重症胰腺炎患者早期营养指标监测及预后评估分析

Early nutritional index monitoring and prognosis evaluation in patients with severe pancreatitis

目的探讨重症胰腺炎(SAP)患者早期营养指标监测及预后评估。方法选取2019年3月至2022年3月菏泽市立医院收治的145例SAP患者为研究组,另选取同时期来该院进行体检的98例健康志愿者为对照组。比较两组营养指标[血清清蛋白(ALB)、转铁蛋白(TRF)、前清蛋白(PA)]水平。研究组患者根据住院期间预后情况分为存活组和死亡组,比较存活组和死亡组患者血清ALB、TRF、PA水平及其他因素。Logistic回归分析法明确影响SAP患者发生死亡的危险因素,并绘制受试者工作特征(ROC)曲线分析血清ALB、TRF、PA水平对SAP患者发生死亡的预测价值。结果研究组血清ALB、TRF、PA水平低于对照组,差异有统计学意义(P<0.05)。死亡组腹水、多器官功能衰竭、休克的占比,急性生理学与慢性健康状况系统Ⅱ(APACHEⅡ)评分水平高于存活组,差异有统计学意义(P<0.05),ALB、TRF、PA水平低于存活组,差异有统计学意义(P<0.05)。Logistic回归分析显示,腹水、多器官功能衰竭、APACHEⅡ评分、ALB、TRF、PA水平均是影响影响SAP患者发生死亡的危险因素(P<0.05)。ROC曲线分析显示,血清ALB、TRF、PA水平联合预测SAP患者发生死亡的灵敏度、曲线下面积(AUC)分别为91.23%、0.846均高于各指标的单独预测,差异有统计学意义(P<0.05)。结论血清ALB、TRF、PA水平在SAP患者体内表达异常,是导致SAP患者发生死亡的危险因素,对SAP患者住院期间发生死亡具有较好的预测价值,且三者联合监测更有助于早期评估患者预后。

Objective To explore early nutritional index monitoring and prognosis evaluation in patients with severe pancreatitis(SAP).Methods One hundred and forty-five SAP patients admitted to Heze Municipal Hospital from March 2019 to March 2022 were selected as the research group,and 98 healthy volunteers who came to our hospital for physical examination during the same period were selected as the control group.Compare the levels of serum albumin(ALB),transferrin(TRF),and prealbumin(PA)between two groups of nutritional indicators.The study group patients were divided into survival and death groups based on the prognosis during hospitalization.The serum ALB,TRF,PA levels,and other factors were compared between the survival and death groups.Logistic regression analysis was used to identify the risk factors that affect the occurrence of death in SAP patients,and a receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum ALB,TRF,and PA levels on the occurrence of death in SAP patients.Results The serum levels of ALB,TRF and PA in the study group were lower than those in the control group(P<0.05).The proportions of ascites,multiple organ failure,and shock in the death group,the acute physiology and chronic health status II(APACHE II)score were higher than those in the survival group(P<0.05),and the levels of ALB,TRF and PA were lower than those in the survival group(P<0.05).Logistic regression analysis showed that ascites,multiple organ failure,APACHE II score,ALB,TRF and PA levels were all risk factors affecting the death of SAP patients(P<0.05).ROC curve analysis showed that the combined sensitivity and AUC of serum ALB,TRF,and PA levels in predicting death in SAP patients were 91.23%and 0.846,respectively,which were higher than those of each index alone(P<0.05).Conclusion The abnormal expression of serum ALB,TRF and PA levels in SAP patients is a risk factor leading to the death of SAP patients.It has good predictive value for the death of SAP patients during hospitalization,and the combined monitoring of the three is more helpful to early evaluate the prognosis of patients.