基于新修订的亚特兰大分类标准评估C反应蛋白和降钙素原早期预测急性胰腺炎病情的价值

Predictive value of C-reactive protein and procalcitonin in the early forecasting acute pancreatitis based on the new Atlanta classification criteria

目的 基于2012年修订的亚特兰大分类标准，探讨检测急性胰腺炎（AP）患者血清C反应蛋白（CRP）和降钙素原（PCT）对评估AP病情的价值。方法 选取AP患者83例，根据2012年修订的亚特兰大分类标准将患者分为轻度AP（MAP）组（39例）、中度AP（MSAP）组（31例）和重度AP（SAP）组（13例），并以27例健康体检者作为对照组。MAP组、MSAP组和SAP组患者于入院第2天，对照组于体检当天检测血清CRP和PCT水平。采用曲线下面积（AUC）评价血清CRP和PCT水平对SAP、感染性胰腺坏死（IPN）、器官衰竭及死亡风险的预测价值。结果 MAP组、MSAP组和SAP组血清CRP和PCT明显高于对照组[（49.84 ± 12.26）、（89.77 ± 22.10）和（123.69 ± 37.09）mg/L比（3.92 ± 1.37）mg/L，（1.15 ± 0.42）、（2.44 ± 0.61）和（3.27 ± 0.96）μg/L比（0.41 ± 0.13）μg/L]，MSAP组和SAP组明显高于MAP组，SAP组明显高于MSAP组，差异均有统计学意义（P〈0.05）。Spearman相关性分析结果显示，AP严重程度与血清CRP和PCT水平呈正相关（r= 0.652和0.714，P〈0.05）。血清CRP水平预测SAP、IPN准确度中等（AUC分别为0.73、0.76），对器官衰竭预测准确度较低（AUC为0.67），对死亡风险预测无意义（AUC为0.46）；血清PCT水平预测SAP、IPN和死亡风险准确度中等（AUC分别为0.71、0.86和0.80），对器官衰竭预测准确度较低（AUC为0.64）。结论 基于2012年修订的亚特兰大分类标准应用血清CRP水平预测SAP准确度高于血清PCT水平，应用血清PCT水平预测IPN和死亡风险高于血清CRP水平，应用血清CRP和PCT水平预测器官衰竭准确度均较低。

Objective Based on the 2012 Atlanta classification criteria, to study the value of C-reactive protein （CRP） and procalcitonin （PCT） in the early forecasting acute pancreatitis （AP）.Methods Eighty-three patients with AP were selected. The patients were divided into mild AP （MAP） group （39 cases）, moderately severe AP （MSAP） group （31 cases） and severe AP （SAP） group （13 cases） according to the 2012 Atlanta classification criteria. Twenty-seven healthy people were selected as control group. The levels of serum CRP and PCT were measured. The predictive value of serum CRP and PCT levels for SAP, infectious pancreatic necrosis （IPN）, organ failure and death risk was assessed using the area under the curve （AUC）.Results The serum CRP and PCT levels in MAP group, MSAP group and SAP group were significantly higher than those in control group： （49.84 ± 12.26）, （89.77 ± 22.10） and （123.69 ± 37.09） mg/L vs. （3.92 ± 1.37） mg/L, （1.15 ± 0.42）, （2.44 ± 0.61） and （3.27 ± 0.96） μg/L vs. （0.41 ± 0.13） μg/L, and those in MSAP group and SAP group were significantly higher than those in MAP group, those in SAP group were significantly higher than those in MSAP group, and there were statistical differences （P〈0.05）. The Spearman correlation analysis result showed that AP severity was positively correlated with serum CRP and PCT levels （r= 0.652 and 0.714, P〈0.05）. The accuracy of serum CRP level for forecasting SAP and IPN was medium （AUC= 0.73 and 0.76）, and for forecasting organ failure accuracy was low （AUC= 0.67）. Serum CRP showed no significance in forecasting death risk （AUC= 0.46）. The accuracy of serum PCT level for forecasting SAP, IPN and death risk accuracy was medium （AUC= 0.71, 0.86 and 0.80）, and for forecasting organ failure accuracy was low （AUC= 0.64）.Conclusions Based on the 2012 Atlanta classification criteria, the accuracy of serum CRP level for forecasting SAP is higher than that of serum PCT level, the accuracy of serum PCT level for forecasting IPN and death risk is higher than that of serum CRP level, and accuracy of serum CRP and PCT levels for forecasting organ failure are low.