CT分级联合血清miR-29c对重症急性胰腺炎预后评估的研究

Study on evaluation of CT grading combined with serum miR-29c in the prognosis of severe pancreatitis

目的探讨CT分级联合血清微小RNA-29c对重症急性胰腺炎(SAP)预后的评估作用。方法回顾性选取2014年6月至2019年11月于西部战区总医院就诊的SAP患者165例,根据患者预后分为生存组(n=91)和死亡组(n=74)。收集患者CT影像学资料,采用实时荧光定量聚合酶链式反应(qRT-PCR)法检测2组血清miR-29c水平,采用Logistic回归分析影响SAP患者死亡的危险因素,采用受试者工作特征曲线(ROC)分析CT分级联合血清miR-29c对SAP不良预后的预测价值。结果死亡组D级患者所占比例(24.32%)显著低于生存组(79.12%),E级患者所占比例(75.68%)显著高于生存组(20.88%),差异有统计学意义(P<0.05)。死亡组SAP患者血清miR-29c水平(1.04±0.24)低于生存组(2.41±0.72),差异有统计学意义(P<0.05)。Logistic回归分析结果显示,急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、Balthazar CT分级、血清miR-29c均是影响SAP患者死亡的独立危险因素(P<0.05);ROC曲线显示,CT分级及血清miR-29c预测SAP不良预后的曲线下面积为0.774、0.873,两者联合预测的曲线下面积为0.896,敏感度与特异度分别为90.1%、94.6%。结论CT分级、血清miR-29c均是影响SAP患者死亡的独立危险因素,应用CT分级联合血清miR-29c共同评估SAP患者的预后具有一定临床指导意义。

Objective To evaluate the effect of CT grading combined with serum microRNA-29c in the evaluation of prognosis of severe pancreatitis(SAP).Methods From June 2014 to November 2019,165 SAP patients treated at the General Hospital of Western Theater Command were retrospectively selected.According to the prognosis of the patients,they were divided into(n=91)the survival group and(n=74)the death group.CT imaging data were collected,the level of miR-29c in serum of each group was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR),Logistic regression was used to analyze the risk factors of SAP patients'death,and receiver operating characteristic curve(ROC)was used to analyze the prognostic value of CT grading combined with serum miR-29c in SAP.Results The proportion of grade D patients in the death group(24.32%)was significantly lower than that of the survival group(79.12%),and the proportion of grade E patients(75.68%)was significantly higher than that of the survival group(20.88%).The difference was statistically significant(P<0.05).The serum miR-29c level of SAP patients in the death group(1.04±0.24)was lower than that in the survival group(2.41±0.72),and the difference was statistically significant(P<0.05).The results of Logistic regression analysis showed that APACHEⅡscore,Balthazar CT grade and serum miR-29c were all independent risk factors of SAP death(P<0.05);ROC curve showed that the area under the curve of CT grading and serum miR-29c in predicting the poor prognosis of SAP was 0.774 and 0.873,and the area under the curve of combining the two was 0.896,the sensitivity and specificity were 90.1%and 94.6%respectively.Conclusion CT grading and serum miR-29c are the independent risk factors of SAP patients'death,and the application of CT grading combined with serum miR-29c has a certain clinical significance in evaluating the prognosis of SAP patients.