联合检测APOB/APOA1、PCT、FIB对重症急性胰腺炎早期病情的评估

Assessment of combined detection of APOB/APOA1,PCT,FIB in early illness of severe acute pancreatitis

目的探讨载脂蛋白B/载脂蛋白A1(apolipoprotein B/apolipoprotein A1,APOB/APOA1)、降钙素原(procalcitonin,PCT)及纤维蛋白原(fibrinogen,FIB)对重症急性胰腺炎(severe acute pancreatitis,SAP)早期病情评估的临床应用价值。方法收集2015年5月至2019年8月于徐州医科大学附属医院住院的初次发病且发病至就诊时间在72 h内资料完整的急性胰腺炎(acute pancreatitis,AP)患者145例。根据病情严重程度分为轻症急性胰腺炎(MAP)组(n=85)、中重症急性胰腺炎(MSAP)组(n=40)、重症急性胰腺炎(SAP)组(n=20)。整理分析患者入院24 h内的PCT、FIB、血脂7项[包括TC、TG、HDL、LDL、LP(a)、APOB、APOA1]的指标,并计算APOB/APOA1值。采用Spearman相关性分析APOB/APOA1、PCT、FIB与AP严重程度的相关性,绘制ROC曲线分析各指标对评估早期AP病情的价值。结果入院24 h内SAP组、MSAP组患者的APOB/APOA1、PCT、FIB均明显高于MAP组(P<0.05),而SAP组与MSAP组比较,APOB/APOA1明显升高(P<0.05),PCT、FIB则差异无统计学意义(P>0.05)。APOB/APOA1、PCT、FIB与AP严重程度均呈正相关(r值分别为0.615、0.544、0.330,P<0.01);APOB/APOA1、PCT和FIB及指标联合后评估SAP的ROC曲线下面积(AUC)依次为0.899、0.801、0.653、0.929。对应的灵敏度分别为85.0%、90.0%、70.0%、100%;特异度分别为88.0%、71.2%、60.8%、75.2%;APOB/APOA1、PCT和FIB对应的最佳临界值分别为1.66、1.29 ng/ml、5.53 g/L。结论APOB/APOA1、PCT、FIB与AP严重程度呈正相关,联合检测对SAP早期病情有一定的临床应用价值。

Objective To investigate the clinical application value of apolipoprotein B/apolipoprotein A1(APOB/APOA1),procalcitonin(PCT)and fibrinogen(FIB)in early severe acute pancreatitis(SAP).Methods A total number of 145 patients with acute pancreatitis(AP)who were hospitalized from May 2015 to Aug.2019 in the Affiliated Hospital of Xuzhou Medical University for the first time and had complete data within 72 hours from onset to treatment were collected.The patients were divided into mild acute pancreatitis(MAP)group(n=85),moderate and severe acute pancreatitis(MSAP)group(n=40),and severe acute pancreatitis(SAP)group(n=20)based on the severity degree of the disease.The detection indexes of PCT,FIB and blood lipid[including TC,TG,HDL,LDL,LP(a),APOB and APOA1]were collected within 24 hours after admission,and the value of APOB/APOA1 was calculated.The Spearman method was performed for the correlation analysis,the ROC curve was draw to analyze the value of each index to evaluate the early AP condition.Results Within 24 hours after admission,APOB/APOA1,PCT and FIB in the SAP group and MSAP group were significantly higher than those in the MAP group,and APOB/APOA1 in the SAP group was remarkably higher than that in MSAP group,which demonstrated statistically significant differences(P<0.05).However,there was no significantly difference in PCT and FIB between the SAP group and MSAP group(P>0.05).APOB/APOA1,PCT and FIB were positively related to the severity of AP(r values were 0.615,0.544 and 0.330,respectively,P<0.05).The area of ROC curve(AUC)of APOB/APOA1,PCT,FIB and the combined detection were 0.899,0.801,0.653 and 0.929,respectively.Their sensitivity were 85.0%,90.0%,70.0%,100%;their specificity were 88.0%,71.2%,60.8%,75.2%,respectively.The correspondent cut-off value of APOB/APOA1,PCT and FIB levels were 1.66,1.29 ng/ml,5.53 g/L.Conclusion APOB/APOA1,PCT,FIB have positive correlation with AP severity,it is of certain value to evaluate early SAP after combined detection of indicators.