血肌酐、尿素、血清钙离子对急性高甘油三酯性胰腺炎严重程度的诊断价值

Diagnostic value of serum creatinine,urea and serum calcium ions in severity of acute hypertriglyceride pancreatitis

目的探讨血肌酐、尿素、血清钙离子对急性高甘油三酯性胰腺炎(AHTGP)严重程度的诊断价值。方法选取2016年6月至2020年6月贵港市人民医院消化内科收治的72例AHTGP患者作为研究对象,按照严重程度分为轻症组(40例)与中重度组(32例)。对两组入院血肌酐、尿素、血清钙离子水平差异进行评估,并比较两组入院时单独应用血清钙离子、尿素、血肌酐或联合使用对于非轻症胰腺炎诊断效能、特异度、灵敏度,以受试者工作特征(ROC)曲线分析各指标对于AHTGP的诊断价值。结果两组患者的性别、年龄、体重指数(BMI)、住院天数、总费用、血淀粉酶、脂肪酶、超敏C反应蛋白、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、肌酐、尿素、是否吸烟、饮酒、糖尿病史和疗效比较,差异均无统计学意义(P>0.05);中重度组有并发症的比例高于轻症组,中重度组的血清钙离子低于轻症组,差异有统计学意义(P<0.05)。尿素氮、血清钙离子、血肌酐、尿素联合肌酐、肌酐联合血清钙离子和尿素联合血清钙离子ROC曲线下面积(AUC)值分别是0.596、0.711、0.571、0.596、0.709和0.755。各指标单一使用或联合使用预测非轻症胰腺炎均有良好价值,其中尿素氮灵敏度最高,为90.6%;肌酐与血清钙离子联合诊断的特异度为97.5%;尿素与血清钙离子联合约登指数最大,为0.444;血肌酐、尿素氮和尿素联合肌酐的AUC比较,差异无统计学意义(P>0.05)。结论入院时的血清钙离子、肌酐、尿素指标可预测AHTGP的严重程度,为临床诊治患者病情提供有效依据和参考,临床上值得推广使用。

Objective To investigate the diagnostic value of serum creatinine,urea and serum calcium ions on the severity of acute hypertriglyceride pancreatitis(AHTGP).Methods A total of 72 AHTGP patients admitted to the Department of Gastroenterology,Guigang People's Hospital from June 2016 to June 2020 were selected as the study objects,and were divided into mild group(40 cases)and moderate and severe group(32 cases)according to the severity.The differences in serum creatinine,urea and serum calcium ions levels between the two groups were evaluated,and the diagnostic efficacy,specificity and sensitivity of serum calcium ions,urea and serum creatinine alone or combined in the diagnosis of non-mild pancreatitis were compared between the two groups at admission.The diagnostic value of each indicator for AHTGP was analyzed by receiver operating characteristic(ROC)curve.Results There were no significant differences in gender,age,body mass index(BMI),length of hospital stay,total cost,blood amylase,lipase,hypersensitive C-reactive protein,alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,urea,smoking status,drinking status,diabetes history and efficacy between the two groups(P>0.05).The proportion of complications in the moderate and severe group was higher than that in the mild group,and the serum calcium ions in the moderate and severe group were lower than those in the mild group,the differences were statistically significant(P<0.05).The area under ROC curve(AUC)values of urea nitrogen,serum calcium ion,serum creatinine,urea combined with creatinine,creatinine combined with serum calcium ion and urea combined with serum calcium ion were 0.596,0.711,0.571,0.596,0.709 and 0.755,respectively.The single or combined use of all indexes had good value in predicting non-mild pancreatitis,and urea nitrogen sensitivity was the highest(90.6%).The specificity of creatinine combined with serum calcium ions was 97.5%.The combined Yoden index of urea and serum calcium was 0.444.There was no significant difference in the AUC of serum creatinine,urea nitrogen and urea combined creatinine(P>0.05).Conclusion The serum calcium ions,creatinine and urea indexes on admission can predict the severity of AHTGP,and provide effective basis and reference for clinical diagnosis and treatment of patients'conditions.It is worth promoting and using in clinic.