体脂参数对急性胰腺炎严重程度的预测价值

Value of body fat parameters in predicting the severity of acute pancreatitis

目的探讨体脂参数与急性胰腺炎(AP)严重程度的相关性及预测价值。方法选取2016年6月-2019年6月西南医科大学附属医院消化内科收治的229例AP患者。根据AP诊断标准将患者分为轻症胰腺炎(MAP)(n=125)、中度重症胰腺炎(MSAP)(n=64)和重症胰腺炎(SAP)(n=40)3组,并通过CT影像计算患者的体脂参数[内脏脂肪组织(VAT)、皮下脂肪组织(STA)、总脂面积(TAT)、腹部肌肉面积(AMA)、内脏脂肪面积与总脂面积的比率(VTR)、内脏脂肪与腹肌的比率(VMR)]。计量资料多组间比较采用单因素方差分析,组内两两比较采用LSD-t检验。采用logistic回归分析比较AP严重程度与各体脂参数的关系。对各体脂参数构建受试者工作特征曲线(ROC曲线),并计算曲线下面积(AUC),通过计算约登指数找出最佳阈值点。结果3组AP患者的年龄、VAT、TAT、AMA、VTR和VMR等指标比较,差异均有统计学意义(F值分别为4.15、35.25、73.02、7.09、462.30和139.4,P值均<0.05)。进一步比较发现,与MAP组比较,MSAP组和SAP组的VAT、TAT、VTR和VMR明显升高(P值均<0.05),AMA则明显降低(P值均<0.05)。且SAP组的VAT、VTR和VMR高于MSAP组,差异均有统计学意义(P值均<0.05)。VMR预测MSAP和SAP的AUC最高[0.84(95%CI:0.76~0.92)],其预测AP严重程度的最佳阈值为1.38,对应的敏感度为67.5%,特异度为90.6%。结论体脂参数与AP严重程度有关,VMR在预测AP严重程度方面有独特的价值,可以纳入未来的AP严重程度预测评分模型。

Objective To investigate the correlation between body fat parameters and the severity of acute pancreatitis(AP)and the value of body fat parameters in predicting the severity of AP.Methods A retrospective analysis was performed for the clinical data of 229 patients with AP who were treated in Department of Gastroenterology in The Affiliated Hospital of Southwest Medical University from June 2016 to June 2019.According to the diagnostic criteria for AP,the patients were divided into mild acute pancreatitis(MAP)group,moderate-severe acute pancreatitis(MSAP)group(all P<0.05),and severe acute pancreatitis(SAP)group,and CT images were used to calculate related body fat parameters[visceral adipose tissue(VAT),subcutaneous adipose tissue(SAT),total adipose tissue(TAT),abdominal muscle area(AMA),VAT/TAT ratio(VTR),and visceral fat-to-muscle ratio(VMR)].A one-way analysis of variance was used for comparison between multiple groups,and the least significant difference t-test was used for further comparison between two groups.A logistic regression analysis was used to investigate the correlation of the body fat parameters with AP severity.The receiver operating characteristic(ROC)curve was established for each body fat parameter and the area under the ROC curve(AUC)was calculated,and then the Youden index was calculated to determine the optimal cut-off value.Results There were significant differences in age,VAT,TAT,AMA,VTR,and VMR between the three groups(F=4.15,35.25,73.02,7.09,462.30,and 139.4,all P<0.05),and further comparison showed that compared with the MAP group,the MSAP group and the SAP group had significant increases in VAT,TAT,VTR,and VMR(all P<0.05)and a significant reduction in AMA(all P<0.05).The SAP group had significantly higher VAT,VTR,and VMR than the MSAP group(all P<0.05).VMR had the largest AUC of 0.84(95%confidence interval:0.76-0.92)in predicting MSAP and SAP,and had the cut-off value of 1.38 in predicting the severity of AP,with a sensitivity of 67.5%and a specificity of 90.6%.Conclusion Body fat parameters are correlated the severity of AP.VMR has a unique value in predicting the severity of AP and can be included in the future scoring models for predicting AP severity.