Leese T, Shaw D
Department of Surgery, University of Leicester, UK.
Br J Surg. 1988 May;75(5):460-2. doi: 10.1002/bjs.1800750519.
Modifications have been proposed in an attempt to improve the clinical value of the original nine-factor Glasgow prognostic scoring system for acute pancreatitis. These include the omission of age or serum transaminase, reducing the factors to eight. Debate exists as to which system should be employed. Assessment of the individual factors in 198 attacks of acute pancreatitis treated conventionally revealed that only serum transaminase did not differ significantly between mild and severe outcome groups. Multivariate analysis demonstrated four factors (Pa,O2, white cell count, lactic dehydrogenase, and urea) with independent significance in predicting severity, while serum glucose, albumin and transaminase were least useful. Findings were similar when considering only patients with gallstone aetiology. The reduction of the prognostic factors to eight by the omission of either age or transaminase improved the predictive value of the scoring system, both when considering all attacks and those of gallstone aetiology alone. We suggest that serum transaminase should be omitted because: it shows no significant difference between mild and severe outcome groups, while age has prognostic significance; the system has greater sensitivity than if age is omitted; and the number of factors requiring emergency laboratory measurement for immediate prognostication is reduced by one.
为提高急性胰腺炎最初的九因素格拉斯哥预后评分系统的临床价值，已有人提出了一些修改建议。这些建议包括省略年龄或血清转氨酶，将因素减少到八个。对于应采用哪种系统存在争议。对198例接受传统治疗的急性胰腺炎发作病例的个体因素评估显示，只有血清转氨酶在轻度和重度预后组之间没有显著差异。多变量分析表明，四个因素（动脉血氧分压、白细胞计数、乳酸脱氢酶和尿素）在预测严重程度方面具有独立意义，而血清葡萄糖、白蛋白和转氨酶最无用。仅考虑胆结石病因患者时结果相似。通过省略年龄或转氨酶将预后因素减少到八个，在考虑所有发作病例以及仅考虑胆结石病因的发作病例时，均提高了评分系统的预测价值。我们建议应省略血清转氨酶，原因如下：它在轻度和重度预后组之间没有显著差异，而年龄具有预后意义；该系统比省略年龄时具有更高的敏感性；并且进行即时预后所需的急诊实验室测量因素数量减少了一个。
