血清丙酮酸、乳酸及极低密度脂蛋白胆固醇水平对急性胰腺炎病情进展的预测价值  

The Predictive Value of Levels of Serum Pyruvic Acid,Lactic Acid and Very-low-density Lipoprotein Cholesterol on the Progression of Acute Pancreatitis

作　　者：韩思静 韦祎 左罗 贺丹 李庆 HAN Sijing;WEI Yi;ZUO Luo;HE Dan;LI Qing(Department of Gastroenterology,The Second Affiliated Hospital of Chengdu MedicalCollege-Nuclear Industry 416 Hospital,Chengdu 610051,China;Department of Laboratory Medicine,The Second Affiliated Hospital of Chengdu MedicalCollege-Nuclear Industry 416 Hospital,Chengdu 610051,China;Department of Oncology,The Second Affiliated Hospital of Chengdu MedicalCollege-Nuclear Industry 416 Hospital,Chengdu 610051,China;Department of Emergency Medicine,The Second Affiliated Hospital of Chengdu MedicalCollege-Nuclear Industry 416 Hospital,Chengdu 610051,China)

机构地区：[1]成都医学院第二附属医院•核工业四一六医院消化内科,四川成都610051 [2]成都医学院第二附属医院•核工业四一六医院检验科,四川成都610051 [3]成都医学院第二附属医院•核工业四一六医院肿瘤科,四川成都610051 [4]成都医学院第二附属医院•核工业四一六医院急诊科,四川成都610051

出　　处：《标记免疫分析与临床》2023年第7期1182-1186,1242,共6页Labeled Immunoassays and Clinical Medicine

基　　金：2020年成都市医学科研课题(编号:2021009)。

摘　　要：目的探究血清丙酮酸、乳酸及极低密度脂蛋白胆固醇水平对急性胰腺炎(AP)病情进展的预测价值。方法回顾性分析我院2020年9月至2022年9月113例AP患者临床病例资料,按照病情进展分为轻症组51例和重症组62例。比较两组患者一般资料、实验室指标等,分析影响AP病情进展的危险因素,绘制受试者工作特征(ROC)曲线评估实验室指标对重症AP的预测价值。结果重症组患者急性生理与慢性健康评分(APACHEⅡ)评分、急性胰腺炎严重程度床边指数(BISAP)评分、血乳酸、极低密度脂蛋白胆固醇及三酰甘油水平均高于轻症组,血清丙酮酸水平低于轻症组(P<0.05);血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油均与AP患者APACHEⅡ评分及BISAP评分呈正相关(P<0.05);多因素分析结果显示,血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油均是造成重症AP的危险因素(P<0.05);ROC曲线显示,丙酮酸、乳酸、极低密度脂蛋白胆固醇、三酰甘油及四者联合预测AP患者病情进展的AUC分别为0.622、0.632、0.752、0.623、0.833,四者联合检测预测重症AP患者的价值最高(P<0.05),其灵敏度为77.42%,特异性为82.35%。结论血清丙酮酸、乳酸、极低密度脂蛋白胆固醇及三酰甘油水平变化可反映AP患者脏器衰竭情况,低水平血清丙酮酸及高水平全血乳酸、极低密度脂蛋白胆固醇、三酰甘油可加重患者胰腺周围组织损伤,四者联合检测对AP患者病情进展有较高预测价值。Objective To explore the predictive value of serum pyruvic acid,lactic acid and very-low-density lipoprotein cholesterol levels on the progression of acute pancreatitis(AP).Methods The clinical medical recorded of 113 patients with AP in the hospital from September,2020 to September,2022 were retrospectively analyzed.According to the disease progression,these patients were divided into the mild group(51 cases)and severe group(62 cases).The general data and laboratory indicators of the two groups were compared,and the risk factors affecting the progression of AP were analyzed.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of laboratory indicators on severe AP.Results The scores of Acute Physiology and Chronic Health Evaluation II(APACHE II),Bedside Index for Severity of Acute Pancreatitis(BISAP)and levels of whole blood lactic acid,very-low-density lipoprotein cholesterol and triglyceride in the severe group were significantly higher than those in the mild group,while serum pyruvate level was significantly lower than the mild group(P<0.05).Serum pyruvate,lactate,very-low-density lipoprotein cholesterol,and triglycerides were positively correlated with APACHE II and BISAP scores in AP patients(P<0.05).Multivariate analysis showed that serum pyruvate,lactate,very-low-density lipoprotein cholesterol,and triglycerides were risk factors for severe AP(P<0.05).ROC curves showed that the area under curves(AUCs)of pyruvate,lactate,very-low-density lipoprotein cholesterol,triglyceride and their combination on predicting disease progression in patients with AP were 0.622,0.632,0.752,0.623 and 0.833,respectively.The combined test of the four markers had the highest AUC value in predicting severe AP patients(P<0.05),with a sensitivity of 77.42%and a specificity of 82.35%.Conclusion Changes in serum pyruvate,lactate,very-low-density lipoprotein cholesterol,and triglycerides can reflect the organ failure of patients with AP.Low levels of serum pyruvate and high levels of whole blood lactat

关 键 词：急性胰腺炎 丙酮酸 乳酸 极低密度脂蛋白胆固醇 病情进展 

分 类 号：R657.51[医药卫生—外科学]