基于早期实验室指标评估急性胰腺炎严重程度与预后的价值探讨  

Investigation on value for evaluation of severity and prognosis of acute pancreatitis based on early laboratory indicators

作　　者：李莉[1] 宋爱琴[1] LI Li;SONG Aiqin(PICU,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266555,China)

机构地区：[1]青岛大学附属医院PICU,山东青岛266555

出　　处：《检验医学与临床》2022年第8期1030-1035,共6页Laboratory Medicine and Clinic

摘　　要：目的探讨急性胰腺炎(AP)患者早期实验室指标对病情严重程度及预后的预测价值。方法选取2016年1月至2020年12月青岛大学附属医院收治的AP患者779例为研究对象。根据2012版亚特兰大分类标准将AP分为轻症急性胰腺炎(MAP)、中度重症急性胰腺炎(MSAP)、重症急性胰腺炎(SAP),MAP和MSAP患者为非SAP组,SAP患者为SAP组。比较2组患者入院24 h内炎症指标、血常规、生化指标、凝血指标的差异,分析预测AP严重程度的独立危险因素;联合现有Glasgow评分8项指标得到改良Glasgow评分,评估2种评分对AP严重程度及预后的预测价值。结果SAP组的C反应蛋白(CRP)、降钙素原、白细胞计数、中性粒细胞计数、红细胞体积分布宽度(RDW)、血小板分布宽度、天门冬氨酸氨基转移酶、乳酸脱氢酶(LDH)、三酰甘油、血糖(GLU)、D-二聚体水平高于非SAP组,凝血酶原时间较非SAP组延长,而淋巴细胞计数、清蛋白、高密度脂蛋白胆固醇(HDL-C)及抗凝血酶Ⅲ水平低于非SAP组,差异均有统计学意义(P<0.05)。多因素Logistic回归模型分析显示,增高的CRP、RDW、LDH、GLU和降低的HDL-C是预测AP严重程度的独立危险因素(P<0.05),其预测SAP的曲线下面积(AUC)分别为0.808、0.649、0.823、0.662、0.643。改良Glasgow评分及Glasgow评分预测SAP的AUC分别为0.904、0.827。Pearson相关分析显示改良Glasgow评分及Glasgow评分与AP患者住院时间均呈正相关(r=0.437、0.280,P<0.05)。结论AP患者早期CRP、LDH、RDW、GLU升高对于预测SAP具有重要意义,改良Glasgow评分可以更早期、准确地评估AP患者的病情严重程度。Objective To investigate the predictive value of early laboratory indicators on the severity and prognosis of acute pancreatitis(AP)patients.Methods A total of 779 AP patients admitted to the Affiliated Hospital of Qingdao University from January 2016 to December 2020 were selected as subjects.According to the Atlanta Classification standard 2012,AP was divided into mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP).MAP and the MSAP patients were the non-SAP group,and SAP patients were the SAP group.The differences of inflammatory indicators,blood routine,biochemical indicators and blood coagulation indicators within 24 hours of admission were compared between the two groups,and the independent risk factors for predicting the severity of AP were analyzed.The modified Glasgow score was obtained by combining the existing 8 Glasgow scores,and the predictive value of the two scores in the severity and prognosis of AP was evaluated.Results The levels of C-reactive protein(CRP),procalcitonin,white blood cell count,neutrophil count,red blood cell volume distribution width(RDW),platelet distribution width,aspartate aminotransferase,lactate dehydrogenase(LDH),triacylglycerol,blood glucose(GLU)and D-dimer in the SAP group were higher than those in the non-SAP group,and prothrombin time was prolonged compared with the non-SAP group.The levels of lymphocyte count,albumin,high-density lipoprotein cholesterol(HDL-C)and antithrombinⅢin the SAP group were lower than those in the non-SAP group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression model analysis showed that increased CRP,RDW,LDH,GLU and decreased HDL-C were independent risk factors for predicting the severity of AP(P<0.05),and their area under the curve(AUC)for predicting SAP were 0.808,0.649,0.823,0.662 and 0.643 respectively.The AUC of SAP predicted by the modified Glasgow score and the Glasgow score were 0.904 and 0.827 respectively.Pearson correlation analysis showed

关 键 词：急性胰腺炎 实验室检查 严重程度 预后 GLASGOW评分 

分 类 号：R576[医药卫生—消化系统]