• 湖南省永州中心醫(yī)院北院普外科（湖南永州 425006）;

目的 　評價入院時急性生理與慢性健康評估Ⅱ（APACHEⅡ）評分在重癥急性胰腺炎（SAP）發(fā)生深部真菌感染（DFI）中的判斷價值。
方法 　回顧性分析2006年1月至2011年6月期間我院收治的132例SAP患者的臨床資料，采用受試者操作特征曲線（ROC）評價APACHEⅡ評分預(yù)測DFI的價值。
結(jié)果 　132例SAP患者中39例發(fā)生DFI（29.5%），其中白色念珠菌感染36例（92.3%），合并熱帶念珠菌2例（5.1%），合并近平滑仿珠菌1例（2.6%）；單部位感染27例（69.2%），多部位感染12例（30.8%）。39例發(fā)生DFI患者入院時APACHEⅡ評分為（17.1±3.8）分，而93例未發(fā)生DFI患者入院時APACHEⅡ評分為（9.7±2.1）分，前者明顯高于后者（t=14.316，P=0.000）。APACHEⅡ評分對SAP患者發(fā)生DFI預(yù)測的ROC曲線下面積為0.745（P=0.000），95%CI為0.641～0.849。當(dāng)截斷值為15分時，預(yù)測效能最佳，其特異度為0.81，靈敏度為0.72，約登指數(shù)為0.53。
結(jié)論 　入院時APACHEⅡ評分能較好地預(yù)測SAP患者DFI的發(fā)生，尤其當(dāng)APACHEⅡ評分大于15分時，高度提示發(fā)生DFI的可能，必要時可行預(yù)防性抗真菌治療。

引用本文： 段群歡,唐朝暉,卿伯華. 入院時APACHEⅡ評分對重癥急性胰腺炎發(fā)生深部真菌感染的判斷價值. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(2): 197-199. doi: 復(fù)制

