血液相关标志物与急性胰腺炎病情严重程度的相关性研究

Correlation study of blood related markers and severity of acute pancreatitis

目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、红细胞分布宽度(red cell distribution width,RDW)、C-反应蛋白(C-reactive protein,CRP)与急性胰腺炎(acute pancreatitis,AP)病情严重程度的相关性。方法选取2017年1月至2019年10月解放军总医院第六医学中心收治的AP患者214例,将其设为病例组。另选取同期健康体检者30例为对照组。根据病情严重程度,将病例组分为轻度组(mild acute pancreatitis,MAP)149例,中重度组(moderately severe acute pancreatitis,MSAP)35例、重度组(severe acute pancreatitis,SAP)30例。比较病例组与对照组及病例组三个亚组间入院24h NLR、RDW、CRP的差异;分析病例组NLR、RDW、CRP与急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHEⅡ评分)的相关性。应用ROC曲线评估NLR、RDW、CRP单独及联合检测对SAP的预测价值。结果病例组NLR、RDW、CRP明显高于对照组(P<0.05);SAP组的NLR、RDW、CRP显著高于MSAP组、且MSAP组显著高于MAP组,差异有显著性(P<0.05);病例组NLR、RDW、CRP与APACHEⅡ评分呈正相关(r分别为0.683、0.594、0.702,P<0.05)。ROC曲线分析提示,NLR、RDW、CRP预测SAP的曲线下面积分别为0.846、0.807和0.872;敏感性分别为87.5%、81.3%和82.5%;特异性分别为79.5%、76.2%和86.1%。NLR、RDW、CRP三者联合检测预测SAP的AUC值为0.916,敏感性为91.8%,特异性为86.2%。结论AP患者发病早期NLR、RDW、CRP明显升高,与病情严重程度相关,均是预测SAP的理想指标。三者联合检测在预测SAP方面诊断价值更高。

Objective To investigate the relationship of neutrophil to lymphocyte ratio(NLR),red cell distribution width(RDW),C-reactive protein(CRP)with severity of acute pancreatitis(AP).Method 214 AP patients admitted to the sixth medical center of PLA General Hospital from January 2017 to October 2019 were selected as case group and 30 healthy people were selected as control group.According to the severity of the disease,214 patients were divided into mild acute group(MAP,n=149),moderately severe acute group(MSAP,n=35)and severe acute group(SAP,n=30).The differences of NLR,RDW and CRP within 24 hours of admission between the three subgroups of case group,between control group and case group were compared,and the correlation between NLR,RDW,CRP and APACHEⅡscore in case group was analyzed.ROC curve was used to evaluate the predictive value of single and combined detection of NLR,RDW and CRP in SAP.Results NLR,RDW and CRP in case group were significantly higher than those in control group(P<0.05);NLR,RDW and CRP in SAP group were significantly higher than those in MSAP group and those in MSAP group were significantly higher than those in MAP group(P<0.05);NLR,RDW,CRP in case group were positively correlated with APACHE II score(r was 0.683,0.594,0.702 respectively,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR,RDW and CRP in predicting SAP was 0.846,0.807 and 0.872,the sensitivity was 87.5%,81.3%and 82.5%,and the specificity was 79.5%,76.2%and 86.1%respectively.The AUC value of combined detection of NLR,RDW and CRP was 0.916,the sensitivity was 91.8%,and the specificity was 86.2%.Conclusion The levels of NLR,RDW and CRP were significantly increased in AP patients at the early stage of onset,which were related to the severity of the disease.The combined detection of NLR,RDW and CRP has higher diagnostic value in predicting SAP.