内脏脂肪指数对高脂血症性急性胰腺炎患者病情严重程度的预测价值  

Predictive value of visceral adiposity index on the severity of hyperlipidemia-induced acute pancreatitis

作　　者：王思盼 张珏 张珂 陈南[1] 陈明迪 李毅[1] Wang Sipan;Zhang Jue;Zhang Ke;Chen Nan;Chen Mingdi;Li Yi(Department of Critical Care Medicine,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China;Department of Critical Care Medicine,Jingjiang People's Hospital,Jingjiang 214500,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院重症医学科,江苏苏州215006 [2]靖江市人民医院重症医学科,江苏靖江214500

出　　处：《中国中西医结合急救杂志》2023年第4期453-457,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省高等学校自然科学面上项目(20KJB320026);江苏省苏州市科技计划项目(SYS2019055)。

摘　　要：目的探讨内脏脂肪指数(VAI)对高脂血症性急性胰腺炎(HLAP)病情严重程度的预测价值。方法选择2020年7月至2022年8月苏州大学附属第一医院重症医学科收治的HLAP患者作为研究对象。根据病情严重程度将患者分为轻症急性胰腺炎(MAP)组、中重度急性胰腺炎(MSAP)组、重症急性胰腺炎(SAP)组3组。收集患者的性别、年龄、既往病史、血压、心率、体质量、腰围等临床资料和入院后24 h内外周静脉血白细胞计数(WBC)、血小板计数(PLT)、降钙素原(PCT)、血尿淀粉酶、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)等实验室指标以及入院24 h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA),并计算体质量指数(BMI)、VAI。比较3组上述各种指标的差异,采用Logistic回归分析HLAP中SAP患者的危险因素,绘制受试者工作特征曲线(ROC曲线)评估各危险因素对HLAP患者发生SAP的预测效能。结果共纳入112例HLAP患者,其中MAP 52例,MSAP 39例,SAP 21例。3组WBC、PCT、APACHEⅡ评分、SOFA评分、TG、HDL及VAI比较差异均有统计学(均P<0.05),SAP组WBC、PCT、APACHEⅡ评分、SOFA评分、TG、VAI均明显高于MSAP组和MAP组〔WBC(×109/L):14.34(12.16,18.65)比12.21(10.83,18.47)、10.54(8.90,12.46),PCT(μg/L):1.72(1.09,6.33)比0.81(0.34,1.16)、0.67(0.31,0.85),APACHEⅡ评分(分):7(5,15)比5(3,10)、3(2,6),SOFA评分(分):6(3,8)比2(0,4)、1(0,2),TG(mmol/L):31.23(24.74,48.26)比27.88(17.52,40.64)、16.15(7.94,20.95),VAI:20.62(8.35,30.43)比12.57(2.84,19.27)、5.52(1.22,10.34),均P<0.05〕,HDL明显低于MSAP组和MAP组〔mmol/L:0.95(0.42,1.82)比1.07(0.44,2.37)、1.24(0.62,1.95),均P<0.05〕。Logistic回归分析显示,PCT〔优势比(OR)=1.374,95%可信区间(95%CI)为1.032~1.830,P=0.004〕、APACHEⅡ评分(OR=2.094,95%CI为1.492~2.939,P<0.001)、SOFA评分(OR=2.762,95%CI为1.464~5.212,P<0.001)和VAI(OR=1.229,95%CI为1.118~1.350,P<0.001)均是HLAP患者发生SAP的独Objective To investigate the predictive value of visceral adiposity index(VAI)on the severity of hyperlipidemia-induced acute pancreatitis(HLAP).Methods The patients diagnosed with HLAP from July 2020 to August 2022 admitted to the department of intensive care unit of the First Affiliated Hospital of Soochow University were enrolled as the research subjects.The patients were divided into the mild acute pancreatitis(MAP)group,moderatesevere acute pancreatitis(MSAP)group,and severe acute pancreatitis(SAP)group.Clinical data such as gender,age,past medical history,blood pressure,heart rate,body mass,and waist circumference of AP patients were collected,and the laboratory indicators such as white blood cell count(WBC),platelet count(PLT),procalcitonin(PCT),hemoamylase,triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL)and other laboratory indicators were collected 24 hours after admission,as well as acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)within 24 hours of admission,body mass index(BMI)and VAI were calculated.A comparison of various indicators was performed among the three groups.The risk factors of SAP patients with HLAP were analyzed by Logistic regression,the receiver operator characteristic curve(ROC curve)was plotted to evaluate the predictive efficiency of SAP in patients with HLAP.Results A total of 112 HLAP patients were enrolled,including 52 MAP patients,39 MSAP patients,and 21 SAP patients.There were significant differences in WBC,PCT,APACHEⅡscore,SOFA score,TG,HDL,and VAI among the three groups(all P<0.05).The level of WBC,PCT,APACHEⅡscore,SOFA score,TG,VAI in SAP group were higher than those in MSAP group and MAP group[WBC(×109/L):14.34(12.16,18.65)vs.12.21(10.83,18.47),10.54(8.90,12.46),PCT(μg/L):1.72(1.09,6.33)vs.0.81(0.34,1.16),0.67(0.31,0.85),APACHEⅡscore:7(5,15)vs.5(3,10),3(2,6),SOFA score:6(3,8)vs.2(0,4),1(0,2),TG(mmol/L):31.23(24.74,48.26)vs.27.88(17.52,40.64),16.15(7.94,20.95),VAI:20.62(8.35,30.43)vs.

关 键 词：急性胰腺炎 高脂血症 严重程度 预测 

分 类 号：R259[医药卫生—中西医结合]