未成熟粒细胞预测急性胰腺炎持续性全身炎症反应综合征的临床价值:附1973例分析

Predictive value of immature granulocytes for persistent systemic inflammatory response syndrome in patients with acute pancreatitis:analysis of 1973 cases

目的分析外周血未成熟粒细胞对急性胰腺炎(AP)患者发生持续性全身炎症反应综合征(SIRS)的预测价值。方法回顾性分析湖南省人民医院2012至2017年1973例AP患者的临床资料,根据入院1周内SIRS持续时间,将患者分为持续性SIRS组、暂时性SIRS组及非SIRS组,收集所有患者的实验室数据及临床资料,采用多元Logistic回归分析AP发生持续性SIRS的独立危险因素;用受试者工作特征曲线(ROC)分析未成熟粒细胞对AP发生持续性SIRS的预测能力。结果1973例AP患者中男性1165例(占59.0%),年龄49(40,60)岁;其中持续性SIRS288例、暂时性SIRS189例、非SIRS1496例。3组患者间性别、年龄及病因比较差异无统计学意义。暂时性SIRS组和持续性SIRS组患者病情程度重于非SIRS组,且持续性SIRS组急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、CT严重指数(CTSI)、多器官功能衰竭(MOF)和急性呼吸窘迫综合征(ARDS)发生率、病死率以及C-反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)、未成熟粒细胞进一步高于暂时性SIRS组[APACHEⅡ(分):9(6,12)比5(3,7),CTSI(分):6(4,6)比4(3,6),MOF发生率:92.0%比32.8%,ARDS发生率:39.9%比10.1%,病死率:11.1%比4.2%,CRP(mg/L):25.00(0.80,212.25)比0.80(0.80,123.50),WBC(×109/L):15.17±6.78比14.84±5.86,PCT(μg/L):0.23(0.10,1.76)比0.10(0.10,0.31),未成熟粒细胞:1.95(0.90,4.95)%比0.80(0.40,2.10)%,均P<0.05]。多元Logistic回归分析显示,除胰腺坏死、WBC、CRP外,未成熟粒细胞同样为AP持续性SIRS的独立危险因素[优势比(OR)=1.844,95%可信区间(95%CI)=1.372~2.220]。ROC曲线分析显示,未成熟粒细胞对AP持续性SIRS的发生具有较好的预测价值,ROC曲线下面积(AUC)为0.806,显著高于APACHEⅡ(AUC=0.783)、CTSI(AUC=0.752)、PCT(AUC=0.676)、CRP(AUC=0.677)、WBC(AUC=0.644)。以未成熟粒细胞≥0.65%为最佳临界值,其敏感度为84.0%,特异度为66.3%,阳性预测值62.4%,阴性预测值76.3%。结论外周血未成熟粒细胞是预测AP患者持续性SIRS发生的潜在指标。

Objective To analyze the clinical value of immature granulocytes in peripheral blood for prediction of persistent systemic inflammatory response syndrome(SIRS)in patients with acute pancreatitis(AP).Methods 1973 patients with AP in Hunan People's Hospital from 2012 to 2017 were retrospectively enrolled and divided by SIRS duration into the persistent SIRS group,temporary SIRS group and non-SIRS group.The independent risk factor for persistent SIRS in AP patients was evaluated by Logistic regression analysis,and predictive value of immature granulocytes for persistent SIRS in AP patients was analyzed by the receiver operating characteristic(ROC)curve.Results These 1973 AP patients(1165 males,59.0%)with an average age of 49(40,60)years old,including 288 persistent SIRS,189 temporary SIRS and 1496 non-SIRS cases.There was no significant difference in gender,age and etiology among three groups.Compared with non-SIRS group,more severe symptoms were observed in the temporary and persistent SIRS groups.Moreover,The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),CT severity index(CTSI),multiple organ failure(MOF)and acute respiratory distress syndrome(ARDS)incidence,mortality and C-reactive protein(CRP),white blood cell count(WBC),procalcitonin(PCT)and immature granulocytes in persistent SIRS group were further higher than those in the temporary SIRS group [APACHEⅡ:9(6,12)vs.5(3,7),CTSI:6(4,6)vs.4(3,6),MOF incidence:92.0% vs.32.8%,ARDS incidence:39.9% vs.10.1%,morbidity:11.1% vs.4.2%,CRP(mg/L):25.00(0.80,212.25)vs.0.80(0.80,123.50),WBC(×109/L):15.17±6.78 vs.14.84±5.86,PCT(μg/L):0.23(0.10,1.76)vs.0.10(0.10,0.31),immature granulocytes:1.95(0.90,4.95)% vs.0.80(0.40,2.10)%,all P<0.05].Logistic regression analysis showed that besides pancreatic necrosis,WBC and CRP,immature granulocyte was an independent risk factor for persistent SIRS associated with AP [odds ratio(OR)= 1.844,95% confidence interval(95%CI)= 1.372-2.220].ROC curve showed that immature granulocytes had better predictive value for persistent SIRS,the area under the curve(AUC)was 0.806,which was significantly higher than the APACHEⅡ(AUC=0.783),CTSI(AUC=0.752),PCT(AUC=0.676),CRP(AUC=0.677),WBC(AUC=0.644).The cut-off value of immature granulocyte was 0.65%,the sensitivity was 84.0%,the specificity was 66.3%,the positive predictive value was 62.4%,and the negative predictive value was 76.3%.Conclusion Immature granulocyte in peripheral blood is a potential indicator for persistent SIRS in AP patients.