Ranson评分联合PCT对急性胰腺炎合并急性肾损伤的预测作用  

Predictive effect of Ranson score combined with PCT in acute pancreatitis complicated by acute kidney injury

作　　者：李丽 叶英 丁伟超 薛婷 周冉冉 LI Li;YE Ying;DING Weichao;XUE Ting;ZHOU Ranran(Department of Emergency Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,江苏徐州221000

出　　处：《胃肠病学和肝病学杂志》2024年第4期426-431,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：江苏省徐州市科技计划项目(KC21215)。

摘　　要：目的探索Ranson评分联合降钙素原(procalcitonin,PCT)在重症急性胰腺炎(severe acute pancreatitis,SAP)并发急性肾损伤(acute kidney injury,AKI)中的预测价值,以期为临床诊疗提供借鉴。方法本研究为回顾性分析,研究对象为2020年1月至2022年12月徐州医科大学附属医院住院治疗的238例SAP患者。以入院7 d时是否发生AKI,将238例SAP患者分为AKI组72例(30.38%)、非AKI组166例(69.62%)。通过电子病历系统收集所有患者的临床资料,采用多因素Logistic回归分析SAP患者继发AKI的危险因素;采用ROC曲线法评估各评分及PCT预测SAP患者继发AKI的性能,结果以AUC表示。结果与非AKI组比较,AKI组中心静脉压、红细胞分布宽度、IL-6、PCT、手术治疗的比例、SOFA、BISAP、Ranson评分均升高(P<0.05)。多因素Logistic回归分析显示,中心静脉压>11 mmHg、PCT>6.30 ng/ml、BISAP评分>4.50分、Ranson评分>4.65分是SAP患者发生AKI的独立危险因素。ROC曲线显示,Ranson评分联合PCT预测SAP患者发生AKI的效能最高,AUC为0.850(95%CI:0.797~0.903)。结论Ranson评分、PCT与SAP相关AKI的发生具有相关性,联合应用可预测SAP患者继发AKI的风险,有助于高危人群的筛查和识别。Objective To investigate the predictive value of Ranson score combined with procalcitonin(PCT)in severe acute pancreatitis(SAP)complicated by acute kidney injury(AKI),in order to offer clinical treatment references.Methods This retrospective analysis included 238 SAP patients hospitalized in the Affiliated Hospital of Xuzhou Medical University from Jan.2020 to Dec.2022.Based on whether AKI occurred at 7 d of admission,238 SAP patients were divided into AKI group(n=72,30.38%)and non-AKI group(n=166,69.62%).The clinical data of all patients were collected through the electronic medical record system.and the risk factors for secondary AKI in SAP patients were analyzed using multifactor Logistic regression.The performance of each score and PCT in predicting secondary AKI in SAP patients was assessed using the ROC curve method,and the results were expressed as AUC.Results In AKI group,central venous pressure,red blood cell distribution width,IL-6,PCT,proportion of surgical treatment,SOFA,BISAP and Ranson scores were significantly higher than those in the non-AKI group(P<0.05).Multifactor Logistic regression analysis identified central venous pressure>11 mmHg,PCT>6.30 ng/ml,and BISAP>4.50 points were risk factors for secondary AKI in SAP patients.ROC curves demonstrated that the Ranson score combined with PCT had the highest efficacy in predicting AKI in SAP patients,with an AUC of 0.835(95%CI:0.797-0.903).Conclusion The Ranson score and PCT are correlated with AKI occurrence in SAP,and their combined application predicts the risk of secondary AKI in SAP patients aiding in the screening and identification of high-risk groups.

关 键 词：急性胰腺炎 急性肾损伤 降钙素原 RANSON评分 

分 类 号：R576[医药卫生—消化系统]