复发性胰腺炎发生急性肾损伤的危险因素分析及诊断效能预测  

Analysis of risk factors and construction of predictive model for acute kidney injury in patients with recurrent pancreatitis

作　　者：周文考 赵方俐 黄灵炎 洪灵鸿 姚亚奔 Zhou Wenkao;Zhao Fangli;Huang Lingyan;Hong Linghong;Yao Yaben(Department of Emergency Medicine,Xiang An Hospital of Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属翔安医院急诊医学科,厦门361000

出　　处：《中国临床实用医学》2024年第3期38-43,共6页China Clinical Practical Medicine

摘　　要：目的:探讨复发性胰腺炎(ARP)发生急性肾损伤(AKI)的危险因素分析及诊断效能预测。方法:本研究为回顾性病例对照研究,选取2019年4月至2023年12月厦门大学附属翔安医院急诊医学科收治的100例ARP患者,男51例,女49例,年龄(49.65±5.42)岁,年龄范围为36~69岁。根据患者是否合并AKI分为AKI组( n=30)与非AKI组( n=70)。采用单因素及多因素逻辑回归分析影响ARP发生AKI的独立危险因素,采用受试者操作特征(ROC)曲线分析各危险因素与联合指标的诊断效能。 结果:非AKI组患者C反应蛋白[(37.91±5.37)mmol/L]、降钙素原[(2.80±0.83)μg/L]、血尿素氮[(7.24±0.84)μmol/L]及急性生理学和慢性健康状况评价[10.1(8.9,11.6)分]低于AKI组[(46.32±3.01)mmol/L、(4.62±0.93)μg/L、(9.08±1.28)μmol/L、18.9(17.8,20.4)分],急性胰腺炎(AP)发作间隔[11.0(8.8,13.6)个月]高于AKI组[8.9(6.1,11.3)个月],AP分级情况、全身炎症反应综合征情况、腹腔间隔室综合征情况、血容量不足情况及辅助通气情况均优于AKI组,差异有统计学意义( P<0.05)。高C反应蛋白、高降钙素原是影响AKI发生的独立危险因素( OR=1.904,95% CI:1.406~2.577;OR=11.448,95% CI:4.265~30.731, P<0.05)。C反应蛋白、降钙素原、血尿素氮及其联合检测均可对ARP合并AKI有较高的诊断效能,且联合检测优于C反应蛋白、降钙素原及血尿素氮单独检测( P<0.05)。 结论:高C反应蛋白、高降钙素原是影响AKI发生的独立危险因素,C反应蛋白、降钙素原、血尿素氮及其联合检测均可对ARP合并AKI有较高的诊断效能,且联合检测优于C反应蛋白、降钙素原及血尿素氮单独检测。ObjectiveTo explore the risk factor analysis and diagnostic efficacy prediction of acute kidney injury(AKI)combined with recurrent pancreatitis(ARP).MethodsThis study was a retrospective case-control study,a total of 100 ARP patients admitted to the Emergency Medicine department of Xiamen University Xiang'an Hospital from April 2019 to December 2023,including 51 males and 49 females,aged(49.65±5.42)years old,ranging from 36 and 69 years old.The patients were divided into AKI group(n=30)and non-AKI group(n=70)according to whether they were combined with AKI or not.Independent risk factors affecting the occurrence of AKI in ARP were analyzed using univariate and multivariate logistic regression,diagnostic efficacy of each risk factor and combined index was analysed using the receiver operator characteristic(ROC)curve.ResultsPatients in the non-AKI group had lower C-reactive protein[(37.91±5.37)mmol/L],calcitoninogen[(2.80±0.83)μg/L],blood urea nitrogen[(7.24±0.84)μmol/L],and acute physiology and chronic health evaluationⅡscore[10.1(8.9,11.6)points]than those in the AKI group[(46.32±3.01)mmol/L,(4.62±0.93)μg/L,(9.08±1.28)μmol/L,and 18.9(17.8,20.4)points],and the interval between AP episodes[11.0(8.8,13.6)months]was higher than that in the AKI group[8.9(6.1,11.3)months],acute pancreatitis grading status,systemic inflammatory response syndrome situation,abdominal septal compartment syndrome situation,and hypovolemia situation,assisted ventilation situation were better than that of the AKI group,and the difference was statistically significant(P<0.05).High C-reactive protein and high calcitoninogen were independent risk factors affecting the occurrence of AKI(OR=1.904,95%CI:1.406 to 2.577;OR=11.448,95%CI:4.265 to 30.731,P<0.05).C-reactive protein,calcitoninogen,blood urea nitrogen and their combined tests all had high diagnostic C-reactive protein,calcitonin,blood urea nitrogen and their combined test all had higher diagnostic efficacy for ARP combined AKI,and the combined test was better than C-reactive p

关 键 词：急性胰腺炎 复发性胰腺炎 急性肾损伤 预测模型 

分 类 号：R576[医药卫生—消化系统] R692[医药卫生—内科学]