血清淀粉样蛋白A联合APACHEⅡ评分对急性胰腺炎预后的预测价值

Predictive value of serum amyloid A combined with APACHEⅡscore for prognosis of acute pancreatitis

目的探究血清淀粉样蛋白A(SAA)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对急性胰腺炎预后的预测价值。方法选取阜阳市第二人民医院2020年1月—2021年10月接诊的103例急性胰腺炎患者作为研究对象,收集患者的病历资料,并于患者入院后24 h(治疗前)内检测血清SAA水平,并评估APACHEⅡ评分,根据患者预后转归情况将其分为预后良好组和预后不佳组。采用Logistic多因素回归分析急性胰腺炎患者预后不佳的相关因素。以受试者工作特征曲线(ROC)判定APACHEⅡ评分及血清SAA水平对重症急性胰腺患者预后不佳的预测价值。结果本研究103例急性胰腺炎患者中,预后不佳组13例(12.61%);预后良好组90例(87.38%)。预后不佳组合并胆囊结石或胆总管结石、膀胱压>25 mmHg所占比例及APACHEⅡ评分、血清SAA水平均高于预后良好组,差异有统计学意义(P<0.05)。Logistic多因素回归分析结果显示,合并胆囊结石或胆总管结石、膀胱压>25 mmHg、APACHEⅡ评分及血清SAA表达水平偏高均为急性胰腺炎患者预后不佳的相关因素(P<0.05)。ROC分析显示,APACHEⅡ评分及血清SAA水平单一及联合对重症急性胰腺患者预后不佳的ROC预测的曲线下面积(AUC)分别为0.730、0.761、0.865,且APACHEⅡ评分及血清SAA水平单一对重症急性胰腺患者预后不佳的预测效能低于联合(P<0.05)。结论APACHEⅡ评分较高及血清SAA表达水平偏高的急性胰腺炎患者更易表现预后不佳,且APACHEⅡ评分及血清SAA表达水平均对急性胰腺炎具有一定的临床预测效能。

Objective To explore the predictive value of serum amyloid A combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ)score for the prognosis of acute pancreatitis.Methods A total of 103 patients with acute pancreatitis admitted to the Second People’s Hospital of Fuyang City from January 2020 to October 2021 were selected as the research subjects,the medical records of the patients were collected,and serum SAA was detected within 24 hours after the patients were admitted to the hospital(before treatment).The APACHEⅡscore was assessed,and the patients were divided into a good prognosis group and a poor prognosis group according to the prognosis of the patients.Logistic multivariate regression analysis was used to analyze the related factors of poor prognosis in patients with acute pancreatitis.The receiver operating characteristic curve(ROC)was used to determine the predictive value of APACHEⅡscore and serum SAA level for poor prognosis in patients with severe acute pancreas.Results 90 of the103 patients with acute pancreatitis were with good prognosis(87.38%),and 13 with poor prognosis(12.61%).The proportion of patients with gallstones or choledocholithiasis,bladder pressure>25 mmHg,high APACHEⅡscore,and high SAA level in the poor prognosis group were all significantly higher than those in the good prognosis group(all P<0.05).Logistic multivariate regression analysis showed that combination of gallbladder stones or common bile duct stones,bladder pressure>25 mmHg,high APACHEⅡscore,and high SAA expression levels were all related factors for the poor prognosis of patients with acute pancreatitis(all P<0.05).ROC analysis showed that the AUC levels of single APACHEⅡscore,single SAA level,and the combined of the two for the poor prognosis of severe acute pancreatic patients were 0.730,0.761,and 0.865 respectively.The predictive power for poor prognosis of combination of APACHEⅡscore and SAA was significantly higher than that of single APACHEⅡscore and that of single SAA(both P<0.05).Conclusion Acute pancreatitis patients with high APACHEⅡscore and high SAA expression level are more likely to have a poor prognosis,and APACHEⅡscore and serum SAA expression level have certain clinical predictive power for acute pancreatitis.