动态分析C-反应蛋白与白蛋白比值预测高脂血症性急性胰腺炎严重程度及预后的意义

Dynamic analysis of C-reactive protein to albumin ratio(CAR)in predicting severity and prognosis of hyperlipemia acute pancreatitis

目的动态分析C-反应蛋白与白蛋白比值(CAR)预测高脂血症性急性胰腺炎严重程度及预后的意义。方法选取2018年8月至2020年6月收治的142例AP患者。根据病因分为高脂血症性急性胰腺炎(HLAP)患者60例为观察组,非高脂血症性急性胰腺炎(NHLAP)患者82例为对照组。比较两组临床特征及观察组急性胰腺炎不同严重程度床边指数(BISAP)评分、CAR及降钙素原(PCT)水平比较。采用ROC曲线分析不同时间段CAR及BISAP评分对HLAP患者严重程度及预后的预测价值。结果观察组年龄低于对照组(P<0.05),观察组脂肪肝、糖尿病、胸腔积液均高于对照组(P<0.05),观察组血清CAR、PCT水平均高于对照组(P<0.05)。观察组入院第1、3、7天,中度重症组、重症组各时间点血清CAR水平均高于轻症组,且重症组血清CAR水平高于中重症组,差异有统计学意义(P<0.05)。血清CAR水平呈动态变化规律,在入院第3天时,血清CAR预测HLAP患者严重程度的有效性最高(曲线下面积:0.855,最佳截断值8.88)。提示当CAR值≥8.88时患者病情较重,预后不佳。结论CAR入院第3天预测HLAP患者严重程度的有效性最高,随着治疗时间的变化,CAR水平可以动态反映HLAP患者病情。

[Objective]To dynamically analyze C-reactive protein to albumin ratio(CAR)in predicting severity and prognosis of hyperlipemia acute pancreatitis.[Methods]A total of 142 AP patients were selected from August 2018 to June 2020.According to the etiology,60 cases of hyperlipidemia acute pancreatitis(HLAP)patients were divided into observation group,82 patients with non-hyperlipidemic acute pancreatitis(NHLAP)as control group.The clinical characteristics of the two groups and the BISAP score,CAR and PCT level in patients with different severity of acute pancreatitis in the observation group were compared.The ROC curve was used to analyze the predictive value of CAR and BISAP scores in different time periods on the severity and prognosis of HLAP patients.[Results]The age of the observation group was lower than that of the control group(P<0.05);fatty liver,diabetes mellitus and pleural effusion in the observation group were higher than those in the control group(P<0.05);the serum CAR level and PCT level in the observation group were higher than those in the control group(P<0.05).On the 1st,3rd and 7th day after admission of the observation group,serum CAR levels in moderate and severe group were higher than those in mild group,and the serum CAR level in the severe group was higher than that in the middle severe group,and the difference was statistically significant(P<0.05).The serum CAR level changed dynamically.On the third day of admission,the serum CAR was the most effective in predicting the severity of HLAP patients(AUC:0.855,the best cut-off value was 8.88).When the CAR value≥8.88,the patient's condition was serious and the prognosis was not good.[Conclusion]CAR at the third day of admission was the most effective in predicting the severity of HLAP patient.With the change of treatment time,the CAR level can reflect HLAP patient's condition dynamically.