NLR和PLR以及CAR联合血清胱抑素C对急性胰腺炎合并急性肾损伤的预测价值

The predicitive value of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio and C-reactive protein/albumin ratio and serum cystatin C for acute pancreatitis with acute kidney injury

目的:探索中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)、C反应蛋白/白蛋白(CAR)联合血清胱抑素C(Cys C)对急性胰腺炎(AP)并发急性肾损伤(AKI)的预测价值。方法:回顾性分析2016年4月-2021年4月期间在四川省绵阳市中心医院住院治疗的393例AP患者的临床资料,其中328例患者未合并AKI(非AKI组),65例患者合并AKI(AKI组)。收集所有患者的病例资料、临床指标并进行统计学分析。结果:性别、氯离子、血小板计数(PLT)、淀粉酶(AMY)、脂肪酶(LPS)组间相比差异无统计学意义(P>0.05);年龄、血肌酐(SCr)、血尿素氮(BUN)、尿酸(UA)、估算肾小球滤过率(eGFR)、钙离子、Cys C、C反应蛋白(CRP)、白蛋白(Alb)、白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、NLR、PLR、CAR、红细胞比容(HCT)组间比较差异均有统计学意义(P<0.05)。二元Logistic回归分析发现,NLR、PLR、CAR、Cys C是AP合并AKI的重要影响因素(P<0.05)。ROC曲线结果显示NLR预测AP合并AKI的曲线下面积为0.867,特异度为0.692,敏感度为0.923。PLR预测AP合并AKI的曲线下面积为0.741,特异度为0.720,敏感度为0.677。CAR预测AP合并AKI的曲线下面积为0.843,特异度为0.851,敏感度为0.785。Cys C预测AP合并AKI的曲线下面积为0.954,特异度为0.942,敏感度为0.862。结论:Cys C、CAR、NLR、PLR在预测AP患者并发AKI中具有重要的预测价值,有一定的临床意义。

Objective:To explore the predictive value of neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),C-reactive protein/albumin ratio(CAR)and serum cystatin C(Cys C)in acute pancreatitis(AP)with acute kidney injury(AKI).Methods:The clinical data of 393 patients with AP hospitalized in Mianyang Central Hospital from April 2018 to April 2021 were analyzed retrospectively.Among them,328 patients did not have AKI(non-AKI group),and 65 patients had AKI(AKI group).The case data and clinical indexes of all patients were collected and statistically analyzed.Results:There was no significant difference between the two groups in gender,chloride ion,platelet(PLT),amylase(AMY)and lipase(LPS)(P>0.05).There were significant differences between the two groups in age,serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA),estimated glomerular filtration rate(eGFR),calcium ion,Cys C,C-reactive protein(CRP),albumin(Alb),white blood cell(WBC),neutrophil(NEUT),lymphocyte(LYM),NLR,PLR,CAR,and hematocrit(HCT)(P<0.05).The analysis of binary Logistic regression found that,NLR,PLR,CAR and Cys C are the important influencing factors of AP merging AKI(P<0.05).NLR had an area under the ROC curve of 0.867,a specificity of 0.692 and a sensitivity of 0.923 in predicting AKI in patients with AP.PLR had an area under the ROC curve of 0.741,a specificity of 0.720 and a sensitivity of 0.677 in predicting AKI in patients with AP.CAR had an area under the ROC curve of 0.843,a specificity of 0.851 and a sensitivity of 0.785 in predicting AKI in patients with AP.Cys C had an area under the ROC curve of 0.954,a specificity of 0.942 and a sensitivity of 0.862 in predicting AKI in patients with AP.Conclusion:NLR,PLR,CAR and Cys C have important predictive value and clinical significance in predicting AKI in patients with AP.