急性生理学与慢性健康状况评分系统Ⅱ评分联合血清糖化血红蛋白、乳酸脱氢酶水平评估急性胰腺炎患者病情严重程度及预后的价值  

Values of the Acute Physiology and Chronic Health Evaluation Ⅱ score combined with serum glycated hemoglobin and lactate dehydrogenase in evaluating the severity and prognosis of patients with acute pancreatitis

作　　者：张臣臣 刘艳玲 ZHANG Chenchen;LIU Yanling(Department of Critical Care Medicine,Jingmen Second People's Hospital in Hubei Province,Jingmen,Hubei,448000)

机构地区：[1]湖北省荆门市第二人民医院重症医学科,湖北荆门448000

出　　处：《实用临床医药杂志》2024年第17期62-67,共6页Journal of Clinical Medicine in Practice

基　　金：湖北省荆门市科技计划项目(2018YDKY020)。

摘　　要：目的 探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清糖化血红蛋白(HbA1c)、乳酸脱氢酶(LDH)对急性胰腺炎(AP)患者病情及预后的评估价值。方法 将2019年8月—2022年5月本院治疗的120例AP患者根据病情严重程度分为轻症组(n=33)、中度重症组(n=52)和重症组(n=35),根据预后分为生存组(n=86)和死亡组(n=34)。采用Pearson法分析AP患者APACHEⅡ评分与血清HbA1c、LDH水平的相关性;采用Logistic回归分析明确AP患者预后的影响因素;采用受试者工作特征(ROC)曲线分析APACHEⅡ评分、HbA1c、LDH对AP预后的评估价值。结果 轻症组、中度重症组、重症组患者血清甘油三酯、HbA1c、LDH、APACHEⅡ评分、改良CT严重指数(MCTSI)评分逐渐增高,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙逐渐降低,差异均有统计学意义(P<0.05)。AP患者APACHEⅡ评分、MCTSI评分与血清HbA1c、LDH水平均呈正相关(P<0.05)。甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙、MCTSI评分、HbA1c、LDH、APACHEⅡ评分是AP患者预后不良的影响因素(P<0.05)。APACHEⅡ评分联合血清HbA1c、LDH水平预测AP患者预后不良的曲线下面积为0.930,敏感度为91.18%,特异度为83.72%,优于各自单独预测(Z_(联合检测-HbA1c)=3.511、Z_(联合检测-LDH)=4.798、Z_(联合检测-APACHEⅡ评分)=2.134,P<0.001、P<0.001、P=0.033)。结论 血清HbA1c、LDH水平与病情严重程度密切相关,二者联合APACHEⅡ评分对AP患者预后有较好的预测价值。Objective To investigate the values of the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,serum glycated hemoglobin(HbA1c) and lactate dehydrogenase(LDH) in evaluating the severity and prognosis of patients with acute pancreatitis(AP).Methods A total of 120 patients with AP treated in the hospital from August 2019 to May 2022 were divided into mild group(n=33),moderately severe group(n=52),and severe group(n=35) according to the severity of the disease,and were also divided into survival group(n=86) and death group(n=34)based on prognosis.Pearson method was used to analyze the correlations of APACHE Ⅱ score with serum HbA1c and LDH levels in patients with AP;the Logistic regression analysis was used to determine the influencing factors of prognosis in patients with AP;the receiver operating characteristic(ROC) curve was used to evaluate the predictive values of APACHE Ⅱ score,HbAlc and LDH for the prognosis of AP.Results The levels of serum triglycerides,HbAlc,LDH,APACHE Ⅱ score,and the Modified CT Severity Index(MCTSI) score gradually increased while high-densitylipoprotein cholesterol,low-density lipoprotein cholesterol,and serum calcium gradually decreased in the mild,moderately severe,and severe groups(P <0.05).APACHE Ⅱ score and MCTSI score were positively correlated with serum HbA1c and LDH levels in patients with AP(P <0.05).Triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,serum calcium,MCTSI score,HbAlc,LDH,and APACHE Ⅱ score were factors influencing poor prognosis in patients with AP(P <0.05).The area under the curve for predicting poor prognosis in patients with AP by the combination of APACHE Ⅱ score,serum HbAlc and LDH levels was 0.930,with a sensitivity of 91.18% and a specificity of 83.72%,which was superior to each factor alone(Z_(combined-HbA1c)=3.511,Z_(combined-LDH)=4.798,Z_(combined-APACHE Ⅱ score)=2.134,P <0.001,P <0.001,P=0.033).Conclusion Serum HbA1c and LDH levels are closely related to the severity of the disease,and

关 键 词：急性胰腺炎 急性生理学与慢性健康状况评分系统Ⅱ 糖化血红蛋白 乳酸脱氢酶 

分 类 号：R657.5[医药卫生—外科学] R446.11[医药卫生—临床医学] R319