CT评价系统联合白蛋白/纤维蛋白原比值对重症急性胰腺炎预后评估的价值

The value of CT evaluation system combined with albumin/fibrinogen ratio in prognostic evaluation of severe acute pancreatitis

目的 探究改良CT严重指数(MCTSI)评分、Balthazar CT分级联合白蛋白/纤维蛋白原比值在重症急性胰腺炎预后评估中的作用。方法 选取2019年1月至2020年6月长江大学附属黄冈市中心医院224例重症急性胰腺炎病人为研究对象,依据院内治疗结果分为死亡组59例和生存组165例。记录入院急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)等一般资料;采用全自动生化分析仪测定血清白蛋白水平,采用全自动凝血分析仪测定纤维蛋白原水平,计算白蛋白/纤维蛋白原比值;采用CT机完成腹部CT检查,进行MCTSI评分和Balthazar CT分级评估;分析MCTSI评分、Balthazar CT分级联合白蛋白/纤维蛋白原比值对重症急性胰腺炎预后的评估价值;分析影响重症急性胰腺炎预后的因素。结果 死亡组纤维蛋白原水平[(4.51±1.04)g/L]、MCTSI评分[(6.18±0.76)分]、Balthazar CT分级[(3.80±0.20)分]、入院APACHEⅡ[(29.03±5.54)分]、机械通气病人比例、肾脏替代治疗病人比例高于生存组[(3.72±0.98)g/L、(5.26±0.74)分、(3.30±0.38)分、(23.17±5.28)分],白蛋白水平[(27.61±4.52)U/L]、白蛋白/纤维蛋白原比值(6.13±1.95)低于生存组[(34.82±4.63)U/L、(9.36±2.56)](P<0.05)。MCTSI评分、Balthazar CT分级、白蛋白/纤维蛋白原比值及其联合预测重症急性胰腺炎预后的曲线下面积(AUC)分别为0.85、0.81、0.84、0.93,且单独预测AUC均小于联合预测AUC(Z=2.64、3.15、2.96,P<0.05)。MCTSI评分、白蛋白/纤维蛋白原比值是重症急性胰腺炎病人死亡的影响因素(P<0.05)。结论 CT评价系统联合白蛋白/纤维蛋白原比值预测重症急性胰腺炎病人死亡的价值较高。

Objective To explore the role of modified CT severity index(MCTSI) score,Balthazar CT grading combined with albumin/fibrinogen ratio in the prognosis assessment of severe acute pancreatitis.Methods A total of 224 patients with severe acute pancreatitis in our hospital were the research objects.According to the results of in-hospital treatment,they were divided into 59 cases in the death group and 165 cases in the survival group.The general information was recorded,such as the Acute Physiology and Chronic Health Status Score Ⅱ(APACHE Ⅱ) on admission;an automatic biochemical analyzer was used to determine the serum albumin level,an automatic coagulation analyzer was used to determine the level of fibrinogen and calculate the albumin/fibrinogen ratio;CT machine was used to complete abdominal CT examination and perform the MCTSI score and Balthazar CT grading assessment;the evaluation value of MCTSI score,Balthazar CT grading combined with albumin/fibrinogen ratio for the prognosis of severe acute pancreatitis was analyzed;the factors affecting the prognosis of severe acute pancreatitis were analyzed.Results The fibrinogen level [(4.51±1.04) g/L],MCTSI score [(6.18±0.76) score],Balthazar CT classification [(3.80±0.20) score],admission APACHE Ⅱ [(29.03±5.54) score],the proportion of mechanically ventilated patients,and the proportion of renal replacement therapy patients in the death group were higher than those in the survival group [(3.72±0.98) g/L,(5.26±0.74) score,(3.30±0.38) score,(23.17±5.28) score],and the albumin level [(27.61±4.52) U/L] and albumin/fibrinogen ratio(6.13±1.95) were lower than those in the survival group [(34.82±4.63) U/L,(9.36±2.56) ](P0.05).The area under the curve(AUC) of MCTSI score,Balthazar CT classification,albumin/fibrinogen ratio and their combination for predicting the prognosis of severe acute pancreatitis was 0.85,0.813,0.84 and 0.93,respectively,and the AUC of single prediction was less than the AUC of combined prediction(Z=2.64,3.15,2.96,P0.05).The MCTSI score and albumin/fibrinogen ratio was the influencing factors for death in patients with severe acute pancreatitis(P0.05).Conclusion CT evaluation system combined with albumin/fibrinogen ratio is of higher value in predicting the death of patients with severe acute pancreatitis.