Hirota Masahiko, Takada Tadahiro, Kawarada Yoshifumi, Hirata Koichi, Mayumi Toshihiko, Yoshida Masahiro, Sekimoto Miho, Kimura Yasutoshi, Takeda Kazunori, Isaji Shuji, Koizumi Masaru, Otsuki Makoto, Matsuno Seiki
Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto 860-0811, Japan.
J Hepatobiliary Pancreat Surg. 2006;13(1):33-41. doi: 10.1007/s00534-005-1049-1.
This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis: (1) Severity assessment is indispensable to the selection of proper initial treatment in the management of acute pancreatitis (Recommendation A). (2) Assessment by a severity scoring system (JPN score, APACHE II score) is important for determining treatment policy and identifying the need for transfer to a specialist unit (Recommendation A). (3) C-reactive protein (CRP) is a useful indicator for assessing severity (Recommendation A). (4) Contrast-enhanced computed tomography (CT) scanning and contrast-enhanced magnetic resonance imaging (MRI) play an important role in severity assessment (Recommendation A). (5) A JPN score of 2 or more (severe acute pancreatitis) has been established as the criterion for hospital transfer (Recommendation A). (6) It is preferable to transfer patients with severe acute pancreatitis to a specialist medical institution where they can receive continuous monitoring and systemic management.
本文论述了日本厚生劳动省的严重程度评估标准及严重程度评分系统；现称日本厚生劳动省评分（JPN评分）。本文还给出了JPN评分与美国和欧洲主要使用的评估量表急性生理与慢性健康状况评估系统（APACHE）Ⅱ评分及兰森评分（Ranson score）相比较的数据。研究这些评分系统的目的是实现对重症或中度急性胰腺炎的早期诊断以及更恰当、更成功的治疗，急性胰腺炎的死亡率很高。本文就评估急性胰腺炎的严重程度提出以下建议：（1）严重程度评估对于急性胰腺炎治疗中选择恰当的初始治疗必不可少（建议A）。（2）通过严重程度评分系统（JPN评分、APACHEⅡ评分）进行评估对于确定治疗策略及确定是否需要转至专科病房很重要（建议A）。（3）C反应蛋白（CRP）是评估严重程度的有用指标（建议A）。（4）增强计算机断层扫描（CT）和增强磁共振成像（MRI）在严重程度评估中起重要作用（建议A）。（5）已确定JPN评分为2分或更高（重症急性胰腺炎）作为转院标准（建议A）。（6）最好将重症急性胰腺炎患者转至能进行持续监测和系统管理的专科医疗机构。
