BISAP评分联合YKL-40和GIP对重症急性胰腺炎患者的预后评估  

Prognostic evaluation of BISAP score combined with YKL-40 and GIP in patients with severe acute pancreatitis

作　　者：赖震宇 赵展庆 余秉昌 蔡秋燕 林奇栋 王宗道 程正 LAI Zhenyu;ZHAO Zhanqing;YU Bingchang;CAI Qiuyan;LIN Qidong;WANG Zongdao;CHENG Zheng(Department of Critical Medicine,Hainan West Central Hospital,Danzhou,Hainan,571700,China;Department of Clinical Laboratory,Hainan West Central Hospital;Department of Gastroenterology,Hainan West Central Hospital)

机构地区：[1]海南西部中心医院重症医学科,海南儋州571700 [2]海南西部中心医院检验科 [3]海南西部中心医院消化内科

出　　处：《临床急诊杂志》2022年第9期649-654,共6页Journal of Clinical Emergency

基　　金：2019年度海南省卫生计生行业科研项目(No:1901320719A2003)。

摘　　要：目的:探讨急性胰腺炎严重程度床边指数(BISAP)评分联合人软骨糖蛋白39(YKL-40)、血清肠抑胃肽(GIP)对于重症急性胰腺炎(SAP)患者的预后评估价值。方法:前瞻性选取2019年6月-2021年11月海南西部中心医院重症医学科收治的SAP患者98例为研究对象(SAP组),另选取同期海南西部中心医院消化内科收治的轻症急性胰腺炎(MAP)患者91例为MAP组,并同期随机选取于海南西部中心医院体检的90例健康体检者为对照组,比较3组研究对象体内血清YKL-40和GIP水平。将SAP组患者按住院期间预后分为死亡组(31例)和生存组(67例),比较两组一般资料和实验室指标,SAP死亡的相关高危因素采用logistic回归分析,绘制受试者工作特征(ROC)曲线分析BISAP评分及血清YKL-40、GIP水平预测SAP预后的价值。结果:SAP组患者血清YKL-40、GIP水平高于MAP组和对照组,MAP组患者血清YKL-40、GIP水平高于对照组(P<0.05);生存组和死亡组在BISAP评分、尿素氮、血肌酐、血糖、降钙素原(PCT)、C反应蛋白(CRP)、血脂肪酶、YKL-40、GIP水平上差异有统计学意义(P<0.05);logistic回归分析结果显示,PCT、BISAP评分、YKL-40、GIP是SAP患者死亡的独立相关因素(P<0.05)。ROC分析显示,BISAP评分、YKL-40、GIP 3个指标联合检测对SAP患者预后的预测价值优于单一指标检测。结论:SAP患者体内血清YKL-40、GIP表达水平异常升高,与SAP患者病情严重程度及预后有一定关系,BISAP评分、血清YKL-40、GIP是SAP患者死亡的独立相关因素,三者联合检测可以提高预测SAP预后的准确性。Objective:To investigate the prognosis evaluation value of bedside index for severity in acute pancreatitis(BISAP)combined with serum human cartilage glycoprotein-39(YKL-40)and glucose-dependent insulinotropic polypeptide(GIP)in patients with severe acute pancreatitis(SAP).Methods:This study was a prospective study.A total of 98 patients with SAP who were admitted to the intensive care unit in Hainan Western Central Hospital from June 2019 to November 2021 were selected as the research subjects(SAP group).In addition,91 patients with mild acute pancreatitis(MAP)treated in gastroenterology department of Hainan Western Central Hospital in the same period were selected as MAP group.At the same time,90 healthy people who underwent physical examination in Hainan Western Central Hospital were randomly selected as the control group.And the serum YKL-40 and GIP levels in the three groups were compared.According to the prognosis of SAP patients during hospitalization,they were divided into death group(n=31)and survival group(n=67).The general data and laboratory indexes of the two groups were compared.The related high-risk factors of SAP death were analyzed by logistic regression,and the receiver operating characteristic(ROC)curve was drawn to analyze the value of BISAP score and serum YKL-40 and GIP levels in predicting the prognosis of SAP.Results:The serum YKL-40 and GIP levels in patients with SAP were higher than those in MAP and control group,and the serum YKL-40 and GIP levels in patients with MAP were higher than those in control group(P<0.05).There were significant differences in BISAP score,urea nitrogen,blood creatinine,blood glucose,procalcitonin(PCT),C-reactive protein(CRP),blood lipase,YKL-40 and GIP levels between survival group and death group(P<0.05).Logistic regression analysis showed that PCT,BISAP score,YKL-40 and GIP were independent related factors of patient death(P<0.05).ROC analysis showed that BISAP score,YKL-40 and GIP combined test had better prognostic value of prognosis for the patients with

关 键 词：重症急性胰腺炎 急性胰腺炎严重程度床边指数评分 人软骨糖蛋白39 肠抑胃肽 预后 预测价值 

分 类 号：R657.51[医药卫生—外科学]