急性胰腺炎发病早期血清C-反应蛋白水平影响因素分析

Analysis of influence factors of serum CRP level in early onset of acute pancreatitis

目的:探讨急性胰腺炎(Acute pancreatitis,AP)患者发病早期C-反应蛋白(C-reactive protein,CRP)水平的影响因素,为临床以早期CRP水平评价AP严重程度提供实验依据。方法:选取2017年12月至2020年5月间在我院收治的325例AP患者为研究对象。详细记录患者一般信息、既往疾病信息、AP病因及患者发病开始第1、2、3 d的CRP水平以及患者住院期间的CRP最高值(分别标记为CRPd1、CRPd2、CRPd3和CRPmax)。参照急性胰腺炎CT严重程度指数对研究对象的胰腺炎程度进行分级,以患者肝/脾CT值比值作为评价患者脂肪肝程度的指标。采用单因素方差分析法对AP患者早期CRP水平进行比较分析,采用多因素方差分析法分析影响AP患者早期CRP水平的主要因素。结果:患者AP严重程度是影响CRPd3和CRPmax的主要因素。中重度AP患者的CRPd2、CRPd3和CRPmax均高于轻度者(P<0.01)。病因是影响AP患者前2 d血清CRP水平的主要因素。酒精性AP患者的CRPd1高于其它病因者(P<0.05),高脂血症性AP患者CRPd2水平高于其它病因者(P<0.01),胆石症性AP患者的CRPd1和CRPd2均低于其它病因者(P<0.01)。此外,是否存在既往慢性病也是影响AP患者血清CRP水平的主要因素,既往患有慢性疾病的AP患者其CRPd3及CRPmax均高于既往无慢性疾病者(P<0.05)。结论:AP发病前2 d血清CRP水平受到病因的影响,以AP发病3 d后的CRP水平来评价胰腺炎的严重程度更加可靠,但仍需考虑到既往慢性疾病对CRP水平的可能影响。

Objective:To explore the influence factors for early C-reactive protein(CRP)level in patients with acute pancreatitis(AP),so as to provide experimental evidence for clinical evaluation of AP severity on the basis of early CRP level.Methods:A total of 325 patients with AP admitted to our hospital from December 2017 to May 2020 were taken as research objects.Patients general and previous disease information,AP etiology,CRP level at the first(CRPd1),second(CRPd2)and third day(CRPd3)after the onset of the disease,and the highest CRP value(CRPmax)during the hospitalization were recorded in detail.The severity of pancreatitis was graded according to the CT severity index of pancreatitis(CTSI),and the CT value ratio of liver/spleen was used as the index to evaluate the degree of fatty liver in patients.Single-factor ANOVA was used to compare and analyze the early CRP level of AP patients,and multi-factor ANOVA was used to analyze the main factors affecting the early CRP level of AP patients.Results:The severity of AP was the main factor that affected the CRPd3 and CRPmax(P<0.01).The CRPd2,CRPd3 and CRPmax in patients with moderate and severe AP were significantly higher than those with mild symptoms(P<0.01).Etiology is the main factor affecting the CRPd1 and CRPd2 of AP patients.The serum CRPd1 of patients with alcoholic AP was significantly higher than that of patients with other causes(P<0.05),the CRPd2 of hyperlipidemic AP patients was significantly higher than that of patients with other causes(P<0.01),and the CRPd1 and CRPd2 of biliary AP patients was significantly lower than those of patients with other causes(P<0.01).In addition,the existence of previous chronic diseases was also a major factor that affecting the serum CRP level of AP patients.The serum CRPd3 and CRPmax of patients with previous chronic diseases were significantly higher than those without(P<0.05).Conclusion:Serum CRP level of first two days after the onset of AP is mainly affected by etiology.It is more reliable to evaluate the severity of pancreatitis with CRP level on 3rd days after the onset of AP,but the possible influence of previous chronic diseases on CRP level still needs to be considered.