急性胆源性胰腺炎继发胰腺坏死高危因素及预测模型分析

Analysis of high risk factors and predictive models of secondary pancreatic necrosis in acute biliary pancreatitis

目的分析急性胆源性胰腺炎继发胰腺坏死的高危因素并建立预测模型。方法回顾性分析自2016年1月至2019年5月池州市人民医院收治的147例急性胰腺炎患者的临床资料,根据是否发生胰腺坏死将患者分为未坏死组(n=102)和坏死组(n=45)。比较两组患者血液指标水平及病程,对具有统计学意义的变量进行Logistic回归分析筛选独立危险因素并建立预测模型,同时通过绘制受试者特征曲线检测模型预测价值。结果坏死组患者病程显著长于未坏死组,坏死组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及C反应蛋白(CRP)水平显著高于未坏死组,血钙水平显著低于未坏死组,差异均有统计学意义(P<0.05)。病程、血钙和CRP为急性胆源性胰腺炎继发胰腺坏死独立危险因素;根据独立危险因素建立预测模型,P=exp[(-31.253+0.559×1+1.020×4+1.270×5)]/(1+exp[(-31.253+0.559×1+1.020×4+1.270×5)]),经Hosmer-Lemeshow检验得出模型拟合优度较高(P=0.254),预测模型的敏感度为85.0%,特异度为95.5%,阳性预测值为95.0%,阴性预测值为86.4%,曲线下面积为0.947。结论病程、血钙和CRP为急性胆源性胰腺炎继发胰腺坏死的独立危险因素,预测模型具有较高的预测能力可为临床治疗和诊断提供参考。

Objective To analyze the high risk factors of pancreatic necrosis secondary to acute biliary pancreatitis and establish a predictive model.Methods A retrospective study was performed on 147 cases of patients with acute pancreatitis who were admitted from January 2016 to May 2019.According to whether pancreatic necrosis occurred,the patients were divided into the non necrosis group(n=102)and the necrosis group(n=45).The blood level and disease course of the two groups of patients were compared,the variables with statistical significance were screened for independent risk factors by Logistic regression analysis,and the predictive model was established.Meanwhile,the predictive value of the model was tested by drawing the subject characteristic curve.Results The course of disease in the necrotic group was significantly longer than that in the non-necrotic group,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and C-reactive protein(CRP)in the necrotic group were significantly higher than those in the non-necrotic group,and the blood calcium levels were significantly lower than those in the non-necrotic group,with statistically significant differences(P<0.05).The course,serum calcium and CRP were independent risk factors for pancreatic necrosis secondary to acute biliary pancreatitis,P=exp[(-31.253+0.559×1+1.020×4+1.270×5)]/(1+exp[(-31.253+0.559×1+1.020×4+1.270×5)]).The Hosmer-Lemeshow test showed that the model had a high goodness of fit(P=0.254).The sensitivity of the prediction model was 85.0%,the specificity was 95.5%,the positive predictive value was 95.0%,the negative predictive value was 86.4%,and the AUC was 0.947.Conclusion The course of disease,blood calcium and CRP are independent risk factors for pancreatic necrosis secondary to acute biliary pancreatitis.