甲状腺激素变化评估急性胰腺炎严重程度的临床价值

Clinical Value of Thyroid Hormone Changes in Evaluating the Severity of Acute Pancreatitis

目的探讨甲状腺激素水平变化评估急性胰腺炎病情严重程度临床价值。方法选择2015年1月-2020年12月我院收治的91例急性胰腺炎患者作为研究对象,记录患者入院信息并行APACHEⅡ评分及MCTSI评分,同时检测患者的血清甲状腺激素水平。根据中国急性胰腺炎诊治指南将患者分为轻症胰腺炎组(MAP组)67例和重症胰腺炎组(SAP组)24例。比较两组血清甲状腺激素水平,使用受试者工作特征(ROC)曲线对血清FT_(3)、TT_(3)、APACHEⅡ评分及MCTSI评分评估疾病严重程度的有效性进行验证;采用Pearson相关性分析甲状腺激素水平与MCTSI评分及APACHEⅡ评分的相关性。结果SAP组与MAP组年龄、性别、病因等一般资料比较,差异无统计学意义(P>0.05);SAP组MCTSI评分及APACHEⅡ评分均低于MAP组(P<0.05)。SAP组血清FT_(3)、TT_(3)水平均低于MAP组(P<0.05);两组血清FT_(4)、TT_(4)及TSH水平比较,差异无统计学意义(P>0.05);ROC曲线显示,血清FT_(3)水平预测急性胰腺炎病情严重程度的曲线下面积(AUC)为0.868,Cut-off值为3.07 pmol/L,其预测病情严重程度的灵敏度为82.16%,特异度为79.24%,95%CI为0.788~0.948;而血清TT_(3)水平预测急性胰腺炎病情严重程度的AUC为0.774,Cut-off值为0.83 nmol/L,其预测病情严重程度的灵敏度为83.63%,特异度为66.71%,95%CI为0.649~0.900。Pearson相关性分析显示,血清FT_(3)水平与APACHEⅡ评分、MCTSI评分均呈负相关(r=-0.733、-0.641)。结论急性胰腺炎患者体内的甲状腺激素水平会发生动态变化,监测血清FT_(3)及TT_(3)水平有助于判断疾病的危重程度,其中FT_(3)<3.07 pmol/L及TT_(3)<0.83 nmol/L可作为评估疾病危重的标志。

Objective To investigate the clinical value of thyroid hormone level changes in evaluating the severity of acute pancreatitis.Methods A total of 91 patients with acute pancreatitis admitted to our hospital from January 2015 to December 2020 were selected as the research objects.The admission information of the patients was recorded and the APACHEⅡscore and MCTSI score were recorded.At the same time,the serum thyroid hormone level of the patients was detected.According to the guidelines for the diagnosis and treatment of acute pancreatitis in China,the patients were divided into mild pancreatitis group(MAP group,n=67)and severe pancreatitis group(SAP group,n=24).The serum thyroid hormone levels of the two groups were compared,and the receiver operating characteristic(ROC)curve was used to verify the effectiveness of serum FT_(3),TT_(3),APACHEⅡscore and MCTSI score in evaluating the severity of the disease.Pearson correlation analysis was used to analyze the correlation between thyroid hormone levels and MCTSI score and APACHEⅡscore.Results There was no significant difference in age,gender,etiology and other general data between SAP group and MAP group(P>0.05).The MCTSI score and APACHEⅡscore in SAP group were lower than those in MAP group(P<0.05).The levels of serum FT_(3) and TT_(3) in SAP group were lower than those in MAP group(P<0.05).There was no significant difference in serum FT_(4),TT_(4) and TSH levels between the two groups(P>0.05).ROC curve showed that the area under the curve(AUC)of serum FT_(3) level in predicting the severity of acute pancreatitis was 0.868,and the Cut-off value was 3.07 pmol/L,the sensitivity of serum FT_(3) level in predicting the severity of acute pancreatitis was 82.16%,the specificity was 79.24%,and the 95%CI was 0.788-0.948;the AUC of serum TT_(3) level in predicting the severity of acute pancreatitis was 0.774,and the Cut-off value was 0.83 nmol/L,the sensitivity of serum TT_(3) level in predicting the severity of acute pancreatitis was 83.63%,the specificity was 66.71%,and the 95%CI was 0.649-0.900.Pearson correlation analysis showed that serum FT_(3) level was negatively correlated with APACHEⅡscore and MCTSI score(r=-0.733,-0.641).Conclusion Thyroid hormone levels in patients with acute pancreatitis will change dynamically.Monitoring serum FT_(3) and TT_(3) levels is helpful to judge the severity of the disease.FT_(3)<3.07 pmol/L and TT_(3)<0.83 nmol/L can be used as markers to evaluate the severity of the disease.