毅;于學忠;孫同文;蘭超;;降鈣素原在急性胰腺炎病情判斷中的意義[J];中國中西醫(yī)結合急救雜志;2014年03期
8 牛省利;楊先芝;;血清IL-6、PCT水平與急性胰腺炎嚴重程度的相關性研究[J];醫(yī)藥論壇雜志;2014年02期
9 王霆;沈雁波;蔡琦;;改良早期預警評分在急性胰腺炎85例診斷中的應用[J];交通醫(yī)學;2013年05期
10 彭春燕;韓真;;C反應蛋白、血鈣和胸腔積液對急性胰腺炎早期預后的評估[J];皖南醫(yī)學院學報;2013年03期
相關會議論文 前1條
1 中華消化病學分會胰腺病學組;王興鵬;袁耀宗;錢家鳴;許國銘;賈林;郝建宇;田字彬;郭曉鐘;唐承薇;;重癥急性胰腺炎內科規(guī)范治療建議[A];第九次全國消化系統(tǒng)疾病學術會議專題報告論文集[C];2009年
,本文編號:2025910
本文鏈接:http://www.sikaile.net/yixuelunwen/xiaohjib/2025910.html