早期中性粒细胞与淋巴细胞比值联合载脂蛋白A-Ⅰ对急性胰腺炎严重程度的预测价值

Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission

目的探讨中性粒细胞与淋巴细胞比值(NLR)联合载脂蛋白A-Ⅰ(ApoA-Ⅰ)水平对急性胰腺炎(AP)病情严重程度的预测价值。方法回顾性研究2015年1月—2019年12月西南医科大学附属医院收治的460例AP患者。其中轻型急性胰腺炎(MAP)250例,中度重型急性胰腺炎(MSAP)166例,重型急性胰腺炎(SAP)44例。收集AP患者的基本资料、实验室指标[入院24 h内的中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、血清TG、血清TC、HDL-C、LDL-C,载脂蛋白包括ApoA-Ⅰ及ApoB]、系统评分(Ranson、BISAP、MCTSI评分)。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H秩和检验。将单因素分析中有统计学意义的变量进行logistic回归分析。Spearman相关性分析用于评价数据间的相关性。受试者工作特征曲线(ROC曲线)用于评价指标的诊断效能,MedCalc软件检验其效能差异有无统计学意义。结果NLR、ApoA-Ⅰ水平在不同严重程度AP组间差异有统计学意义(χ2=64.124、F=40.277,P值均<0.001)。入院时NLR与亚特兰大分级、Ranson评分、MCTSI评分和BISAP评分呈正相关(r值分别为0.370、0.129、0.260、0.122,P值均<0.05);ApoA-Ⅰ水平与亚特兰大分级、Ranson评分、MCTSI评分和BISAP评分呈负相关(r值分别为-0.358、-0.220、-0.297、-0.251,P值均<0.05)。NLR是非MAP的独立危险因素[OR=1.104,95%CI:1.070~1.140,P<0.001],ApoA-Ⅰ是非MAP的独立保护因素(OR=0.138,95%CI:0.070~0.264,P<0.001);NLR是SAP的独立危险因素(OR=1.163,95%CI:1.107~1.222,P<0.001),ApoA-Ⅰ是SAP的独立保护因素(OR=0.013,95%CI:0.003~0.056,P<0.001)。NLR预测非MAP的AUC=0.700,95%CI:0.656~0.742,P<0.001;ApoA-Ⅰ预测非MAP的AUC=0.684,95%CI:0.640~0.726,P<0.001,联合预测非MAP的AUC=0.748,95%CI:0.706~0.787,P<0.001。两指标联合对非MAP的预测价值优于单一指标(Z值分别为3.439、2.462,P值均<0.05)。NLR预测SAP的AUC=0.752,95%CI:0.710~0.791,P<0.001;ApoA-Ⅰ预测SAP的AUC=0.797,95%CI:0.757~0.833,P<0.001,联合预测SAP的AUC=0.857,95%CI:0.822~0.888,P<0.001。两指标联合对SAP的预测价值优于单一指标(Z值分别为3.171、2.630,P值均<0.05)。结论入院早期NLR联合ApoA-Ⅰ可作为预测AP严重程度的良好指标。

Objective To investigate the value of neutrophil-lymphocyte ratio(NLR)combined with apolipoprotein A-I(ApoA-I)level in predicting the severity of acute pancreatitis(AP).Methods A retrospective analysis was performed for 460 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2015 to December 2019,among whom 250 had mild acute pancreatitis(MAP),166 had moderate-severe acute pancreatitis,and 44 had severe acute pancreatitis(SAP).Related clinical data were collected,including basic information,laboratory markers(neutrophil count,lymphocyte count,serum triglyceride,serum total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,ApoA-I,and apolipoprotein B),and scores(Ranson,BISAP,and MCTSI).A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups;a logistic regression analysis was performed for the variables with statistical significance in univariate analysis;a Spearman correlation analysis was performed to investigate the correlation between data.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of indices,and MedCalc software was used to investigate whether there was a significant difference in diagnostic efficiency.Results There were significant differences in NLR and ApoA-I level between the groups with different severities of AP(χ2=64.124,F=40.277,P<0.001).On admission,NLR was positively correlated with Atlanta grading,Ranson score,MCTSI score,and BISAP score(r=0.370,0.129,0.260,and 0.122,all P<0.05),and ApoA-I level was negatively correlated with Atlanta grading,Ranson score,MCTSI score,and BISAP score(r=-0.358,-0.220,-0.297,and-0.251,all P<0.05).NLR was an independent risk factor for non-MAP(odds ratio[OR]=1.104,95%confidence interval[CI]:1.070-1.140,P<0.001),while ApoA-I was an independent protective factor against non-MAP(OR=0.138,95%CI:0.070-0.264,P<0.001);NLR was an independent risk factor for SAP(OR=1.163,95%CI:1.107-1.222,P<0.001),while ApoA-I was an independent protective factor against SAP(OR=0.013,95%CI:0.003-0.056,P<0.001).NLR had an area under the ROC curve(AUC)of 0.700(95%CI:0.656-0.742,P<0.001)in predicting non-MAP;ApoA-I had an AUC of 0.684(95%CI:0.640-0.726,P<0.001)in predicting non-MAP;NLR combined with ApoA-I had an AUC of 0.748(95%CI:0.706-0.787,P<0.001)in predicting non-MAP.NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting non-MAP(Z=3.439 and 2.462,both P<0.05).NLR had an AUC of 0.752(95%CI:0.710-0.791,P<0.001)in predicting SAP;ApoA-I had an AUC of 0.797(95%CI:0.757-0.833,P<0.001)in predicting SAP;NLR combined with ApoA-I had an AUC of 0.857(95%CI:0.822-0.888,P<0.001)in predicting SAP.NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting SAP(Z=3.171 and 2.630,both P<0.05).Conclusion NLR combined with ApoA-I can be used as a good indicator for predicting the severity of AP in the early stage after admission.