外周血炎症指标和淀粉酶与急性胰腺炎病人严重程度及预后的关系

Relationship between peripheral blood inflammatory indexes and amylase and severity and prognosis in patients with acute pancreatitis

目的探究外周血炎症指标联合淀粉酶检测对急性胰腺炎(AP)病人严重程度及预后的影响。方法选取2021年1月至2023年1月信阳市中心医院收治的80例AP病人作为研究对象。根据病人严重程度将其分为重症组(35例)和非重症组(45例),按照预后情况分为死亡组(15例)和存活组(65例)。以速率法检测血清淀粉酶水平,以酶联免疫吸附测定检测外周血内毒素(ET)及降钙素原(PCT)水平,以全自动血液分析仪检测中性粒细胞、淋巴细胞比值、白细胞(WBC)计数水平,计算中性粒细胞与淋巴细胞比值(NLR)。比较不同严重程度及预后AP病人血清淀粉酶、外周血NLR、WBC、ET及PCT水平,绘制受试者操作特征曲线(ROC曲线)评估上述指标对AP严重程度及预后的预测价值。以多因素logistic回归分析影响AP病人严重程度及预后的因素。结果重症组、死亡组外周血ET(0.74±0.15)EU/mL、(0.82±0.16)EU/mL,PCT(2.78±0.31)ng/L、(3.01±0.31)ng/L,WBC(4.56±1.47)×10^(9)/L、(15.49±1.61)×10^(9)/L,NLR(11.23±1.15)、(11.45±1.19),淀粉酶(102.23±10.34)U/L、(103.02±10.56)U/L水平明显高于非重症组(0.58±0.09)EU/mL,(2.41±0.26)ng/L、(12.14±1.25)×10^(9)/L,9.11±0.93,(85.12±8.56)U/L,存活组(0.61±0.12)EU/mL,(2.47±0.24)ng/L、(12.67±1.29)×10^(9)/L,9.71±0.99,(86.12±8.63)U/L(P<0.05),且重症组死亡病人上述血清水平明显高于存活者(P<0.05);绘制ROC曲线评估外周血ET、PCT、WBC、NLR联合淀粉酶对AP病人严重程度及预后的预测价值显示,预测AP严重程度时:单独检测时NLR灵敏度最高,WBC、淀粉酶特异度最高,以上指标联合检测时灵敏度、特异度均处于较高水平。预测AP病人预后时,单独检测PCT灵敏度最高,WBC特异度最高。重症组急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)明显高于非重症组(P<0.05),死亡组年龄、APACHEⅡ评分明显高于存活组(P<0.05);多因素logistic回归分析显示,外周血PCT、NLR及淀粉酶为影响重症AP发生的因素(P<0.05),外周血NLR、淀粉酶为影响AP病人死亡的因素(P<0.05)。结论外周血ET、PCT、WBC、NLR和淀粉酶与AP严重程度有关,可作为临床预测AP严重程度及预后的潜在指标。

Objective To investigate the effect of peripheral blood inflammation indexes combined with amylase detection on the severity and prognosis of acute pancreatitis(AP)patients.Methods A total of 80 AP patients admitted to Xinyang Central Hospital from January 2021 to January 2023 were selected as the research object.According to the severity of the patients,they were divided into severe(35 cases)and non-severe groups(45 cases),and according to the prognosis,they were divided into death group(15 cases)and survival group(65 cases).Serum amylase levels were measured by rate method,peripheral blood endotoxin(ET)and procalcitonin(PCT)levels were detected by enzyme-linked immunosorbent method,neutrophils,lymphocyte ratios,white blood cell count(WBC)levels were measured by automatic blood analyzer,and neutrophil-to-lymphocyte ratio(NLR)were calculated.The levels of serum amylase,peripheral blood NLR,WBC,ET and PCT in patients with different severity and prognosis of AP were compared,and the ROC curve was drawn to evaluate the predictive value of the above indicators on the severity and prognosis of AP.Multivariate logistic regression was used to analyze the factors affecting the severity and prognosis of AP patients.Results The levels of peripheral blood ET(0.74±0.15)EU/mL,(0.82±0.1)EU/mL,PCT(2.78±0.31)ng/L,(3.01±0.31)ng/L,WBC(4.56±1.47)×10^(9)/L,(15.49±1.61)×10^(9)/L,NLR(11.23±1.15),(11.45±1.19)and amylase(102.23±10.34)U/L,(103.02±10.56)U/Lin the severe and death groups were significantly higher than those in the non-severe group(0.58±0.09)EU/mL,(2.41±0.26)ng/L,(12.14±1.25)×10^(9)/L,9.11±0.93,(85.12±8.56)U/L and survival group(0.61±0.12)EU/mL,(2.47±0.24)ng/L,(12.67±1.29)×10^(9)/L,9.71±0.99,(86.12±8.63)U/L,the difference was statistically significant(P<0.05),and the above serum levels were significantly higher in the critically ill group of patients who died than in those who survived,the difference was statistically significant(P<0.05).The ROC curve was plotted to evaluate the predictive value of peripheral blood ET,PCT,WBC,NLR combined with amylase on the severity and prognosis of AP patients.In predicting the severity of AP,the sensitivity of NLR the sensitivity of NLR was the highest when measured alone,and the specificity of WBC and amylase was the highest.The sensitivity and specificity of the above indexes were all at a high level when measured jointly..When predicting the prognosis of AP patients,PCT alone had the highest sensitivity and WBC had the highest specificity.The APACHEⅡscore in the severe group was significantly higher than that in the non-severe group(P<0.05),and the age and APACHEⅡscores in the death group were significantly higher than those in the survival group.Multivariate logistic regression analysis of different clinical features and peripheral blood indexes showed that PCT,NLR and amylase in peripheral blood were the factors affecting the occurrence of severe AP(P<0.05),and peripheral blood NLR and amylase were factors affecting the death of AP patients(P<0.05).Conclusion Peripheral blood ET,PCT,WBC,NLR combined with amylase is associated with AP severity,and can be used as potential indicators for clinical prediction of AP severity and prognosis.