新型全身性炎症指标对急性胰腺炎早期病情严重程度的预测价值

Novel markers of systemic inflammation in prediction of the early severity of acute pancreatitis

目的探讨全身炎症反应指数(SIRI)、全身免疫炎症指数(SII)、中性粒细胞计数/淋巴细胞计数(NLR)、血小板计数/淋巴细胞计数(PLR)和淋巴细胞计数/单核细胞计数(LMR)对早期急性胰腺炎(AP)患者病情严重程度的预测价值。方法回顾性分析2020年1月至2023年11月安徽理工大学第一附属医院肝胆外科收治的666例AP患者的临床资料,患者分为轻症组(MAP组,轻症急性胰腺炎)和非轻症组(non-MAP组,包括中度重症和重症急性胰腺炎)。收集患者入院时和入院24 h后的血常规、生化指标,比较两组SIRI、SII、NLR、PLR和LMR的差异及预测non-MAP的价值。结果666例AP患者,MAP组507例,non-MAP组159例。non-MAP组患者入院24 h后C反应蛋白(CRP)、SIRI、SII和NLR较MAP组高,而LMR低于MAP组,差异均有统计学意义(P<0.05);CRP(HR=1.008,95%CI:1.004~1.012,P<0.05)和SIRI(HR=1.216,95%CI:1.029~1.436,P<0.05)是AP患者病情严重程度的危险因素。ROC曲线显示,入院24 h后SIRI预测non-MAP的AUC和灵敏度分别为0.718和75.00%,高于SII、CRP、NLR和LMR。SIRI和CRP的AUC均>0.7,两者联合AUC为0.788(0.738~0.837)、灵敏度86.00%、特异度81.44%。结论SIRI可作为早期AP患者病情严重程度的预测指标,联合CRP后可提高预测价值。

Objective To investigate the values of systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII),neutrophil count/lymphocyte count(NLR),platelet count/lymphocyte count(PLR)and lymphocyte count/monocyte count(LMR)in prediction of the severity of acute pancreatitis(AP)at early stage.Methods The clinical data on 666 AP patients admitted to the department of hepatobiliary surgery,the First Affiliated Hospital of Anhui University of Science and Technology,from January 2020 to November 2023 were retrospectively analyzed.The patients were divided into a mild group(MAP group,mild acute pancreatitis)and a non-mild group(non-MAP group,including moderate to severe acute pancreatitis).Blood routine and biochemical indicators were collected at admission and 24 hours after admission.The differences in SIRI,SII,NLR,PLR and LMR between the two groups were compared,so were the values of these five indexes in prediction of non-MAP.Results Of the 666 AP patients,507 were in the MAP group and 159 in the non-MAP group.In the non-MAP group,C-reactive protein(CRP),SIRI,SII,and NLR were higher than those in the MAP group 24 hours after admission,while LMR was lower than that in the MAP group,and the differences were statistically significant(P<0.05).CRP(HR=1.008,95%CI:1.004~1.012,P<0.05)and SIRI(HR=1.216,95%CI:1.029~1.436,P<0.05)were identified as the risk factors for the severity of AP.The ROC curve showed that the AUC and sensitivity of SIRI for predicting non-MAP 24 hours after admission were 0.718 and 75.00%,respectively,higher than those of SII,CRP,NLR,and LMR.Both SIRI and CRP had AUC values greater than 0.7,and the combined AUC was 0.788(0.738~0.837),the sensitivity was 86.00%and the specificity was 81.44%.Conclusions SIRI can be used as a predictor of disease severity in early AP patients,and combined with CRP can improve the predictive value.