重症急性胰腺炎患者胰岛素抵抗指数、可溶性尿激酶型 纤溶酶原激活物受体水平及其与预后相关性分析  

Homeostasis model assessment insulin resistance index,level of soluble urokinase-type plasminogen activator receptor and correlation analysis with prognosis in patients with severe acute pancreatitis

作　　者：吴艳杰[1] 朱爱华[1] 刘佳 邢兰访[1] 卢军利[1] WU Yan-jie;ZHU Ai-hua;LIU Jia;XING Lan-fang;LU Jun-li(Department of Emergency,Tangshan People′s Hospital,Tangshan 063001,China)

机构地区：[1]唐山市人民医院急诊科,河北唐山063001

出　　处：《创伤与急危重病医学》2020年第5期312-316,共5页Trauma and Critical Care Medicine

基　　金：河北省医学科学研究重点课题(20181264)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者胰岛素抵抗指数(HOMA-IR)和血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)的表达水平及其与预后的相关性。方法选取自2017年12月至2019年12月唐山市人民医院收治的158例急性胰腺炎患者为研究对象。根据患者病情的严重程度分为轻症急性胰腺炎(MAP)组(n=74)和重症急性胰腺炎(SAP)组(n=84),另选取同期我院健康体检者70例纳入健康组。检测并比较各组HOMA-IR、suPAR水平差异;采用Pearson相关性分析急性胰腺炎(AP)患者HOMA-IR、suPAR与急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)的相关性;应用受试者工作特征(ROC)曲线,分析HOMA-IR、suPAR对SAP患者预后的评估价值。结果SAP组患者HOMA-IR、suPAR水平高于MAP组、健康组,MAP组患者的HOMA-IR、suPAR水平高于健康组,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,AP患者的HOMA-IR、suPAR分别与APACHEⅡ评分呈正相关(r=0.518,P=0.001;r=0.625,P=0.001)。AP患者的HOMA-IR、suPAR分别与SOFA评分呈正相关(r=0.611,P=0.001;r=0.573,P=0.001)。ROC曲线结果显示,HOMA-IR评估SAP患者预后的曲线下面积为0.851,敏感度和特异度分别为0.833和0.724;suPAR评估SAP患者预后的曲线下面积为0.816,敏感度和特异度分别为0.783和0.776;两项联合检测的曲线下面积为0.929,敏感度和特异度分别为0.900和0.875。多因素logistic回归分析结果显示,患者APACHEⅡ评分、SOFA评分、HOMA-IR和血清suPAR升高与SAP患者不良预后有关。结论HOMA-IR、suPAR水平可反映SAP患者病情的严重程度,两项联合检测对SAP患者的预后有较高预测价值。Objective To investigate the correlation between homeostasis model assessment insulin resistance index(HOMA-IR)and serum soluble urokinase-type plasminogen activator receptor(suPAR)and prognosis in patients with severe acute pancreatitis(SAP).Methods A retrospective study was performed on 158 cases of patients with SAP who were admitted from December 2017 to December 2019.According to the severity of the disease,the patients were divided into mild acute pancreatitis(MAP)group(n=74)and severe acute pancreatitis(SAP)group(n=84).In addition,70 healthy physical examination subjects in hospital during the same period were selected and included into the healthy group.The levels of HOMA-IR and suPAR in each group were detected and compared.Using Pearson correlation analysis in patients with acute pancreatitis(AP)HOMA-IR,suPAR and acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure estimation(SOFA)correlation;ROC curve was used to analyze the evaluation value of HOMA-IR and suPAR for the prognosis of SAP patients.Results The levels of HOMA-IR and suPAR in SAP group were higher than those in MAP group and the healthy group,and the levels of HOMA-IR and suPAR in MAP group were higher than those in the healthy group,with statistically significant differences(P<0.05).Pearson correlation analysis,according to the results of AP patients with HOMA-IR,suPAR with APACHEⅡscores were positively correlated(r=0.518,P=0.001;r=0.625,P=0.001).HOMA-IR and suPAR of AP patients were positively correlated with SOFA score(r=0.611,P=0.001;r=0.573,P=0.001).The receiver operation characteristic(ROC)curve showed that the area under the curve for HOMA-IR to evaluate the prognosis of SAP patients was 0.851,and the sensitivity and specificity were 0.833 and 0.724,respectively.The area under the curve for suPAR to evaluate the prognosis of SAP patients was 0.816,and the sensitivity and specificity were 0.783 and 0.776 respectively.The subcurve area of the two combined tests was 0.929,and the sensitivity and specif

关 键 词：重症急性胰腺炎 胰岛素抵抗指数 可溶性尿激酶型纤溶酶原激活物受体 预后 

分 类 号：R576[医药卫生—消化系统]