未成熟粒细胞计数早期预测重度急性胰腺炎的应用价值

Application value of immature granulocyte count in the early prediction of severe acute pancreatitis

目的评估未成熟粒细胞以及联合检测对重度急性胰腺炎(SAP)的早期预测价值。方法回顾性分析2017年2~12月杭州市第一人民医院收治的63例急性胰腺炎患者的临床资料,根据患者是否存在持续性器官衰竭或局部并发症分为重度组(22例)和轻中度组(41例)。患者入院时测量未成熟粒细胞绝对值(IG#)、未成熟粒细胞百分比(IG%)、C反应蛋白(CRP)、降钙素原(PCT)以及血常规和生化常规等指标。对单因素分析中各组之间差异有统计学意义的参数纳入多因素分析;最后运用ROC曲线比较IG%、PCT、CRP以及联合检测在早期判断SAP中的预测价值。结果重度组的腹内压(IAP)、急性生理学与慢性健康状况评分(APACHEⅡ)、CT严重性指数(CTSI)、改良Marshall评分均显著高于轻中度组(P<0.001)。在实验室指标中,两组CRP、PCT、IG%、白蛋白差异均有统计学意义(P<0.001);多因素分析结果显示IG%(P=0.026)、CRP(P=0.011)、PCT(P=0.029)是预测SAP的独立危险因素。ROC曲线显示CRP、PCT、IG%均被证明对SAP具有预测价值(P<0.001)。IG%+CRP+PCT联合检测敏感度和特异度均较单一指标的AUC显著升高(P<0.001)。结论在急性胰腺炎发病48 h内,IG%是预测SAP的有效指标,IG%、CRP、PCT是预测SAP的独立危险因素,三者联合检测对疾病严重程度的评估具有更高的敏感度和特异度。

Objective To evaluate the early predictive value of immature granulocyte count and combined detection of severe acute pancreatitis（SAP）. Methods The clinical data of 63 patients with acute pancreatitis who were admitted to Hangzhou First People′s Hospital from February to December 2017 was analyzed retrospectively, and the patients were divided into severe group（22 cases） and mild-to-moderate group（41 cases） according to whether the patient had persistent organ failure or local complications. At the time of admission, patients were checked about immature granulocyte count（IG#）, immature granulocyte percent（IG%）, C-reactive protein（CRP）, procalcitonin（PCT）, blood routine and biochemical routine. In the univariate analysis, parameters with statistical differences between the groups were included in the multivariate analysis. Finally, ROC curve was used to compare the predictive value of IG%, PCT, CRP and combined detection in the early determination of severe acute pancreatitis. Results The intra-abdominal pressure（IAP）, acute physiology and chronic health evaluation（APACHE Ⅱ） scores, CT severity index（CTSI） scores and modified Marshall scores of the severe group were significantly higher than those of the mild-to-moderate group（P〈0.001）. In laboratory indicators, there were significant differences in CRP, PCT, IG% and albumin between the two groups（P〈0.001）; multivariate analysis showed that IG%（P = 0.026）, CRP（P = 0.011）, and PCT（P = 0.029） were independent risk factors to predict severe acute pancreatitis. The ROC curve showed that CRP, PCT, and IG% all proved to have predictive value for severe acute pancreatitis（P〈0.001）. The combined detection of IG%＋CRP＋PCT had a higher AUC than the single indicator（P〈0.001）. Conclusion Within 48 hours of the attack of acute pancreatitis, IG%is a useful index for predicting SAP. IG%, CRP, and PCT are independent risk factors to predict SAP, and the combination of the three indicators has a higher sensitivity and specificity in the assessment of severity evaluation.