C-反应蛋白/血清白蛋白联合D-二聚体预测急性胰腺炎严重程度的临床价值研究

CRP to albumin ratio and D-dimer as a predictor of severity in acute pancreatitis patients

目的探索C-反应蛋白(CRP)/血清白蛋白比值(CAR)及D-二聚体(D-dimer)联合应用对急性胰腺炎(AP)严重程度的预测价值。方法回顾性分析2020年1月至2021年12月在孝感市中心医院住院治疗的246例AP患者的临床资料,其中206例患者为非重症急性胰腺炎组,40例为重症急性胰腺炎组(SAP组),收集所有患者的病历资料、临床指标进行统计学分析。结果入院时的体温、呼吸频率、白细胞、淋巴细胞、血淀粉酶、谷丙转氨酶、谷草转氨酶、血脂肪酶、总胆红素组间比较差异无统计学意义(P>0.05),入院时的心率、中性粒细胞、D-二聚体、降钙素原、血肌酐、CRP、血尿素氮、血清白蛋白、血糖及CAR组间比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析发现,CAR、D-二聚体是SAP的重要预测因子(P<0.05)。入院时CAR与急性胰腺炎严重程度床边指数(BISAP)评分成正相关(r=0.370,P<0.05),D-二聚体与BISAP评分成正相关(r=0.445,P<0.05)。受试者工作特征(ROC)曲线结果显示,CAR预测SAP的曲线下面积为0.835(95%CI:0.770~0.901),灵敏度75.00%,特异度分别为85.9%;D-二聚体预测SAP的曲线下面积为0.809(95%CI:0.731~0.887),灵敏度为80%,特异度为71.4%;CAR、D-二聚体两者联合预测SAP的曲线下面积为0.891(95%CI:0.847~0.936),灵敏度为77.5%,特异度为87.4%。结论CAR、D-二聚体预测AP病情严重程度方面有着明显的优势,尤其当两者联合检测时其预测效能进一步增加。

【Objective】To explore the predictive value of C-reactive protein/serum albumin ratio(CAR)and D-dimer in the severity of acute pancreatitis.【Methods】A total of 246 acute pancreatitis patients who met the inclusion criteria were enrolled in the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2020 to December 2021.The patients were divided into 206 cases of non-severe acute pancreatitis and 40 cases of severe acute pancreatitis(SAP).The differences among the clinical indicators were compared.【Results】There were no significant difference in body temperature,respiratory rate,WBC,lymphocyte,blood amylase,alanine aminotransferase,aspartate aminotransferase,blood lipase and total bilirubin between groups(P>0.05).There were significant differences in the ratio of neutrophil,heart rate,D-dimer,PCT,serum creatinine,CRP,BUN,ALB,Glu and CAR between the two groups(P<0.05).Multivariate logistic regression analysis found that CAR and D-dimer were important predictors of SAP(P<0.05).CAR was positively correlated with BISAP scores on admission(r=0.370,P<0.05),and D-dimer was positively correlated with BISAP scores(r=0.445,P<0.05).CAR had an area under the ROC curve of 0.835(95%CI:0.770–0.901),a specificity of 0.859 and a sensitivity of 0.750 in acute severe pancreatitis.D-dimer had an area under the ROC curve of 0.809(95%CI:0.731-0.887),a specificity of 0.714 and a sensitivity of 0.080 in acute severe pancreatitis.CAR and D-dimer had an area under the ROC curve of 0.891(95%CI:0.847-0.936),a specificity of 0.874 and a sensitivity of 0.775 in acute severe pancreatitis.【Conclusion】CAR and D-dimer have clear advantages in predicting the SAP,especially when the two are combined to detect their predictive efficiency.