血清淀粉酶及肝损伤相关指标在急性胰腺炎病情评估中的应用

Application of serum amylase and liver injury-related indicators in the evaluation of disease severity of acute pancreatitis

目的 探究血清淀粉酶及肝损伤相关指标在急性胰腺炎(AP)病情评估中的应用价值。方法 选择2020年3月至2022年4月首都医科大学附属北京世纪坛医院收治的AP患者112例,根据病情状况分为轻症AP(MAP)组(n=62)、中度重症AP(MSAP)组(n=36)、重症AP(SAP)组(n=14),入院时均检测血清淀粉酶、肝损伤相关指标[白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)]水平,分析各指标评估SAP的效能。结果 三组血清淀粉酶水平比较差异无统计学意义(P>0.05),ALB:MAP组>MASP组>SAP组,ALT、AST、TBil:MAP组0.05;ALB水平与病情严重程度负相关(r=-0.446,P<0.05);ALT、AST、TBil水平与病情严重程度正相关(r=0.757,0.588,0.584,P<0.05);肝损伤指标联合预测SAP的ROC曲线下面积为0.970(95%CI:0.919~0.993),敏感度、特异度均为92.86%,预测效能较单项指标提高。结论 血清淀粉酶与AP病情严重程度无关,ALB、ALT、AST、TBil水平均与AP病情严重程度相关,可用于预测SAP。

Objective To explore the application value of serum amylase and liver injury-related indicators in the disease severity evaluation of acute pancreatitis(AP). Methods A total of 112 patients with AP admitted to Beijing Shijitan Hospital,Capital Medical University from March 2020 to April 2022 were selected and divided into the MAP group(n=62),the MSAP group(n=36)and the SAP group(n=14)according to the disease severity status. The levels of serum amylase and liver injury-related indicators[albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)]were detected at admission,and the efficiency of each indicator on evaluating SAP was analyzed. Results There was no statistical significance in serum amylase level among the three groups(P>0.05). The ALB level was shown as MAP group>MASP group>SAP group,while the levels of ALT,AST and TBil were manifested as MAP group 0.05. ALB level was negatively correlated with disease severity(r=-0.446,P<0.05),and the levels of ALT,AST and TBil were positively correlated with the disease severity(r=0.757,0.588,0.584,P<0.05). The area under the ROC curve,sensitivity,and specificity of combination of liver injury indicators in predicting SAP were 0.970(95%CI:0.919-0.993),92.86% and 92.86%,and its predictive efficiency was higher than that of each indicator alone. Conclusion Serum amylase is not related to the disease severity of AP,and the levels of ALB,ALT,AST and TBil are all correlated with the disease severity of AP,which can be used to predict the SAP.