联合PCT、D-D、CRP及IL-6检测在急性胰腺炎早期的临床价值

The clinical value of the combined detection of PCT,D-D,CRP and IL-6 in acute pancreatitis

目的探讨急性胰腺炎(acute pancreatitis,AP)患者降钙素原(procalcitonin,PCT)、D-二聚体(D-dimer,D-D)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)与病情严重程度的相关性,评价联合四项实验室指标早期评估AP病情的临床价值。方法回顾性分析2015年3月至2017年5月徐州医科大学附属医院收治的146例AP患者的临床资料。依据病情严重程度分为轻症急性胰腺炎组(MAP) 85例、中度重症急性胰腺炎组(MSAP) 34例、重症急性胰腺炎组(SAP) 27例,统计入院24 h PCT、D-D、CRP、IL-6水平。采用Spearman相关分析病情严重程度与PCT、D-D、CRP、IL-6的相关性。采用曲线下面积(area under the receiver operating characteristic curve,AUC)评价PCT、D-D、CRP、IL-6及联合四项实验室指标对SAP的预测价值。结果入院24 h内SAP患者PCT、D-D、CRP和IL-6水平显著高于MAP、MSAP组(P <0. 05); MSAP组D-D、CRP和PCT水平显著高于MAP组(P <0. 05);而MAP与MSAP组IL-6水平比较,差异无统计学意义(P> 0. 05)。Spearman相关分析提示,PCT、D-D、CRP、IL-6与病情严重程度呈正相关(r值分别为0. 63、0. 57、0. 53、0. 46,P <0. 05)。受试者工作特征曲线(receiver operating characteristic curves,ROC)分析示,PCT、D-D、CRP、IL-6及联合四项实验室指标的AUC分别为0. 90、0. 85、0. 85、0. 83、0. 95;对应灵敏度分别为88. 89%、88. 89%、96. 30%、70. 37%、92. 59%;特异度分别为83. 19%、70. 59%、59. 66%、89. 92%、88. 24%; PCT、D-D、CRP、IL-6对应临界值分别为1. 40 ng/ml、1. 65μg/ml、118 mg/L、221 pg/ml。结论 PCT、D-D、CRP、IL-6可有效评估AP患者病情严重程度,PCT是SAP的最佳预测因子,联合四项实验室指标可进一步预测SAP。

Objective To evaluate the clinical value of the combined detection of procalcitonin （PCT）, D-dimer （D-D）, C-reactive protein （CRP）, interleukin-6 （IL-6） in patients with acute pancreatitis （AP）.Methods Clinical data of 146 cases of AP patients were collected and analyzed retrospectively from Mar. 2015 to May. 2017, including 85 cases of MAP, 34 cases of moderately MSAP and 27 cases of SAP. All patients collected venous blood in the next morning to detect the levels of PCT, D-D, CRP and IL-6. The relationship of the severity of AP with PCT, D-D, CRP, IL-6 were measured by Spearman correlation analysis. The predictive value of PCT, D-D, CRP, IL-6 and combined four biomarkers in diagnosing SAP were assessed by the area under the receiver operating characteristic curve （ AUC ）.Results Within 24 hours of admitted in hospital, PCT, D-D, CRP and IL-6 levels were significantly different in MAP, MSAP and SAP groups （ P 〈0.05）; PCT, D-D, CRP, IL-6 levels in SAP group were significantly higher than those in MAP and MSAP group （ P 〈0.05）. D-D, CRP and PCT levels in MSAP group were significantly higher than those in MAP group （ P 〈0.05）. There was no significant difference in level of IL-6 between MSAP and MAP group （ P 〉 0.05 ）. PCT, D-D, CRP and IL-6 were all positively correlated with the severity of AP （ r=0.63, 0.57, 0.53, 0.46, P 〈0.05）. The area under the receiver operating characteristic curve （ ROC ） of PCT, D-D, CRP, IL-6 and the combined detection of four biomarkers were 0.90, 0.85, 0.85, 0.83, 0.95; their sensitivity were 88.89%, 88.89%, 96.30% , 70.37%, 92.59%; specificity were 83.19%, 70.59%, 59.66%, 89.92%, 88.24%, respectively. The correspondent cut-off value of PCT, D-D, CRP and IL-6 were 1.40 ng/ml, 1.65 μg/ml, 118 mg/L, 221 pg/ml, respectively .Conclusion PCT, D-D, CRP and IL-6 can effectively evaluate the severity of AP. PCT can be the strongest single predictive biomarker for SAP. Meanwhile, the combined detection of four biomarkers has a better predictive value for SAP.