POP评分联合D-二聚体及前白蛋白对急性胰腺炎严重程度评估价值的研究

The clinical value of POP scoring systems combined with D-Dimer and prealbumin in predicting severity in patients with acute pancreatitis

目的探讨胰腺炎结局预测(Pancreatitis Outcome Prediction,POP)评分联合D-二聚体(D-Dimer,D-D)、前白蛋白(Prealbumin,PA)对于急性胰腺炎疾病严重程度的预测价值。方法选取165例AP患者的临床资料,其中轻症胰腺炎(MAP组)46例,中度重症急性胰腺炎(MSAP组)49例、重症胰腺炎(SAP组)70例,比较三组白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、肌酐、尿素氮、白蛋白、D-D、PA等指标及POP评分、APACHEII评分、改良Marshall评分、器官衰竭发生率及腹腔感染率等差异;根据POP评分是否≥6分,将AP患者分组,比较两组的一般指标及APACHEII评分、改良Marshall评分及器官衰竭、胰腺坏死率差异;绘制受试者工作特征曲线(ROC),分析D-D、PA、POP评分、APACHEII评分、POP评分联合D-D、PA对于AP疾病严重程度的预测价值。结果比较MAP、MSAP和SAP三组中D-D、血钙、POP评分、APACHEII评分、改良Marshall评分及器官衰竭发生率,差异均有统计学意义(P均<0.05);比较POP评分2组中年龄、CRP、肌酐、尿素氮、总胆红素、Ca、D-D、PA、APACHEI评分、器官衰竭发生率及胰腺坏死率均具有差异(P均<0.05);D-D、PA、POP评分、A-PACHEI评分、POP评分联合D-二聚体、PA预测AP严重程度的AUC分别为0.793(0.715~0.871)、0.726(0.629~0.822)、0.763(0.672~0.853)、0.849(0.767~0.931)0.865(0.806~0.924),具有统计学差异(P均<0.001)。结论POP评分系联合D-D、PA可早期用于AP疾病严重程度的评估,对改善预后具有重要指导意义。

Objective To investigate whether the results of POP scoring systems combined with serum D-Dimer(D-D)and prealbumin(PA)can evaluate the severity of acute pancreatitis.Methods The clinical data of 165 patients with AP were enrolled retrospectively and divided into the mild acute pancreatitis(MAP),moderately severe acute pancreatitis(MSAP),and severe acute pancreatitis(SAP)groups.WBC,CRP,PCT,CRE,BUN,albumin,D-D,PA,POP score,APACHE II score,modified Marshall score,organ failure rate and abdominal infection rate among the three groups were compared.AP patients were divided into two groups according to whether the POP score was≥6 points.The clinical parameters and POP score,APACHE II score and modified Marshall score between the two groups were compared.The receiver operating characteristic curve was employed to analyze the value of D-D,PA,POP score,APACHE II score,POP score combined D-D and PA for the severity of AP.Results D-D,Ca,POP score,APACHE II score,modified Marshall score and organ failure rate had significant difference among the three groups(P<0.05),while age,CRP,CRE,BUN,TBIL,Ca,D-D,PA,APACHE II score,organ failure rate and pancreatic necrosis rate had significant difference between the two groups(P<0.05).ROC curves were generated to evaluate the predictive value of these factors,and the area under the curve for the D-D,PA,POP score,APACHE II score,POP score combined D-D and PA were 0.793,0.726,0.763,0.849 and 0.865(P<0.001),respectively.Conclusion POP score combined D-D and PA have high efficacy in predicting the severity of AP.It is of clinical value to detect the disease early and to improve the outcomes.