血浆和肽素水平与重症急性胰腺炎患者预后的关系

Relationship between plasma copeptin level and prognosis in patients with severe acute pancreatitis

目的：探讨血浆和肽素水平与重症急性胰腺炎（severe acute pancreatitis，SAP）患者临床预后的关系。方法收集2012年1月～2014年10月于我科就诊的 SAP 患者48例的临床资料，并选取同期于我院行健康体检的患者48例作为对照组。比较两组患者血浆和肽素的水平。实验组患者入院后24 h 内行 APACHEⅡ、Ranson 及改良 Marshall 评分以评价 SAP 疾病严重程度及MODS 发生情况。记录实验组患者胰腺及胰周组织积液、坏死，胰腺及胰周脓肿、胰腺假性囊肿及MODS 等局部或全身性并发症发生情况，患者住院期间病死情况，分析血浆和肽素水平与 SAP 患者并发症发生情况及病死率间的关系。结果实验组血浆和肽素水平为（0．83～5．49）ng／ml，平均（3．48±1．32）ng／ml；对照组血浆和肽素水平为（0．09～1．46）ng／ml，平均（0．23±0．06）ng／ml。组间比较差异有统计学意义（P ＜0．05）。和肽素水平高的患者局部并发症、MODS 发生率较高，病死率较高，组间比较差异有统计学意义（P ＜0．05）。血浆和肽素水平预测 SAP 患者病死风险的约登指数为＞4．02 ng／ml，其敏感性和特异性分别为72．7％和81．0％（AUC ＝0．831，95％CI ＝1．051～1．679，P ＜0．001）。结论SAP 患者血浆和肽素表达水平升高，高和肽素水平预示患者并发症、病死风险较高。

Objective To analyze the relationship between plasma copeptin level and prognosis in patients with severe acute pancreatitis（SAP）.Methods The clinical data of 48 SAP patients from January 2010 to October 2014 were collected and another 48 patients who accepted healthexamination dur-ing the same period were selected as controls.Difference in plasma copeptin level was compared between groups.The results of APACHEⅡ,Ranson and modified Marshall scores were also collected to evaluate the severity of disease and the existence of MODS.The prevalence of pancreas and peripancreatic tissues effusion,necrosis,pancreas and peripancreatic abscess,pancreatic pseudocyst and mortality of the experi-mental group were recorded to analyze the relationship among plasma copeptin,complications and mortali-ty.Results The plasma level of copeptin of the experimental group was 0.83 ~5.49ng/ml,with a mean of（3.48 ±1.32）ng/ml;while in the control group,it was 0.09 ~1.46ng/ml,with a mean of（0.23 ± 0.06）ng/ml.There was significant difference between the groups（P 〈0.05）.Patient with a high plasma copeptin level may have a higher risk for local complication,MODS and mortality,and there was significant difference between the groups（P 〈0.05）.A ROC curve identified that a plasma copeptin level 〉4.02 ng/mL predicted in-hospital mortality of patients,with a sensitivity of 72.7%and a specificity of 81.0%（AUC =0.831,95%CI =1.051 ~1.679,P 〈0.001）.Conclusion SAP patients have elevated levels of plasma copeptin,and higher copeptin levels predict high risks of complications and mortality.