PCT/PLT和CRP/ALB对重症急性胰腺炎及并发肝损伤的预测价值  

Predictive value of PCT/PLT and CRP/ALB in severe acute pancreatitis and associated liver injury

作　　者：崔梦巍 何倩倩[1,2,3] 王海峰 李慧慧 李继业[1,2,3] 崔宗朝 王巧芳 陈三洋 朱长举 Cui Mengwei;He Qianqian;Wang Haifeng;Li Huihui;Li Jiye;Cui Zongchao;WangQiaofang;Chen Sanyang;Zhu Changju(Emergency Department,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Henan Medical Key Laboratory of Emergency and Trauma Research,Zhengzhou 450052,China;Henan Emergency and Trauma Engineering Research Center,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院急诊医学部,郑州450052 [2]河南省急诊与创伤研究医学重点实验室,郑州450052 [3]河南省急诊与创伤工程研究中心,郑州450052

出　　处：《中华急诊医学杂志》2024年第10期1369-1375,共7页Chinese Journal of Emergency Medicine

基　　金：河南省医学科技攻关联合共建项目(LHGJ20220338);河南省高等学校重点科研项目(21A320050,23A320041);河南省自然科学基金面上项目(222300420558)。

摘　　要：目的探讨降钙素原/血小板(procalcitonin to platelet ratio,PPR)和C反应蛋白/白蛋白(C-reactive protein to albumin ratio,CAR)对重症急性胰腺炎(severe acute pancreatitis,SAP)及并发急性肝损伤(acute liver injury,ALI)的预测价值。方法从本院2021年6月至2022年12月374名AP患者中筛出195名纳入研究,将之分为非重症急性胰腺炎(non-severe acute pancreatitis,NSAP)组和SAP组,同时根据ALI诊断标准分为非急性肝损伤(non-acute liver injury,NALI)组和ALI组,并将ALI组分为肝细胞型ALI亚组、胆管细胞型ALI亚组和混合型ALI亚组。于48 h内完成降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、白蛋白(albumin)、血小板(platelet,PLT)等实验室检测。经过二元Logistic回归分析AP患者进展SAP、并发ALI以及其不同亚组ALI的各自危险因素。绘制受试者工作特征(ROC)曲线并计算PPR和CAR的最佳阈值,和PPR、CAR及其联合指标分别对SAP、ALI及各型ALI的预测价值。结果通过绘制ROC曲线,计算急性胰腺炎严重程度床旁指数(BISAP评分)、PPR、CAR、PPR联合CAR、PPR联合BISAP评分、CAR联合BISAP评分,及PPR、CAR和BISAP联合评分预测SAP的ROC曲线下面积(AUC)分别为0.82、0.85、0.79、0.86、0.90、0.88、0.91。PPR、CAR及联合预测ALI的AUC分别为0.81、0.85、0.88;PPR、CAR及联合预测肝细胞型ALI的AUC分别为0.93、0.77、0.92;PPR、CAR及联合预测胆管细胞型ALI的AUC分别为0.76、0.91、0.91;PPR、CAR及联合预测混合型ALI的AUC分别为0.83、0.76、0.82。结论PPR和CAR升高是SAP的危险因素,也是AP发生ALI的危险因素,PPR对肝细胞型和混合型ALI预测价值优于CAR,CAR对胆管细胞型ALI预测价值优于PPR。Objective To investigate the predictive value of procalcitonin to platelet ratio(PPR)and C-reactive protein to albumin ratio(CAR)in severe acute pancreatitis(SAP)and the value of SAP and concomitant acute liver injury(ALI).Methods Total of 195 patients with AP from June 2021 to December 2022 from 374 patients were screened for inclusion in the study and were divided into nonsevere acute pancreatitis(NSAP)and SAP groups.The ALI group was divided into non-acute liver injury(NALI)and ALI groups according to ALI criteria,and then into hepatocellular ALI subgroup,cholangiocellular ALI subgroup and mixed ALI subgroup.Laboratory tests for procalcitonin(PCT),C-reactive protein(CRP),albumin and platelet(PLT)were completed within 48 h.Risk factors for SAP,ALI and each subgroup of ALI were analysed by binary logistic regression.Subject work characteristic(ROC)curves were plotted and the optimal thresholds for PPR and CAR were calculated.The predictive value of PPR,CAR and their combination for SAP,ALI and each type of ALI was determined.Results The AUCs for predicting SAP by plotting ROC curves and calculating the bedside index score of acute pancreatitis severity(BISAP score),PPR,CAR,PPR combined with CAR,PPR combined with BISAP score,CAR combined with BISAP score and combined PPR,CAR and BISAP score were 0.82,0.85,0.79 and 0.86.The areas under the ROC curves for PPR,CAR and combined prediction of ALI were 0.81,0.85 and 0.88,respectively;the areas under the ROC curves for PPR,CAR and combined prediction of hepatocellular ALI were 0.93,0.77 and 0.92,respectively;and the areas under the ROC curves for PPR,CAR and combined prediction of cholangiocellular ALI were 0.76,0.76 and 0.77,respectively.The area under the ROC curves for PPR,CAR and combined prediction of mixed ALI were 0.83,0.76 and 0.82 Conclusions Elevated PPR and CAR are risk factors for SAP and for the development of ALI in AP.PPR has better predictive value than CAR for hepatocellular and mixed ALI,and CAR has better predictive value than PPR for cholangiocellula

关 键 词：降钙素原 C反应蛋白 急性胰腺炎 急性肝损伤 危险因素 

分 类 号：R576[医药卫生—消化系统] R575[医药卫生—内科学]