炎症指标对妊娠合并高脂血症性急性胰腺炎严重程度的预判价值

Predictive value of inflammatory markers for severity of hyperlipidemic acute pancreatitis in pregnancy

目的探究炎症指标:外周血白细胞计数与淋巴细胞计数比值(neutrophil-lymphocyte ration,NLR)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-Reactive Protein,CRP)对妊娠合并高脂血症性急性胰腺炎(Hyperlipidemic acute pancreatitis in pregnancy,HLAPIP)的病情严重程度有无预判价值。方法收集2012年6月至2019年12月郑州大学第一附属医院产科收治的妊娠合并高脂血症性急性胰腺炎患者共24例,根据疾病严重程度分为观察组(重症HLAPIP,14例)和对照组(轻症及中度重症HLAPIP,10例)。应用SPSS 21.0统计学软件分析两组患者发病24小时内的NLR、CRP、PCT有无差异,通过受试者工作特征曲线(ROC曲线)及约登指数取相关指标的最佳临界值及其灵敏度、特异性。以取得的临界值对患者重新分组,对比组间住院时间、ICU住院时间、禁食时间及Ranson评分有无差异性。结果观察组与对照组相比,入院24 h内NLR、PCT值分别为(18.759±9.240)vs(7.880±4.591)、(1.127±1.269)vs(0.255±0.364),P均<0.05,差异有统计学意义;而两组CRP对比,P>0.05,差异无统计学意义。通过ROC曲线及约登指数,取得诊断准确度最高的NLR、PCT临界值分别为13.775、0.34 ng/mL,灵敏度分别为71.4%、64.3%,特异性分别为100%、90%。以NLR、PCT临界值分别对患者重新分组后,高于临界值的一组其住院时间、ICU住院时间及Ranson评分均高于另一组,而禁食时间无明显差异。结论HLAPIP发病早期外周血NLR及血清PCT在疾病严重程度的预判中有重要意义。

Objective To explore whether the inflammatory indicators such as neutrophil-lymphocyte ration(NLR),procalcitonin(PCT),C-Reactive Protein(CRP)can predict the severity of hyperlipidemic acute pancreatitis in pregnancy(HLAPIP).Methods A total of 24 patients with hyperlipidemic acute pancreatitis in pregnancy who were admitted to the obstetrics department of the First Affiliated Hospital of Zhengzhou University were collected from June 2012 to December 2019.According to the severity of the disease,patients were divided into observation group(severe pancreatitis)and control group(mild and moderate severe pancreatitis).SPSS 21.0 statistical software was used to compare and analyze the differences of NLR,CRP and PCT in patients of the two groups within 24 hours after onset.The critical value,sensitivity and specificity of the relevant indicators were determined by ROC curve and Yoden index.Patients were regrouped by the obtained threshold value,comparing the difference of the hospital stay,ICU stay,fasting time and Ranson score between groups.Results When the two groups were compared,the NLR and PCT values within 24 hours after admission were respectively(18.759±9.240)vs(7.880±4.591),(1.127±1.269)vs(0.255±0.364),the difference was statistically significant(P<0.05).However,the CRP of the two groups was compared with P>0.05,showing no statistically significant difference.The critical values of NLR and PCT with the highest diagnostic accuracy obtained by ROC curve and Yoden index were respectively 13.775,0.34 ng/mL,The sensitivity was 71.4 and 64.3%,and the specificity was 100%and 90%respectively.After regrouping with the critical value,the length of stay,length of stay in ICU and Ranson score of the group above the critical value were all higher than those of the other group,while there was no significant difference in fasting time.Conclusion Early onset of HLAPIP NLR and serum PCT have important significance in the prediction of disease severity.