老年SAP患者血清PCT、hs-CRP、PA、Ca及FIB水平变化及临床意义

Changes and clinical significance of serum procalcitonin,hypersensitivity C-reactive protein,prealbumin,calcium,and fibrinogen levels in elderly patients with severe acute pancreatitis

目的 探究老年重症急性胰腺炎(SAP)患者血清降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、血清前白蛋白(PA)、血钙(Ca)及纤维蛋白原(FIB)水平变化及其临床意义。方法 前瞻性选取2021年11月至2022年10月宝鸡第三医院收治的90例老年SAP患者作为A组,另选取38例老年轻症急性胰腺炎患者作为B组,选择同期40例健康体检者作为C组,测定并比较所有受检者的血清PCT、hs-CRP、PA、Ca和FIB水平,分别收集A组、B组患者入院后24 h内的急性生理与慢性健康(APACHEⅡ)评分状况;采用Spearman相关分析法分析PCT、hs-CRP、PA、Ca、FIB、APACHEⅡ评分指标与病情严重程度的相关性,绘制受检者工作特征曲线(ROC),计算曲线下面积(AUC),评估各指标对老年SAP患者病情严重程度的诊断价值。结果 A组患者的PCT、hs-CRP、FIB水平分别为(5.49±1.64)μg/L、(39.78±8.21) mg/L、(4.49±2.04) g/L,明显高于B组的(1.94±1.24)μg/L、(15.78±5.45) mg/L、(3.34±1.54) g/L和C组的(0.48±0.21)μg/L、(2.78±0.34) mg/L、(2.08±0.21) g/L,且B组患者的上述各项指标明显高于C组,差异均有统计学意义(P<0.05);A组患者的PA、Ca水平分别为(150.12±8.22) mg/L、(2.55±0.48) mmol/L,明显低于B组的(211.12±13.18) mg/L、(3.32±0.95) mmol/L和C组的(316.35±18.32) mg/L、(3.89±1.18) mmol/L,且B组患者的上述各项指标明显低于C组,差异均有统计学意义(P<0.05);A组患者APACHEⅡ评分为(19.82±3.53)分,明显高于B组的(8.85±3.67)分,差异有统计学意义(P<0.05);随着APACHEⅡ评分升高,PCT、hs-CRP、FIB水平也升高,而PA、Ca水平降低,差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,PCT、hs-CRP、FIB及APACHEⅡ评分与老年SAP病情严重程度成正相关(r=0.623、0.457、0.650、0.758,P<0.05),PA、Ca与老年SAP病情严重程度成负相关(r=-0.232、-0.335,P<0.05)。经ROC分析结果显示,APACHEⅡ评分对老年SAP患者病情严重程度诊断的AUC最大为0.889,特异性为86.3%,敏感性为88.2%;PCT、hs-CRP对老年SAP患者病情严重程度诊断的AUC分别为0.823、0.809,特异性为88.3%、75.2%,敏感性为69.2%、68.6%;PA、Ca、FIB对老年SAP患者病情严重程度诊断的AUC分别为0.759、0.782、0.714,特异性为73.3%、74.1%、76.5%,敏感性为66.6%、70.3%、68.3%。结论 老年SAP患者机体血清PCT、hs-CRP、FIB均明显升高,PA、Ca明显降低。PCT、hs-CRP、FIB与SAP病情严重程度具有正相关性,PA、Ca与老年SAP病情严重程度呈负相关,对临床病情诊断和预后评估有重要意义。

Objective To investigate the changes and clinical significance of serum procalcitonin(PCT),hyper-sensitivity C-reactive protein(hs-CRP),serum prealbumin(PA),blood calcium(Ca),and fibrinogen(FIB)in elderly pa-tients with severe acute pancreatitis(SAP).Methods A total of 90 elderly patients with SAP admitted to Baoji Third Hospital from November 2021 to October 2022 were prospectively selected as group A,38 elderly patients with acute pancreatitis were selected as group B,and 40 healthy individuals undergoing physical examination were selected as group C.The levels of serum PCT,hs-CRP,PA,Ca,and FIB of all subjects were measured and compared.The Acute Physiology and Chronic Health Evaluation(APACHEⅡ)scores of group A and group B were collected within 24 h after admission.Spearman correlation analysis was used to analyze the correlation between PCT,hs-CRP,PA,FIB and APACHEⅡscores and the severity of the disease.Receiver operating characteristic curve(ROC)was drawn,and the ar-ea under the curve(AUC)was calculated to evaluate the diagnostic value of each index on the severity of the disease in elderly SAP patients.Results The levels of PCT,hs-CRP,and FIB in the group A were(5.49±1.64)μg/L,(39.78±8.21)mg/L,(4.49±2.04)g/L,which were significnatly higher than(1.94±1.24)μg/L,(15.78±5.45)mg/L,(3.34±1.54)g/L in the group B and(0.48±0.21)μg/L,(2.78±0.34)mg/L,(2.08±0.21)g/L in the group C,and the levels in group B were significantly higher than those in the group C,with statistically significant differences(P<0.05).The levels of PA and Ca in the group A were(150.12±8.22)mg/L and(2.55±0.48)mmol/L,which were significantly lower than(211.12±13.18)mg/L,(3.32±0.95)mmol/L in the group B and(316.35±18.32)mg/L,(3.89±1.18)mmol/L in the group C,and the levels in group B were significantly lower than those in the group C,with statistically significant differences(P<0.05).The score of APACHEⅡin the group A was(19.82±3.53)points,which was significnatly higher than(8.85±3.67)points in the group B(P<0.05).With the increase of APACHEⅡscore,the levels of PCT,hs-CRP,and FIB also increased,while the levels of PA and Ca decreased,and the differences were statistically significant(P<0.05).Spearman correlation analysis showed that PCT,hs-CRP,FIB,and APACHEⅡscores were positively correlated with the severity of SAP in elderly pa-tients(r=0.623,0.457,0.650,0.758,P<0.05),while PA and Ca were negatively correlated with the severity of SAP in the elderly(r=-0.232,-0.335,P<0.05).ROC analysis results showed that the maximum AUC of APACHEⅡscore for the diagnosis of disease severity in elderly SAP patients was 0.889,the specificity was 86.3%,and the sensitivity was 88.2%.The AUC of PCT and hs-CRP for diagnosis of disease severity in elderly SAP patients were 0.823 and 0.809,with specificity of 88.3%and 75.2%and sensitivity of 69.2%and 68.6%.The AUC of PA,Ca,and FIB for diagno-sis of disease severity in elderly SAP patients were 0.759,0.782,and 0.714,respectively,the specificity were 73.3%,74.1%,and 76.5%,and the sensitivity were 66.6%,70.3%,and 68.3%.Conclusion The levels of serum PCT,hs-CRP,and FIB in elderly patients with SAP were significantly increased,and PA and Ca were significantly decreased.PCT,hs-CRP,and FIB are positively correlated with the severity of SAP,while PA and Ca are negatively cor-related with the severity of SAP in the elderly patients,which has great significance for clinical diagnosis and prognosis evaluation.