摘要目的 对比CT严重指数(CTSI)和改良CT严重指数(MCTSI)对急性胰腺炎(AP)严重程度和预后的预测价值.方法 回顾性分析72例AP患者的临床资料,通过Kappa检验分别比较MCTSI和CTSI与2012版亚特兰大AP分类标准(临床分级诊断)的一致性,计算MCTSI和CTSI预测重度急性胰腺炎(SAP)的敏感度、特异度、阳性预测值和阴性预测值.通过受试者工作特征(ROC)曲线分析MCTSI和CTSI对SAP和死亡的预测价值,计算曲线下面积(AUC).结果 MCTSI和CTSI与2012版亚特兰大AP分类标准均具有较好的一致性(Kappa系数=0.653和0.656).MCTSI预测SAP的敏感度、特异度、阳性预测值和阴性预测值分别为90.0%(18/20)、86.5%(45/52)、72.0%(18/25)和95.7%(45/47),CTSI分别为50.0%(10/20)、96.2%(50/52)、83.3%(10/12)和83.3%(50/60).MCTSI预测SAP和死亡的AUC分别为0.932和0.913,CTSI预测SAP和死亡的AUC分别为0.908和0.874.结论 MCTSI和CTSI在预测AP严重程度方面的整体一致性均较好,但MCTSI对SAP和预后预测的敏感度和准确度更高.

abstractsObjective To compare the predictive value of CT severity index(CTSI)and modified CT severity index (MCTSI) for the severity and prognosis of acute pancreatitis (AP).Methods The clinical data of 72 patients with AP were retrospectively analyzed.The consistency between MCTSI,CTSI and revised Atlanta classification of AP-2012 was respectively compared by the Kappa test.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the MCTSI and CTSI in differentiating severe acute pancreatitis (SAP) were calculated.The predictive value of MCTSI and CTSI for SAP and mortality was respectively analyzed by receiver operating characteristic (ROC)curve,and the area under the curve(AUC)was respectively calculated.Results The MCTSI and CTSI showed good agreement with the revised Atlanta classification of AP-2012(the Kappa statistic was 0.653 and 0.656 respectively).The sensitivity,specificity,PPV and NPV of MCTSI were 90.0%(18/20)86.5% (45/52)72.0% (18/25) and 95.7% (45/47) respectively; and those of CTSI were 50.0% (10/20)96.2% (50/52)83.3% (10/12) and 83.3% (50/60) respectively.The AUC of MCTSI for predicting SAP and mortality were 0.932 and 0.913 respectivelyand of CTSI were 0.908 and 0.874 respectively.Conclusions The MCTSI and CTSI have a similar and good consistency in predicting severity of AP.However,the MCTSI shows more sensitive and accurate in predicting SAP and prognosis.