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急性胰腺炎严重程度的预测

Author
Santhi Swaroop Vege, MD
Section Editor
David C Whitcomb, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF
Translators
何文华, 副主任医师

引言

所有急性胰腺炎(acute pancreatitis, AP)患者中，约有15%-25%的患者会发生重症AP。根据美国的一项大型流行病学研究结果，在1988-2003年间，AP的死亡率从12%降至2%[1]。然而，重症AP患者亚组的死亡率仍然保持较高水平。能够预测AP严重程度可帮助识别并发症发病和死亡风险增高的患者，从而有助于将这些患者进行适当地早期分诊至重症监护病房(intensive care units, ICU)，并为其选择特定的干预措施。

本专题将总结预测AP严重程度的方法。AP的临床表现、诊断和治疗将单独讨论。 (参见“急性胰腺炎的临床表现和诊断”和“急性胰腺炎的治疗”)

一般性考虑

已开发出大量用于预测AP严重程度(基于临床、实验室和影像学危险因素、不同的严重程度分级系统以及血清标志物)的预测模型[2]。其中一些预测模型可在患者入院时帮助分诊患者，而其他预测模型只能在患者入院最初的48-72小时后或更晚使用。

然而，这些预测模型的特异性低(即假阳性率高)，当加上重症AP的低患病率(15%-25%)时，导致低阳性预测值[3]。进一步的预测模型需要将其他因素(例如，生物标志物、基因多态性和突变、蛋白质组学和代谢组学模式)和分析方法相结合[4]。

急性胰腺炎的分类

修订后的亚特兰大分类系统将AP分为两大类(表 1)[5,6]：

                            

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-14.
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