早期中性粒细胞与淋巴细胞比值联合降钙素原在诊断重症急性胰腺炎中的价值及临床预测模型的构建  

Value of early neutrophil-to-lymphocyte ratio combined with procalcitonin in the diagnosis of severe acute pancreatitis and the procalcitonin of a clinical prediction model

作　　者：张周祥 王旋 宁长青[1] ZHANG Zhouxiang;WANG Xuan;NING Changqing(Department of Gastrointestinal Surgery,Fuyang People's Hospital of Anhui Medical University,Fuyang 236000,China;Department of General Surgery,Suixi County People's Hospital,Huaibei 235100,China)

机构地区：[1]安徽医科大学附属阜阳人民医院胃肠外科,安徽阜阳236000 [2]濉溪县人民医院普外科,安徽淮北235100

出　　处：《邵阳学院学报（自然科学版）》2024年第3期108-116,共9页Journal of Shaoyang University：Natural Science Edition

基　　金：安徽省科技攻关计划项目(1607a0202076)。

摘　　要：目的探讨入院时患者血清中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)及降钙素原(procalcitonin,PCT)水平对于预测重症急性胰腺炎(severe acute pancreatitis,SAP)的价值,并构建临床预测模型。方法选取安徽医科大学附属阜阳人民医院2021年9月至2022年9月收治的急性胰腺炎(acute pancreatitis,AP)患者112例,根据疾病严重程度分为SAP组(n=58)和非SAP组(n=54)。收集两组患者的一般临床资料和入院24 h内外周血实验室指标,分析SAP组与非SAP组相关危险因素并绘制森林图,使用多因素logistic回归分析筛选出独立危险因素,绘制出受试者工作特征曲线(receiver operating characteristic,ROC)并构建临床预测模型,比较不同指标的曲线下面积、敏感度和特异度。结果两组患者在入院时收缩压、住院天数、合并基础疾病(高血压)差异均存在统计学意义(均P<0.05);白细胞计数(white blood cell,WBC)、中性粒细胞计数绝对值(neutrophil,NE)、淋巴细胞计数绝对值(lymphocyte,L)、NLR、血小板-淋巴细胞比值(platelet to lymphocyte ratio,PLR)、总胆固醇(total cholesterol,TC)、甘油三酯(triglycerides,TG)、高密度脂蛋白(high-density lipoprotein,HDL)、Ca^(2+)、载脂蛋白A1(apolipoprotein A1,APO A1)、载脂蛋白A2(apolipoprotein A2,APO A2)、血肌酐(serum creatinine,SCR)、白蛋白(albumin,ALB)、血糖(glucose,Glu)、C-反应蛋白(C-reaction protein,CRP)、PCT、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer)为AP患者病情严重有关(均P<0.05);多因素logistic回归分析显示,NLR、APO A1、APO A2、Glu和PCT是影响AP严重程度的独立危险因素(P<0.05);ROC曲线分析显示,NLR、PCT、NLR+PCT及临床模型预测AP严重程度的AUC(95%CI)分别为0.786(0.702~0.869)、0.744(0.651~0.838)、0.883(0.822~0.944)和0.964(0.096~1.000)。结论NLR和PCT是影响AP病情严重程度的独立危险因素,对其具有一定预测价值,且二者联合使用预测价值更高。Objective To investigate the values of serum neutrophil to lymphocyte ratio(NLR)and procalcitonin(PCT)levels in patients at admission for predicting severe acute pancreatitis(SAP)and to construct a clinical prediction model.Methods One hundred and twelve patients with AP admitted to our hospital from September 2021 to September 2022 were selected and divided into a SAP group(n=58)and a non-SAP group(n=54)according to the disease severity.The general clinical characteristics datas and peripheral blood laboratory indexes within 24 h of admission were collected from both groups.The risk factors associated with the SAP and non-SAP groups were analyzed and forest plots were drawn.Independent risk factors were screened using multifactorial logistic regression analysis.Receiver operating characteristic curves(ROC)were drawn and clinical prediction models were constructed,and the area under the curve,sensitivit,and specificity of different indexes were compared.Results The differences between the 2 groups were significant(P<0.05)in systolic blood pressure at admission,days of hospitalization,and combined underlying disease(hypertension).White blood cell(WBC),neutrophil(NE),lymphocyte(L),NLR,platelet to lymphocyte ratio(PLR),total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL),Ca^(2+),apolipoprotein A1(APO A1),apolipoprotein A2(APO A2),serum creatinine(SCR),albumin(ALB),glucose(Glu),C-reaction protein(CRP),PCT,prothrombin time(PT),and D-dimer were related to AP severity(all P<0.05).Multifactorial logistic regression analysis showed that NLR,APO A1,APO A2,Glu,and PCT were independent risk factors for AP severity(P<0.05).ROC curve analysis showed that NLR,PCT,NLR+PCT,and clinical model predicted AP severity of AUC(95%CI)were 0.786(0.702~0.869),0.744(0.651~0.838),0.883(0.822~0.944),and 0.964(0.096~1.000),respectively.Conclusion NLR and PCT are independent risk factors influencing the disease severity of AP and have some predictive value,and the combination of the two has a higher predictive value.

关 键 词：急性胰腺炎 早期中性粒细胞与淋巴细胞比值 降钙素原 预测价值 

分 类 号：R576[医药卫生—消化系统]