NLR、LDH、WBC水平与合并脂肪肝的急性胰腺炎严重程度的相关性及对预后的预测价值

Correlation between the levels of NLR,LDH,WBC and the severity of acute pancreatitis with fatty liver and its prognostic value

目的分析中性粒细胞淋巴细胞比值(NLR)、乳酸脱氢酶(LDH)、白细胞计数(WBC)水平与合并脂肪肝的急性胰腺炎(AP)严重程度的相关性及其对预后的预测价值。方法选择2018年8月—2021年9月医院收治的182例合并脂肪肝的AP患者为研究对象,根据患者病情严重程度不同分为轻度组(92例)、中度组(53例)与重度组(37例)。入院时检测所有患者NLR、WBC、血清LDH水平,比较不同严重程度患者入院时NLR、WBC、血清LDH水平;入院28 d内,根据患者预后分为存活组与死亡组,收集存活组与死亡组的一般资料,以Logistic多因素回归法分析合并脂肪肝的AP患者入院28 d内死亡的影响因素,分析入院时NLR、WBC、血清LDH水平对合并脂肪肝的AP患者入院28 d内死亡的预测价值。结果重度组入院时NLR、WBC、血清LDH水平高于中度组、轻度组(P<0.05),中度组入院时NLR、WBC、血清LDH水平高于轻度组(P<0.05);182例患者中,入院28 d内死亡38例,死亡率为20.88%,存活144例。死亡组病情严重程度为重度例数占比、入院时急性生理与慢性健康评分(APACHEⅡ)评分、降钙素原(PCT)、NLR、WBC、血清LDH水平高于存活组(P<0.05)。Logistic多因素回归分析结果显示,病情严重程度为重度,入院时NLR、WBC、血清LDH水平为合并脂肪肝的AP患者入院28 d内死亡的危险因素(P<0.05)。入院时NLR、WBC、血清LDH水平预测合并脂肪肝的AP患者入院28 d内死亡的曲线下面积(AUC)分别为0.777、0.763、0.826(P<0.05)。结论入院时NLR、WBC、血清LDH水平与合并脂肪肝的AP患者病情严重程度密切相关,且可作为临床评估预后的重要指标。

Objective To analyze the correlation between neutrophil lymphocyte ratio(NLR),lactate dehydrogenase(LDH),white blood cell count(WBC)levels and the severity of acute pancreatitis(AP)with fatty liver and its prognostic value.Methods A total of 182 AP patients with fatty liver who were admitted to the hospital from March2017 to April 2021 were selected as the research objects.According to the severity of the patient’s condition,they were divided into mild group(92 cases),moderate group(53 cases)and severe group(37 cases).NLR,WBC,and serum LDH levels in all patients were tested on admission.NLR,WBC,and serum LDH levels were compared when patients with different severity levels were admitted to the hospital.Within 28 days after admission,the patients were divided into survival group and death group according to the prognosis.General data of the survival group and the death group were collected.The logistic multivariate regression method was used to analyze the influencing factors of death within 28 days of admission for AP patients with fatty liver.The predictive value of NLR,WBC and serum LDH levels on admission to death within 28 days of admission in AP patients with fatty liver was analyzed.Results The levels of NLR,WBC,and serum LDH in the severe group were higher than those in the moderate group and mild group(P<0.05).The levels of NLR,WBC and serum LDH in the moderate group were higher than those in the mild group(P<0.05).Of the 182 patients,38 died within 28 days of admission,the mortality rate was 20.88%,and144 survived.The severity of illness in the death group was the proportion of severe cases,the acute physiology and chronic health score(APACHEⅡ)score at admission,procalcitonin(PCT),NLR,WBC,and serum LDH levels were higher than those in the survival group(P<0.05).Logistic multivariate regression analysis showed that the severity of the disease,NLR,WBC,and serum LDH levels at admission were risk factors for death within 28 days of admission for AP patients with fatty liver(P<0.05).The area under the curve(AUC)values of NLR,WBC and serum LDH levels on admission to predict the death of AP patients with fatty liver within 28 days of admission were 0.777,0.763,and 0.826,respectively(P<0.05).Conclusion NLR,WBC,and serum LDH levels at admission are closely related to the severity of AP patients with fatty liver,and can be used as important indicators for clinical evaluation of the prognosis of AP patients with fatty liver.