胸腔积液和乳酸脱氢酶对急性胰腺炎严重度评估的价值

Values of Pleural Effusion and Lactate Dehydrogenase in the Severity of Acute Pancreatitis

目的 探讨胸腔积液和乳酸脱氢酶在急性胰腺炎严重度评估中的价值.方法 对2009年7月1日～2010年6月30日123例急性胰腺炎病例资料作回顾性分析.按照中国急性胰腺炎诊治指南（草案）分为轻症急性胰腺炎组（76例）和重症急性胰腺炎组（47例）,采用Logistic多因素回归及ROC曲线分析入院后24h内乳酸脱氢酶和C-反应蛋白、72h内胸腔积液与急性胰腺炎严重度的相关性.结果 胆道疾病是急性胰腺炎最常见的原因（55.28%）,胸腔积液、乳酸脱氢酶和C-反应蛋白在急性胰腺炎轻症组和重症组间差异均有显著性（P〈0.01）,三者ROC曲线下面积分别为0.748、0.875、0.873;经Z检验,胸腔积液与乳酸脱氢酶、C-反应蛋白两指标ROC曲线下面积的分别比较均有统计学意义（P=0.012,P=0.013）,乳酸脱氢酶、C-反应蛋白两指标ROC曲线下面积的比较无统计学意义（P=0.976）;胸腔积液和乳酸脱氢酶联合应用其平行试验的敏感度、特异度分别为0.973、0.548,其序列试验的灵敏度、特异度分别为0.623、0.939.结论 胸腔积液、乳酸脱氢酶对急性胰腺炎严重度评估具有一定的临床价值.

Objective To explore the estimated values of pleural effusion and lactate dehydrogenase in the severity of acute pancreatitis. Methods A total of 123 consecutive patients from July 1,2009, to June 30,2010 in the gastroenterology department were studied retrospectively.Etiology and gender were recorded.According to the Guide to Diagnosis and Treatment of acute pancreatitis in China,there were seventy six cases with mild acute pancreatitis and forty seven cases with severe acute pancreatitis.Logistic regression and receiver operating characteristic curve were used to assess the association of lactate dehydrogenase and C-reactive protein in 24 hour after admission as well as pleural effusion in 72 hour after admission with the severity in acute pancreatitis. Results Biliary disease was the most frequent etiology（55.28%）.Incidence of pleural effusion, levels of lactate dehydrogenase and C -reactive protein in patients with severe acute pancreatitis was significantly higher than mild acute pancreatitis（P〈0.0 l）.Area under the receiver operating characteristic curve was 0.748,0.875 ＆ 0.873. By means of Z test,area under the receiver operating characteristic curve of pleural effusion with comparison to lactate dehydrogenase and C-reactive protein＇s was statistically significant（P=0.012,P=0.013）.Area under the receiver operating characteristic curve of lactate dehydrogenase with comparison to C-reactive protein＇s was not statistically significant（P=0.976）.Sensitivity and specificity were 0.973,0.548 in parallel trial of combination of lactate dehydrogenase and pleural effusion.Sensitivity and specificity were 0.623,0.939 in serial test. Conclusion Lactate dehydrogenase and pleural effusion were useful markers to predict the severity in acute pancreatitis.