联合检测D-二聚体C反应蛋白及乳酸对急性胰腺炎严重程度的预测价值

Predictive value of combined measurement of serum D-dimer C-reactive Protein and arterial blood lactic acid level for severity of acute pancreatitis

目的探讨血清D-二聚体、C反应蛋白及动脉血乳酸水平对急性胰腺炎(AP)病情严重程度评估的预测价值。方法选择2017年8月至2018年8月盐城市大丰人民医院收治的入院与发病时间在24 h内且未经治疗的首次发病的急性胰腺炎患者126例,其中轻症急性胰腺炎组(MAP)56例,重症急性胰腺炎组(SAP)70例。收集所有患者的血清D-二聚体、C反应蛋白及动脉血乳酸水平,并进行Ranson评分、急性生理与慢性健康(APACHEⅡ)评分、急性胰腺炎严重程度床边指数评分(BISAP)及改良的CT严重指数评分(MCTSI),采用受试者工作特征曲线(R0C曲线)分析血清D-二聚体、C反应蛋白、动脉血乳酸、Ranson评分、APACHEⅡ评分、BISAP评分及MCTSI评分对急性胰腺炎病情严重程度的预测价值,并分析血清D-二聚体、C反应蛋白及动脉血乳酸与Ranson评分、APACHEⅡ评分、BISAP评分及MCTSI评分之间的相关性。结果与MAP组比较,SAP组患者血清D-二聚体、C反应蛋白及动脉血乳酸水平明显升高,差异均有统计学意义(t=5.901、4.452、5.811,P<0.05);血清D-二聚体、C反应蛋白、动脉血乳酸、Ranson评分、APACHEⅡ评分、BISAP评分及MCTSI评分的受试者工作特征曲线下面积(AUC)分别为0.842、0.632、0.755、0.831、0.811、0.849、0749;3项指标联合检测的AUC为0.864;血清D-二聚体、C反应蛋白、动脉血乳酸均与Ranson评分呈正相关(r=0.375、0.292、0.325,P<0.05);血清D-二聚体、C反应蛋白、动脉血乳酸均与APACHEⅡ评分呈正相关(r=0.386、0.301、0.285,P<0.05);血清D-二聚体、C反应蛋白、动脉血乳酸均与BISAP评分呈正相关(r=0.373、0.273、0.308,P<0.05);血清D-二聚体、C反应蛋白、动脉血乳酸均与MCTSI评分呈正相关(r=0.359、0.317、0.296,P<0.05)。结论 D-二聚体、C反应蛋白、乳酸对预测AP严重程度均具有重要价值,三者联合检测具有重要意义。

Objective To explore the predictive value of combined measurement of serum D-dimer, C-reactive protein, and arterial blood lactic acid level for the severity of acute pancreatitis(AP). Methods The clinical data of 126 hospitalized patients who were diagnosed with acute pancreatitis in The People’ s Hospital of Yancheng, Dafeng from August 2017 to August 2018 were selected. All patients were admitted to the hospital within 24 hours of onset and received no treatment before admission. The patients were divided into mild acute pancreatitis(MAP) group(n=56) and severe acute pancreatitis(SAP) group(n=70). The initial measurements of serum D-dimer, C-reactive protein, and arterial blood lactic acid were collected. The scores of Ranson, APACHEⅡ, BISAP and MCTSI were obtained. The receiver operating characteristic(ROC) curve was used to analyze the predictive values of serum D-dimer, C-reactive protein, arterial blood lactic acid Level, Ranson scores, APACHEⅡ scores, BISAP scores, MCTSI scores for the severity of AP. The correlations between serum D-dimer, C-reactive protein, arterial blood lactic acid level and Ranson scores,APACHE Ⅱ scores, BISAP scores, MCTSI scores were analyzed. Results Compared with the MAP group, the SAP group had significantly increased serum D-dimer, C-reactive protein, and arterial blood lactic acid levels(t=5.901, 4.452, 5.811, P<0.05). The areas under the ROC curve(AUCs) of serum D-dimer, C-reactive protein, arterial blood lactic acid levels, Ranson scores, APACHEⅡ scores, BISAP scores, MCTSI scores were0.842, 0.632, 0.755, 0.831, 0.811, 0.849, 0749. The AUC of a combination of serum D-dimer、C-reactive protein and arterial blood Lactic Acid levels was 0.864. Serum D-dimer、C-reactive protein and arterial blood lactic acid levels were all positively correlated with Ranson scores(r=0.375、0.292、0.325, P<0.05). Serum D-dimer、C-reactive Protein and arterial blood lactic acid levels were all positively correlated with APACHEⅡ scores(r=0.386, 0.301, 0.285, P<0.05). Serum D-dimer、C-reactive Protein and arterial blood lactic acid levels were all positively correlated with BISAP scores(r=0.373、0.273、0.308, P<0.05). Serum D-dimer, C-reactive Protein and arterial blood lactic acid levels were all positively correlated with MCTSI scores(r=0.359, 0. 317, 0.296, P<0.05). Conclusion Serum D-dimer, C-reactive protein and arterial blood lactic acid levels are important for judgment of the severity of AP, and a combination of the three markers has greater significance.