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2. Kochhar R, Ahammed SK, Chakrabarti A, et al. Prevalence and outcome of fungal infection in patients with severe acute pancreatitis[J]. J Gastroenterol Hepatol, 2009, 24(5)：743-747.
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4. 陳爾真，蔣健，袁祖榮，等．重癥急性胰腺炎合并深部真菌感染的特點及防治[ J]．中國急救醫(yī)學(xué)，2004，24(5)：318-321．.
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6. Knaus WA, Draper EA, Wagner DP, et al. APACHE II：a severity of disease classification system[J]. Crit Care Med, 1985, 13(10)：818-829.
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8. 潘耀振，孫誠誼．暴發(fā)性胰腺炎的治療體會 (附 18例報道 )[J]．中國普外基礎(chǔ)與臨床雜志，2011，18(3)：255-258．.
9. Besselink MG, van Santvoort HC, Renooij W, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis[J]. Ann Surg, 2009, 250(5)： 712-719.
10. Zhang J, Yuan C, Hua G, et al. Early gut barrier dysfunction in patients with severe acute pancreatitis：attenuated by continuous blood purification treatment[J]. Int J Artif Organs, 2010, 33(10)：706-715.
11. Xia XM, Wang FY, Wang ZK, et al. Emodin enhances alveolar epithelial barrier function in rats with experimental acute pancreatitis[J]. World J Gastroenterol, 2010, 16(24)：2994-3001.
12. Lutgendorff F, Nijmeijer RM, Sandstr.m PA, et al. Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J]. PLoS One，2009，4(2)：e4512-e4524.
13. Eggimann P, Jamdar S, Siriwardena AK. Pro/con debate： antifungal prophylaxis is important to prevent fungal infection in patients with acute necrotizing pancreatitis receiving broad-spectrum antibiotics[J]. Crit Care, 2006, 10(5)：229-232.
14. Trikudanathan G, Navaneethan U, Vege SS. Intra-abdominal fungal infections complicating acute pancreatitis：a review[J]. Am J Gastroenterol, 2011, 106(7)：1188-1192.
15. Vege SS, Gardner TB, Chari ST, et al. Outcomes of intraabdominal fungal vs. bacterial infections in severe acute pancreatitis[J]. Am J Gastroenterol, 2009, 104(8)：2065-2070.
16. Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC)curve：practical review for radiologists[J]. Korean J Radiol, 2004, 5(1)：11-18.
17. Akobeng AK. Understanding diagnostic tests 3：Receiver operating characteristic curves[J]. Acta Paediatr, 2007, 96(5)： 644-647.
18. Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction[J]. Circulation, 2007, 115(7)：928-935.
  1. 1. Kochhar R, Noor MT, Wig J. Fungal infections in severe acute pancreatitis[J]. J Gastroenterol Hepatol, 2011, 26(6)：952-959.
  2. 2. Kochhar R, Ahammed SK, Chakrabarti A, et al. Prevalence and outcome of fungal infection in patients with severe acute pancreatitis[J]. J Gastroenterol Hepatol, 2009, 24(5)：743-747.
  3. 3. 賀軍，胡虞乾．急性重癥胰腺炎合并真菌感染的相關(guān)因素[ J]．檢驗醫(yī)學(xué)與臨床，2009，6(3）：191-192．.
  4. 4. 陳爾真，蔣健，袁祖榮，等．重癥急性胰腺炎合并深部真菌感染的特點及防治[ J]．中國急救醫(yī)學(xué)，2004，24(5)：318-321．.
  5. 5. 中華醫(yī)學(xué)會外科學(xué)會胰腺學(xué)組．急性胰腺炎的臨床診斷及分級標(biāo)準(zhǔn)[ J]．中華外科雜志，1997，35(12)：773-775．.
  6. 6. Knaus WA, Draper EA, Wagner DP, et al. APACHE II：a severity of disease classification system[J]. Crit Care Med, 1985, 13(10)：818-829.
  7. 7. Berzin TM, Rocha FG, Whang EE, et al. Prevalence of primary fungal infections in necrotizing pancreatitis[J]. Pancreatology, 2007, 7(1)：63-66.
  8. 8. 潘耀振，孫誠誼．暴發(fā)性胰腺炎的治療體會 (附 18例報道 )[J]．中國普外基礎(chǔ)與臨床雜志，2011，18(3)：255-258．.
  9. 9. Besselink MG, van Santvoort HC, Renooij W, et al. Intestinal barrier dysfunction in a randomized trial of a specific probiotic composition in acute pancreatitis[J]. Ann Surg, 2009, 250(5)： 712-719.
  10. 10. Zhang J, Yuan C, Hua G, et al. Early gut barrier dysfunction in patients with severe acute pancreatitis：attenuated by continuous blood purification treatment[J]. Int J Artif Organs, 2010, 33(10)：706-715.
  11. 11. Xia XM, Wang FY, Wang ZK, et al. Emodin enhances alveolar epithelial barrier function in rats with experimental acute pancreatitis[J]. World J Gastroenterol, 2010, 16(24)：2994-3001.
  12. 12. Lutgendorff F, Nijmeijer RM, Sandstr.m PA, et al. Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J]. PLoS One，2009，4(2)：e4512-e4524.
  13. 13. Eggimann P, Jamdar S, Siriwardena AK. Pro/con debate： antifungal prophylaxis is important to prevent fungal infection in patients with acute necrotizing pancreatitis receiving broad-spectrum antibiotics[J]. Crit Care, 2006, 10(5)：229-232.
  14. 14. Trikudanathan G, Navaneethan U, Vege SS. Intra-abdominal fungal infections complicating acute pancreatitis：a review[J]. Am J Gastroenterol, 2011, 106(7)：1188-1192.
  15. 15. Vege SS, Gardner TB, Chari ST, et al. Outcomes of intraabdominal fungal vs. bacterial infections in severe acute pancreatitis[J]. Am J Gastroenterol, 2009, 104(8)：2065-2070.
  16. 16. Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC)curve：practical review for radiologists[J]. Korean J Radiol, 2004, 5(1)：11-18.
  17. 17. Akobeng AK. Understanding diagnostic tests 3：Receiver operating characteristic curves[J]. Acta Paediatr, 2007, 96(5)： 644-647.
  18. 18. Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction[J]. Circulation, 2007, 115(7)：928-935.