基于新亚特兰大分类标准研究C反应蛋白和降钙素原在急性胰腺炎早期病情评估中的价值

Value of C-reactive protein and procalcitonin in assessment of the early stage of acute pancreatitis based on the new Atlanta classification criteria

目的 基于新修订的亚特兰大分类标准评估CRP和降钙素原早期预测重度急性胰腺炎（SAP）、感染性胰腺坏死（IPN）、器官衰竭和死亡风险的准确性.方法 纳入2011年3月至2013年12月入院且起病至入院＜3 d的连续性急性胰腺炎（AP）患者975例,按新亚特兰大分类标准判断其AP严重程度,分成轻度急性胰腺炎（MAP）组、中度急性胰腺炎（MSAP）组和SAP组.采用秩和检验比较3组患者入院后24 h的CRP和降钙素原水平,采用Spearman秩相关分析CRP和降钙素原与AP严重程度的相关性,采用AUC值分析CRP和降钙素原预测器官衰竭、SAP、IPN和死亡风险的准确性.结果 975例AP患者中,器官衰竭401例（41.13％）,IPN78例（8.00％）,死亡5例（0.51％）.MAP组、MSAP组和SAP组的中位CRP水平（下四分位数,上四分位数）分别为26.00 mg/L（12.95 mg/L,88.50 mg/L）、96.80 mg/L（26.00 mg/L,177.50 mg/L）和165.00 mg/L（73.70 mg/L,259.50 mg/L）,差异有统计学意义（H=227.58,P＜0.01）;CRP水平与病情严重程度呈正相关（r=0.41,P＜0.01）.MAP组、MSAP组和SAP组的中位降钙素原水平（下四分位数,上四分位数）分别为0.26 μg/L（0.18 μg/L,0.60 μg/L）、0.54 μg/L（0.26 μg/L,1.70 μg/L）和1.42 μg/L（0.50 μg/L,4.82 μg/L）,差异有统计学意义（H=169.99,P＜0.01）;降钙素原水平与病情严重程度呈正相关（r=0.35,P＜0.01）.CRP和降钙素原预测器官衰竭的AUC值均为0.65,预测IPN、SAP和死亡风险的AUC值分别为0.74和0.85,0.71和0.70,0.48和0.79.结论 在新亚特兰大分类标准下,CRP与降钙素原预测器官衰竭准确性较低,CRP预测SAP的准确性稍高于降钙素原,降钙素原预测IPN和死亡风险的准确性均高于CRP.

Objective To evaluate the accuracy of C-reactive protein （CRP） and procalcitonin （PCT） in early prediction of the severe acute pancreatitis（SAP）,infected pancreatic necrosis（IPN）,organ failure and death risk based on the new Atlanta classification criteria.Methods From March 2011 to December 2013,975 hospitalized acute pancreatitis （AP） patients were enrolled and the time between their onset and admission were less than three days.The patients were divided into mild acute pancreatitis （MAP） group,moderately severe acute pancreatitis （MSAP） group and SAP group according to the severity of AP determined by the revised Atlanta classification,The levels of CRP and PCT at 24 h after admission of three groups were compared with rank test.Spearman＇s rho analysis was used to analyze the correlation between CRP,PCT levels and the severity of AP.The area under the receiver operating characteristic curve （AUC） value was performed to analyzethe accuracy of CRP and PCT in predicting organ failure,IPN,SAP and death risk.Results Among 975 AP patients,there were 401 patients （41.13%） with organ failure,78 patients （8.00%） with IPN,five patients （0.51%） died.The median CRP value of MAP,MSAP and SAP group were 26.00 mg/L（12.95 mg/L,88.50 mg/L）,96.80 mg/L （26.00 mg/L,177.50 mg/L） and 165.00 mg/L （73.70 mg/L,259.50 mng/L）,respectively,and the difference was statistically significant （H=227.58,P〈0.01）.CRP level was positively correlated with the severity of the disease （r=0.41,P〈0.01）.The median PCT value of MAP,MSAP and SAP group were 0.26 μg/L （0.18 μg/L,0.60 μg/L）,0.54 μg/L（0.26 μg/L,1.70 μg/L）and 1.42 μg/L（0.50 μg/L,4.82 μg/L）,respectively,and the difference was statistically significant （H =169.99,P〈0.01）.PCT was also positively correlated with the severity of the disease （r=0.35,P〈0.01）.AUC value of CRP and PCT in predicting organ failure both were 0.65;AUC value for IPN,SAP and death risk were 0.74 and 0.85,0.71 and 0.70,0.48 and 0.79,respectively.Conclusions Based on the new Atlanta classification criteria,the accuracy of CRP and PCT in the prediction of organ failure is low.The accuracy of CRP in the prediction of SAP is slightly higher than that of PCT.And the accuracy of PCT in prediction of IPN and death risk are both higher than that of CRP.