心肌损伤标记物对急性胰腺炎严重程度的预测效应

The predictive effect of myocardial injury markers on the severity of acute pancreatitis

目的探讨心肌损伤标记物肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）、脑钠肽前体（proBNP）对急性胰腺炎（acute pancreatitis，AP）严重程度的预测效应。方法回顾性观察研究246例2015年1月至2016年12月上海瑞金医院急诊科收治的急性胰腺炎患者，按照2012年修订的亚特兰大国际共识分为轻症（47例）、中度重症（151例）、重症急性胰腺炎（severe acute pancreatitis，SAP，48例）三组，检测并记录其入院72h内的cTnI、CK-MB、proBNP、C-反应蛋白（CRP）、降钙素原（PCT）等生物标志物的最高值，对所有患者进行急性生理慢性健康（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）、床旁急性胰腺炎严重程度评分（BISAP）、Balthazar CT严重指数评分（CTSI），同时记录AP患者入院时有无器官功能障碍、功能障碍的器官种类及持续时间。统计学分析采用SNK-q检验、方差分析和成组t检验。结果SAP组较非SAP组（即轻症＋中度重症）proBNP、CK．MB、cTnI水平显著升高。用ROC曲线表示心肌损伤标记物对SAP的预测能力，结果显示cTnI对SAP的预测能力最大（AUC=0．872），proBNP的预测能力最小（AUC=0．763o建立模型比较心肌损伤标记物对AP严重程度是否有预测价值，结果提示心肌损伤标记物（CK—MB、cTnI）与传统指标相结合比单纯传统指标对SAP有更高的预测能力（AUC=0．966VS．AUC=0.945，P=0．04）。结论心肌损伤标记物cTnI和CK．MB对SAP有一定的预测价值。

Objective To assess the predictive effect of myocardial injury biomarkers （proBNP, CK-MB, and cTnI） on the severity of acute pancreatitis （AP）. Methods The records of 246 patients diagnosed with acute pancreatitis who were treated at Ruijin Hospital Emergency Department from January 2015 to December 2016 were retrospectively analyzed. According to the revised 2012 Atlanta guidelines, these patients were divided into the mild acute pancreatitis （MAP, n=47）, moderately severe acute pancreatitis （MSAP, n=151） and severe acute pancreatitis （SAP, n=48） groups. The highest plasma levels of troponin I （cTnI）, creatine kinase （CK）-MB, N-terminal B-type brain natriuretic peptide （NT- proBNP）, C-reactive protein （CRP）, and procalcitonin （PCT） were recorded for comparison within 72 h after admission. The acute physiology and chronic health evaluation II （APACHE II ） score, sequential organ failure assessment （SOFA）, bedside index for severity in acute pancreatitis （BISAP） and Balthazar computed tomography severity index （CTSI） were calculated at admission within 72 h. Whether there is an occurrence of organ dysfunction, and the organ types and persist time of organ dysfunction were recorded. The analysis of variance, SNK-q test and paired samples t test were used for the statistical analysis. Results The levels ofproBNP, CK-MB, and cTnI were significantly higher in the SAP group than in the non-SAP group. The receiver operating characteristic （ROC） curve demonstrated cTnI had the maximum predictive power （AUC=0.872）, while proBNP had the least predictive ability （AUC=0.763）. The established model, which is to explore whether the myocardial injury markers had the predictive value, showed that the combination of myocardial injury indicators （CK-MB, cTnI） and traditional indicators had higher predictive value for SAP than traditional indicators alone （AUC=0.966 vs. AUC=0.945, P=0.04）. Conclusions The elevated markers of myocardial injury had certain predictive value for severe acute pancreatitis.