C反应蛋白、白细胞介素-6和降钙素原对急性胰腺炎严重程度的早期评估价值

C-Reactive Protein,Interleukin-6 and Procalcitonin in Early Assessment of Severity of Acute Pancreatitis

背景:急性胰腺炎(AP)是临床常见急腹症,重症AP(SAP)病情进展迅速,可导致全身炎症反应综合征、多器官功能衰竭甚至死亡。早期识别重症患者并及时采取有效治疗措施可改善预后,降低病死率。目的:探讨C反应蛋白(CRP)、白细胞介素-6(IL-6)和降钙素原(PCT)单项或联合检测在病程早期对AP严重程度的预测价值。方法:回顾性纳入上海交通大学医学院附属第一人民医院2018年1月-2020年12月收治的472例AP患者,采集入院48 h内实验室指标,并根据2012年修订版亚特兰大分类标准分为轻症AP(MAP)组和SAP组[包括中度SAP(MSAP)和SAP]。比较两组间CRP、IL-6、PCT水平的差异,以ROC曲线分析三项指标单项或联合检测对SAP的预测价值。结果:SAP组CRP、IL-6、PCT水平均明显高于MAP组,差异有统计学意义(P均<0.05)。ROC曲线分析显示,三项指标单项、两两联合和三项联合检测预测SAP的曲线下面积(AUC)均>0.7,具有一定的诊断准确性;三项联合检测诊断准确性最高(AUC=0.826),敏感性和特异性分别为71.4%和79.3%。结论:CRP、IL-6和PCT检测可用于AP病情严重程度的早期评估,三项联合检测预测SAP的总体诊断价值最优。

Background: Acute pancreatitis(AP) is a common acute abdominal disease in clinical practice. Severe AP(SAP) usually progresses rapidly, leading to systemic inflammatory response syndrome, multiple organ failure, and even death. Early identification of severe cases with timely and effective treatment can improve patient’s prognosis and reduce mortality. Aims: To explore the value of single and combined detection of C-reactive protein(CRP), interleukin-6(IL-6) and procalcitonin(PCT) in the early assessment of severity of AP. Methods: A total of 472 AP patients hospitalized in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2020 were enrolled retrospectively. The laboratory data within 48 h of admission were extracted, and the patients were allocated into mild AP(MAP) group and SAP group(including moderately severe and severe AP) according to the 2012 revised Atlanta classification. The differences of CRP, IL-6 and PCT between the two groups were statistically analyzed, and the value of single and combined detection of the three indicators for predicting the disease severity was determined by ROC curve analysis. Results: The levels of CRP, IL-6 and PCT in SAP group were significantly higher than those in MAP group(all P< 0.05). ROC curve analysis revealed that the area under the curve(AUC) of single, two and three indicators combined for predicting SAP was all higher than 0.7, which represented a moderately diagnostic accuracy. Three indicators combined demonstrated the highest diagnostic accuracy(AUC=0.826);with an optimal cut-off value, the sensitivity and specificity were 71.4% and 79.3%, respectively. Conclusions: CRP, IL-6 and PCT are meaningful in early assessment of severity of AP. The overall diagnostic value of combined detection of three indicators is superior to single and two indicators combination in predicting SAP.