血清脂蛋白(a)、降钙素原、红细胞分布宽度水平与急性胰腺炎严重程度关系及其预后评估价值

The relationship between serum lipoprotein(a),procalcitonin,red blood cell distribution width levels and the severity of acute pancreatitis and prognostic value

目的探讨血清脂蛋白(a)[Lp(a)]、降钙素原(PCT)、红细胞分布宽度(RDW)水平与急性胰腺炎(AP)严重程度的关系及其预后评估价值。方法选取2022年1月至12月如皋市人民医院收治的180例AP患者为研究对象。根据AP病情严重程度分为轻症AP组(n=75)、中重症AP组(n=54)与重症AP组(n=51);根据预后情况分为预后良好组(n=137)与预后不良组(n=43)。收集患者一般资料,常规检测血液生化指标和血清Lp(a)、PCT、RDW水平。采用Spearman相关性分析对Lp(a)、PCT和RDW与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性进行分析;采用Logistic回归模型分析AP预后不良的独立危险因素;绘制受试者工作特征(ROC)曲线,评估Lp(a)、PCT和RDW对AP预后的预测价值。结果中重症AP组和重症AP组血清Lp(a)、PCT、RDW水平及APACHEⅡ评分高于轻症AP组,且重症AP组高于中重症AP组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,血清Lp(a)、PCT和RDW水平与AP严重程度(APACHEⅡ评分)呈正相关(r=0.711、0.874、0.759,P<0.001)。APACHEⅡ评分、Lp(a)、PCT、RDW、急性胰腺炎严重程度床旁指数评分、Ranson评分是AP预后不良的独立危险因素(P<0.05)。血清Lp(a)、PCT、RDW及三者联合预测AP预后不良的曲线下面积分别为0.816、0.921、0.793、0.951,三者联合的预测价值最高。结论血清Lp(a)、PCT、RDW水平与AP严重程度呈正相关,是AP预后不良的独立危险因素,三者联合对AP预后不良的预测价值最高。

Objective To investigate the relationship between serum lipoprotein(a)[Lp(a)],procalcitonin(PCT),red blood cell distribution width(RDW)levels and the severity of acute pancreatitis(AP)and its prognostic value.Methods A total of 180 patients with AP admitted to Rugao People’s Hospital from January 2022 to December 2022 were selected as the study objects.According to the severity of AP,the patients were divided into mild AP group(n=75),moderate-severe AP group(n=54)and severe AP group(n=51).According to the prognosis,the patients were divided into good prognosis group(n=137)and poor prognosis group(n=43).The general data of the patients were collected,and the blood biochemical indexes and serum Lp(a),PCT and RDW levels were routinely detected.Spearman correlation analysis was used to analyze the correlation between Lp(a),PCT,RDW and acute physiology and chronic health evaluationⅡ(APACHEⅡ).Logistic regression model was used to analyze the independent risk factors for poor prognosis of AP.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of Lp(a),PCT and RDW for the prognosis of AP.Results The levels of serum Lp(a),PCT,RDW and APACHEⅡscores in the moderate-severe AP group and severe AP group were higher than those in the mild AP group,and those in the severe AP group were higher than the moderate-severe AP group,the differences were statistically significant(P<0.05).Spearman correlation analysis showed that serum Lp(a),PCT and RDW levels were positively correlated with AP severity(APACHEⅡscore,r=0.711,0.874,0.759,P<0.001).APACHEⅡscore,Lp(a),PCT,RDW,bedside index for severity in acute pancreatitis score and Ranson score were independent risk factors for poor prognosis of AP(P<0.05).The area under the ROC curve of serum Lp(a),PCT,RDW and their combination in predicting poor prognosis of AP were 0.816,0.921,0.793 and 0.951,respectively,and the value of their combination was the highest.Conclusion Serum Lp(a),PCT and RDW levels were positively correlated with the severity of AP and were independent risk factors for poor prognosis of AP.The combination of three factors has the highest predictive value for poor prognosis of AP.