血清甘油三酯与IL-6及APACHEⅡ评分对重症急性胰腺炎患者感染及预后的预测价值

Value of serum triglyceride,IL-6and APACHE Ⅱ scores in prediction of infection and prognosis of patients with severe acute pancreatitis

目的探讨血清甘油三酯(TG)、白细胞介素-6(IL-6)及急性生理与慢性健康评估Ⅱ(Acute physiology and chronic health evaluation scoring system,APACHEⅡ)评分对重症急性胰腺炎(Severe acute pancreatitis,SAP)患者感染及预后的预测价值。方法回顾性分析武汉市第一医院2017年4月-2018年10月收治的SAP患者80例临床资料,分别于入院第1天测定患者血清TG、IL-6,并对患者进行APACHEⅡ评分,通过受试者工作特征曲线(ROC曲线)评估血清TG、IL-6及APACHEⅡ评分对患者感染及预后的预测分析。结果80例患者中发生感染28例,未感染者52例;28d后生存64例、死亡16例;感染患者血清TG、IL-6分别为(5.66±1.79)mmol/L、(104.87±10.85)μmol/L高于未感染患者,而APACHEⅡ评分为(15.49±4.63)分高于未感染患者(12.81±3.95)分(P<0.05);血清TG、IL-6及APACHEⅡ评分联合预测SAP患者感染ROC曲线下面积0.926大于TG、IL-6、APACHEⅡ评分单独检测(P<0.05);IL-6预测SAP患者感染ROC曲线下面积大于TG、APACHEⅡ评分(P<0.05);生存患者血清TG、IL-6分别为(2.85±0.64)mmol/L、(85.73±13.97)μmol/L低于死亡患者(6.31±2.30)mmol/L、(108.70±11.68)μmol/L,APACHEⅡ评分为(12.35±2.40)分低于死亡患者(19.34±2.07)分(P<0.05);血清TG、IL-6及APACHEⅡ评分联合预测SAP患者预后ROC曲线下面积0.947大于TG、IL-6、APACHEⅡ评分单独检测(P<0.05)。结论血清TG、IL-6及APACHEⅡ评分可提示SAP患者感染风险,评估患者预后状态,三者联合可作为SAP患者感染及预后的敏感指标,早期应加强上述指标监测。

OBJECTIVE To investigate the predictive value of serum triglyceride(TG),interleukin-6(IL-6)and scores of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)for infection and prognosis of patients with severe acute pancreatitis(SAP).METHODS The clinical data of 80SAP patients who were admitted to Wuhan First Hospital from Apr.2017to Oct.2018were retrospectively analyzed.On the first day of admission,serum TG and IL-6were measured,and APACHE Ⅱ scoring of patients was performed.The receiver operating characteristic curves(ROC curves)were applied to evaluate the predictive value of serum TG,IL-6and APACHE Ⅱ scores for infection and prognosis of patients.RESULTS Among the 80patients,there were 28cases with infection and 52cases without infection.28days later,64cases survived and 16cases died.The serum TG and IL-6of infection group were(5.66±1.79)mmol/L and(104.87±10.85)μmol/L,respectively,significently higher than those in non-infection group,and APACHE Ⅱ score was(15.49±4.63)points,significently higher than that in non-infection group(P<0.05).The area under the ROC curve(AUC)of serum TG combined with IL-6and APACHE Ⅱ score for predicting infection of SAP patients was 0.926,which was significently greater than that of TG,IL-6and APACHE Ⅱ score alone(P<0.05).AUC of IL-6for predicting infection was significently greater than that of TG and APACHE Ⅱ score(P<0.05).The serum TG and IL-6in survival patients were(2.85±0.64)mmol/L and(85.73±13.97)μmol/L,respectively,significently lower than those in dead patients(6.31±2.30)mmol/L and(108.70±11.68)μmol/L,respectively,and APACHE Ⅱ score was(12.35±2.40)points,significently lower than that in dead patients(19.34±2.07)points(P<0.05).AUC of serum TG combined with IL-6and APACHE Ⅱ score for predicting prognosis of SAP patients was 0.947,which was significently greater than that of TG,IL-6and APACHE Ⅱ scores alone(P<0.05).CONCLUSIONSerum TG,IL-6and APACHE Ⅱ scores could indicate the risk of infection in SAP patients,and assess their prognosis status.The combination of three can be applied as sensitive indicators for infection and prognosis in SAP patients.The monitoring of the above indicators should be strengthened in the early stage.