生物化学标志物预测高脂血症性急性胰腺炎脏器衰竭的临床价值

Clinical value of biochemical markers in predicting organ failure in acute pancreatitis induced by hyperlipidemia

目的探讨常用的几种生物化学标志物对高脂血症性急性胰腺炎(HLAP)并发持续性脏器衰竭(POF)的早期预测价值。方法回顾性分析2015年1月至2017年12月间海军军医大学附属长海医院消化内科收治的发病72 h内的157例HLAP患者的临床资料,其中106例患者未发生POF(无POF组),51例患者并发POF(POF组)。记录入院24 h内血浆红细胞比容(Hct)、血清尿素氮(BUN)和肌酐(Cr)水平、APACHEⅡ评分和BISAP评分。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估Hct、BUN、Cr、APACHEⅡ评分、BISAP评分预测HLAP并发POF的效能,并通过DeLong检验对各指标的预测效能进行比较。结果POF组HLAP患者血清BUN和Cr水平、APACHEⅡ和BISAP评分均显著高于无POF组HLAP患者[(10.30±7.43)mmol/L比(5.34±2.26)mmol/L,(165.31±123.93)μmol/L比(65.61±20.82)μmol/L,(10.22±6.22)分比(4.61±2.99)分,(2.61±0.87)分比(1.42±1.07)分],差异均有统计学意义(P值均<0.05);而Hct与无POF组HLAP患者的差异无统计学意义。Cr、BUN预测HLAP并发POF的AUC分别为0.77(95%CI0.69~0.86)、0.71(95%CI0.61~0.81),预测的临界值(Cut-off值)分别为130 μmol/L、8.95 mmol/L,敏感度均为53%,特异度分别为99%、94%,准确度分别为84%、81%,阴性预测值均为81%,阳性预测值分别为96%、82%。DeLong检验显示Cr、BUN水平与APACHEⅡ、BISAP评分预测HLAP患者并发POF效能的差异均无统计学意义。结论Cr≥130 μmol/L、BUN≥8.95 mmol/L可用于预测HLAP是否伴发POF,其预测效能与APACHEⅡ、BISAP评分相当。

Objective To investigate the early predictive value of several commonly used biochemical markers for predicting persistent organ failure (POF) in patients with hyperlipidemic acute pancreatitis (HLAP). Methods Clinical data of 157 patients with HLAP within 72 hours after the onset of first attack who were admitted to the Dept. of Gastroenterology in Changhai Hospital from January 2015 to December 2017 were retrospectively analyzed, including 106 cases without POF (non POF group) and 51 cases with POF (POF group). Hct, BUN, Cr, APACHE Ⅱ and BISAP were recorded within 24 hours after admission. Receiver-operating characteristic (ROC) curve was drawn to calculate area under the ROC curve (AUC) and evaluate the performance of Hct, BUN, Cr, APACHE Ⅱ and BISAP scores in predicting HLAP complicated with POF, which was compared by DeLong test. Results Values of BUN, Cr, APACHE Ⅱ and BISAP were significantly higher in HLAP patients with POF than those without POF [(10.30±7.43) vs (5.34±2.26)mmol/L,(165.31±123.93) vs (65.61±20.82)μmol/L,(10.22±6.22) vs (4.61±2.99) points,(2.61±0.87) vs (1.42±1.07) points], and the differences were all statistically significant (all P<0.05), whereas Hct was not significantly different between the two groups. The AUC of Cr and BUN for predicting POF was 0.77(95% CI, 0.69-0.86) and 0.71 (95% CI, 0.61-0.81), respectively, and the optimum predictive Cut-off values were 130 μmol/L and 8.95 mmol/L, respectively. The sensitivity was 53%, and the specificity was 99% and 94%;the accuracy was 84% and 81%;negative predictive value was 81%, and positive predictive value was 96% and 82%. DeLong test showed that predictive performance of BUN and Cr was not statistically different from that of APACHE Ⅱ and BISAP. Conclusions Cr≥130 μmol/L and BUN≥8.95 mmol/L can be used clinically to predict the presence of POF in HLAP, and the predictive efficacy were comparable to APACHE Ⅱ and BISAP.