BISAP评分联合血清sRAGE评估急性高脂血症性胰腺炎严重程度和短期预后的价值

BISAP score combined with serum sRAGE for predicting hyperlipidemic acute pancreatitis severity and short-term prognosis

目的探讨急性胰腺炎严重程度床旁指数(BISAP)评分联合血清可溶性晚期糖基化终产物受体(sRAGE)对急性高脂血症性胰腺炎(HLAP)严重程度和预后评估的价值。方法选取2017年3月—2022年8月安徽医科大学第二附属医院HLAP患者142例。对所有患者行急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分和BISAP评分。收集所有患者的临床资料和实验室检测结果,并检测血清sRAGE水平。根据BISAP评分结果将患者分为重症HLAP(重症组,54例)和非重症HLAP(非重症组,88例)。根据患者入院30 d的生存状态分为死亡组(42例)和非死亡组(100例)。采用Logistic回归分析评估HLAP患者入院30 d死亡的危险因素。采用受试者工作特征(ROC)曲线评价各项指标鉴别诊断重症HLAP和判断HLAP患者入院30 d死亡的效能。结果与非重症组比较,重症组APACHEⅡ评分、SOFA评分和sRAGE水平均显著升高(P<0.05)。与非死亡组比较,死亡组C反应蛋白(CRP)、sRAGE水平和BISAP评分≥3分所占比例、APACHEⅡ评分、SOFA评分均显著升高(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分升高和sRAGE水平升高均是重症HLAP的危险因素[比值比(OR)值分别为1.17和1.01,95%可信区间(CI)分别为1.03~1.34和1.00~1.01]。BISAP评分≥3分和血清sRAGE水平是HLAP患者入院30 d死亡的危险因素(OR值分别为1.99和1.01,95%CI分别为1.53~2.98和1.00~1.03)。sRAGE鉴别诊断重症HLAP的曲线下面积(AUC)为0.73。BISAP评分、sRAGE单项和联合检测判断HLAP患者入院30 d死亡的AUC分别为0.81、0.67、0.86。CRP、SOFA评分、APACHEⅡ评分和sRAGE联合检测鉴别诊断重症HLAP的AUC为0.77。CRP、SOFA评分、APACHEⅡ评分、sRAGE和BISAP评分联合检测判断HLAP患者入院30 d死亡的AUC为0.89。结论sRAGE对HLAP患者病情严重程度的判断有一定意义。联合应用sRAGE和BISAP评分有助于提高对患者短期预后的评估效能。

Objective To investigate the efficacy of bedside index for severity in acute pancreatitis(BISAP)score combined with serum soluble receptor for advanced glycation end product(sRAGE)for predicting the severity and prognosis in hyperlipidemic acute pancreatitis(HLAP).Methods A total of 142 HLAP patients admitted to the Second Affiliated Hospital of Anhui Medical University from March 2017 to August 2022 were enrolled.The acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and BISAP were scored.The clinicopathologic data and clinical laboratory determination results were collected,and serum sRAGE levels were determined.The patients were classified into severe HLAP(severe group,54 cases)and non-severe HLAP(non-severe group,88 cases)according to BISAP score.According to the 30 d survival status after admission,the patients were classified into death group(42 cases)and survival group(100 cases).Logistic regression analysis was used to evaluate the risk factors for 30 d admission death in HLAP patients.Receiver operating characteristic(ROC)curve was used to evaluate the differential diagnosis of severe HLAP and death at 30 d after admission.Results The levels of APACHEⅡscore,SOFA score and sRAGE were increased in severe group compared with non-severe group(P<0.05).Compared with survival group,C-reactive protein(CRP),sRAGE,BISAP score≥3 points,APACHEⅡscore and SOFA score in death group were increased(P<0.05).Multivariate Logistic regression analysis showed that increased APACHEⅡscore and increased sRAGE level were risk factors for severe HLAP[odds ratios(OR)were 1.17 and 1.01,95%confidence intervals(CI)were 1.03-1.34 and 1.00-1.03,respectively].BISAP score≥3 and serum sRAGE level were risk factors for death at 30 d after admission in HLAP patients(OR=1.99 and 1.01,95%CI 1.53-2.98 and 1.00-1.01,respectively).The area under curve(AUC)of sRAGE for differential diagnosis of severe HLAP was 0.73.The AUC of BISAP score,sRAGE single and combined determinations for HLAP patients were 0.81,0.67 and 0.86,respectively.The AUC of CRP,SOFA score,APACHEⅡscore and sRAGE in the differential diagnosis of severe HLAP was 0.77.The AUC of combined determination of CRP,SOFA score,APACHEⅡscore,sRAGE and BISAP score for death in 30 d among HLAP patients after admission was 0.89.Conclusions The sRAGE plays a role in assessing HLAP severity.The combined determination of sRAGE and BISAP score can improve the assessment efficacy of short-term prognosis in HLAP.