本文選題：急性胰腺炎 + 急性胰腺炎嚴(yán)重程度床邊指數(shù)�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討紅細(xì)胞分布寬度(Red Cell Distribution Width,RDW)、血清Ca~(2+)水平、改良早期預(yù)警的評分(Modified Early Warning Score,MEWS)、急性胰腺炎嚴(yán)重程度床邊指數(shù)(Bedside Index for Severity in Acute Pancreatitis,BISAP)對預(yù)測急性胰腺炎嚴(yán)重程度的價值,并構(gòu)建一種更為精確的評分系統(tǒng)在發(fā)病早期來預(yù)測急性胰腺炎(Acute Pancreatitis,AP)的嚴(yán)重程度指導(dǎo)基層對AP進(jìn)行分級,從而及時進(jìn)行干預(yù)和轉(zhuǎn)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(xì)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(yán)重程度的預(yù)測指標(biāo)。將單因素logistic回歸中有統(tǒng)計學(xué)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(gòu)建多因素預(yù)測模型。構(gòu)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(yù)測模型和各單因素模型預(yù)測AP嚴(yán)重程度的意義,并采用bootstrap法對模型的內(nèi)部效度進(jìn)行驗證。[結(jié)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(yán)重程度的預(yù)測指標(biāo)(P值均0.001),而RDW不是AP嚴(yán)重程度的預(yù)測指標(biāo)(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(yán)重程度的獨(dú)立預(yù)測指標(biāo)(P值均0.001),而MEWS不是AP嚴(yán)重程度的獨(dú)立預(yù)測指(P0.05),且血清Ca~(2+)水平和 BISAP 呈負(fù)相關(guān)(r =-0.330, P0.001)。各模型對SAP的預(yù)測能力為:聯(lián)合血清Ca~(2+)水平和BISAP、新構(gòu)建的預(yù)測模型血清Ca~(2+)水平BISAP,血清Ca~(2+)水平和BISAP的預(yù)測能力無統(tǒng)計學(xué)意義(P0.05);新構(gòu)建的預(yù)測模型分別與單項血清Ca~(2+)水平、BISAP的預(yù)測能力有顯著統(tǒng)計學(xué)意義(P0.01)。采用bootstrap法對各模型的內(nèi)部效度進(jìn)行驗證后發(fā)現(xiàn)3個模型內(nèi)部效度良好。[結(jié)論]血清Ca~(2+)水平和BISAP對AP嚴(yán)重程度的預(yù)測價值較高,但聯(lián)合血清Ca~(2+)水平和BISAP構(gòu)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(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576

【參考文獻(xiàn)】

相關(guān)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(yīng)用改良早期預(yù)警評分與APACHEⅡ評估急診內(nèi)科病人預(yù)后能力的對比研究[J];護(hù)理研究;2016年13期

2 盧生芳;郭玉剛;李長風(fēng);張成人;韓蕓;陳麗芳;艾自勝;;改良早期預(yù)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(yù)后評估的應(yīng)用價值研究[J];中國全科醫(yī)學(xué);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(yù)后的臨床價值[J];檢驗醫(yī)學(xué)與臨床;2015年22期

4 徐永紅;閆領(lǐng);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(dá)明;程禹帥;;血清降鈣素原在急性胰腺炎病情及預(yù)后評估中的價值[J];實(shí)用醫(yī)學(xué)雜志;2015年16期

6 盧清龍;趙萍;馬增香;王文生;侯運(yùn)輝;張霞;李春艷;;紅細(xì)胞分布寬度對急性胰腺炎嚴(yán)重程度及預(yù)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(xué)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(jié)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(yán)重程度的相關(guān)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(yù)警評分在急性胰腺炎85例診斷中的應(yīng)用[J];交通醫(yī)學(xué);2013年05期

10 彭春燕;韓真;;C反應(yīng)蛋白、血鈣和胸腔積液對急性胰腺炎早期預(yù)后的評估[J];皖南醫(yī)學(xué)院學(xué)報;2013年03期

相關(guān)會議論文 前1條

1 中華消化病學(xué)分會胰腺病學(xué)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(nèi)科規(guī)范治療建議[A];第九次全國消化系統(tǒng)疾病學(xué)術(shù)會議專題報告論文集[C];2009年

，

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