血清PCT、NLR及CRP水平与急性胰腺炎严重程度的相关性

Analysis of correlation between serum PCT,NLR and CRP levels and severity of acute pancreatitis

目的分析血清降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)及C-反应蛋白(CRP)水平与急性胰腺炎(AP)严重程度的相关性。方法选择2019年8月~2020年2月我院收治的108例AP患者设为AP组,并根据其多器官功能不全评分(Marshall评分)分为轻症组(n=51)、中症组(n=36)和重症组(n=21),另选取同期体检的30例健康人群设为对照组。检测各组血清PCT、NLR、CRP水平,分析其与患者病情严重程度的相关性,并采用受试者工作特征曲线(ROC)分析血清PCT、NLR、CRP对AP的诊断价值。结果AP组血清PCT、NLR、CRP水平明显高于对照组(P<0.05);随着AP患者病情严重程度的加重,血清PCT、NLR、CRP水平逐渐升高(P<0.05);相关性分析显示,AP患者血清PCT(r=0.551,P<0.001)、NLR(r=0.785,P<0.001)、CRP(r=0.538,P<0.001)与Marshall评分均呈显著正相关;血清PCT、NLR、CRP诊断AP的AUC依次为0.911(95%CI:0.832~0.989)、0.840(95%CI:0.756~0.923)、0.861(95%CI:0.762~0.960);以PCT>1.27 ng/mL、NLR>4.38、CRP>11.57 mg/L为最优截断值时,三者诊断的敏感度分别为77.78%、87.96%、62.04%,特异度依次为90.00%、70.00%、80.00%,三者联合诊断的灵敏度高于各指标单独检测(P<0.05)。结论血清PCT、NLR及CRP水平与AP的发生及其严重程度密切相关,三者联合检测对AP的诊断及评估具有较高的临床价值。

Objective To analyze the correlation between levels of serum procalcitonin(PCT),neutrophil-to-lymphocyte ratio(NLR)and C-reactive protein(CRP)and severity of acute pancreatitis(AP).Methods 108 AP patients were selected as AP group,and were divided into mild group(n=51),moderate group(n=36)and severe group(n=21),according to the multiple organ dysfunction score(Marshall score).Another 30 healthy people who had physical examination at the same time were selected as control group.The levels of serum PCT,NLR and CRP were detected in each group,and their correlation with disease severity was analyzed.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of serum PCT,NLR and CRP on AP.Results The levels of serum PCT,NLR and CRP in AP group were significantly higher than those in control group(P<0.05).As disease severity of AP patients worsened,the levels of serum PCT,NLR and CRP were gradually increased,and the differences between the groups were statistically significant(P<0.05).Correlation analysis showed that serum PCT(r=0.551 P<0.001),NLR(r=0.785,P<0.001)and CRP(r=0.538,P<0.001)in patients with AP had a significant positive correlation with the Marshall score.The AUC values of serum PCT,NLR and CRP in the diagnosis of AP were 0.911(95%CI:0.832-0.989),0.840(95%CI:0.756-0.923)and 0.861(95%CI:0.762-0.960).With PCT>1.27 ng/mL,NLR>4.38 and CRP>11.57mg/L as the optimal cutoff value,the sensitivities of the three diagnosis were 77.78%,87.96%and 62.04%,and the specificities were 90.00%,70.00%and 80.00%,and the sensitivity(96.30%)of the combined diagnosis of the three was higher than that of each index(P<0.05).Conclusion Serum PCT,NLR and CRP levels are closely related to the occurrence and severity of AP.The three have certain value in the diagnosis and evaluation of AP.