红细胞比容和血肌酐测定对胰腺坏死早期预测的价值

Early prediction of pancreatic necrosis assessed by hematocrit and serum creatinine

目的探讨检测红细胞比容（HCT）和血肌酐（Scr）对急性胰腺炎（AP）患者发生胰腺坏死（PN）早期预测的价值。方法采用回顾性分析的方法，比较胰腺坏死组和非胰腺坏死组患者人院时HCT值和48小时内Scr峰值的差异，以及高、低HCT组，高、低Scr组的胰腺坏死发生率、CTSI评分、APACHEⅡ评分之间的差异。并对HCT和Scr这两项指标判断胰腺坏死的灵敏度、特异度、阳性预测值和阴性预测值进行计算。结果低HCT组胰腺坏死发生率低于高HCT组（P〈0．01），高Scr组胰腺坏死发生率高于低Scr组（P〈0．01），HCT值判断胰腺坏死的的敏感度、特异度分别为68．8％和82．8％，阳性预测值、刚忡颅洲位分别为52．4％和90．6％，Scr值判断胰腺坏死的敏感性、特异性分别为37．5％和99．1％，阳性预测值、阴性预测值分别为92．3％和85．2％。结论HCT和Scr有助于胰腺坏死的早期预测。

Objective To discuss the value of hematocrit（HCT） and serum creatinine （Scr） in early prediction pancreatic necrosis. Methods Groups of patients of acute pancreatitis with pancreatic necrosis （PN） or non-pancreatic necrosis were retrospectively analysed. Admission Hct, peak Scr within 48 h, CTSI score at 24 h and APACHE II score at 24 h from both group of patients were included for analysis. The incidence of pancreatic necrosis in high HCT group and low HCT group, high Scr group and low Scr group was calculated. Finally, we calculate sensitivity, specicity, positive predictive value, and negative predictive value of admission Hct and peak Scr within 48h as predictive tests for the development of PN. Resuits HCT in the non-pancreatic necrosis group was significantly lower than pancreatic necrosis group（P 〈0.01 ）. Scr in the pancreatic necrosis group was significantly higher than non-pancreatic necrosis group （P 〈 0.01 ）. Low admission Hct （ ≤44.8% ） yielded a negative predictive value of 90.6% ,while elevated peak Scr （ 〉 159 μmol/L） within 48 h yielded a positive predictive value of 92.3%. Conclusion HCT and Scr can predict PN in early phase and guide treatment.