血生化指标对急性胰腺炎严重程度早期预测价值的研究

Serum Biochemical Markers for Early Prediction of Severity of Acute Pancreatitis

背景:急性胰腺炎(AP)发病率逐年上升,病死率却居高不下,早期识别有重度发展倾向的患者并予早期干预具有重要临床意义。目的:探讨临床常用AP相关血生化指标对其严重程度的早期预测价值。方法:收集2014年1月-2014年12月武汉大学人民医院收治的AP患者205例,其中轻度、中度和重度AP(SAP)分别为92例、72例和41例,同期92名健康体检者作为对照组。采集人口统计学资料、慢性病史、入院48 h内血生化指标、Ranson评分、BISAP评分以及其他临床资料,进行四组间比较。以ROC曲线评价各项指标对SAP的预测效能,以Logistic回归分析评价其与SAP的关联性。结果:Ranson评分、BISAP评分、D-二聚体、血钙、降钙素原(PCT)、CRP、超敏CRP(HS-CRP)、三酰甘油、血糖在四组间的差异有统计学意义(P<0.05)。血钙早期预测SAP的曲线下面积(AUC)为0.838,仅次于Ranson评分和BISAP评分,PCT和D-二聚体的准确性亦较高,但低于血钙,其他指标准确性均较低。Logistic回归分析显示,Ranson评分、PCT和HS-CRP与SAP的关联性最强(OR均>1 000),血钙和D-二聚体OR值分别为0.013和19.479。结论:血钙、D-二聚体和PCT是较好的早期预测AP严重程度的血生化指标。

Background：As the incidence of acute pancreatitis（ AP）is increasing and the mortality remains high,early identification and early intervention of patients at risk of severe acute pancreatitis（SAP）is of great clinical significance. Aims：To investigate the value of commonly used AP-related serum biochemical markers for early prediction of severity of AP. Methods：Retrospective analysis was performed in 205 AP patients in Renmin Hospital of Wuhan University from Jan. 2014 to Dec. 2014,and 92 healthy subjects were served as controls. Patients with AP were divided into mild（n = 92）, moderately severe（n = 72）and severe AP（n = 41）groups. The demographic characteristics,history of chronic diseases, serum biochemical markers within 48 hours after admission,Ranson score,BISAP score and other related clinical data were collected and compared between the four groups. The diagnostic performance of these indices in predicting SAP was evaluated by ROC curve,and the correlation of these indices with SAP was assessed by Logistic regression analysis. Results：There were significant differences in Ranson score,BISAP score,D-dimer,blood calcium,procalcitonin（PCT）, CRP,hypersensitive CRP（HS-CRP）,triacylglycerol and blood glucose between the four groups（P 〈 0. 05）. The area under curve（AUC）of blood calcium was 0. 838 for early prediction of SAP,which was second to that of Ranson score and BISAP score. The accuracies of PCT and D-dimer were acceptable but inferior to blood calcium,while the accuracies of other indices were considerably low. Logistic regression analysis revealed that the odds ratio of risk for SAP of Ranson score,PCT and HS-CRP were all greater than 1 000,while that of blood calcium and D-dimer were 0. 013 and 19. 479, respectively. Conclusions：Of the AP-related serum biochemical markers,blood calcium,D-dimer and PCT are the preferred early predictors for severity of AP.