老年重症急性胰腺炎患者继发胰腺感染的危险因素

Risk factors for secondary pancreatic infection in elderly patients with severe acute pancreatitis

目的分析老年重症急性胰腺炎(SAP)患者继发胰腺感染的危险因素,观察急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、细胞间黏附分子-1(ICAM-1)及外周血炎症指标的预测价值。方法回顾性分析2020年3月-2023年3月如皋市人民医院收治的继发胰腺感染的老年SAP患者50例,未继发胰腺感染的老年SAP患者50例,分为观察组和对照组。对比两组患者基线资料及入院时的APACHEⅡ、血清ICAM-1、中性粒细胞-淋巴细胞比值(NLR)、白细胞介素(IL-8)、C反应蛋白(CRP)水平,分析影响老年SAP患者继发胰腺感染的影响因素,并采用受试者工作特征(ROC)曲线评估诸指标对老年SAP患者继发胰腺感染的预测价值。结果合并糖尿病(P=0.013)、接受机械通气(P=0.015)、肠功能障碍时间(>3 d)(P=0.041)、中心静脉留置时间(>6 d)(P=0.041)、禁食时间(>3 d)(P=0.001)均为老年SAP患者继发胰腺感染的独立危险因素。观察组患者APACHEⅡ评分(t=8.150)、ICAM-1(t=18.828)、NLR(t=16.737)、IL-8(t=6.161)、CRP(t=7.848)水平均显著高于对照组,差异均有统计学意义(P均<0.05)。APACHEⅡ评分,血清ICAM-1、NLR、IL-8、CRP单独及联合检测的曲线下面积(AUC)分别为0.872、0.775、0.805、0.769、0.851、0.952,联合检测AUC高于各单项检测(P<0.05)。结论APACHEⅡ评分、血清ICAM-1、NLR、IL-8、CRP水平高表达对老年SAP患者继发胰腺感染均有较高的诊断价值,联合检测能提升检测的敏感度、特异度。

Objective To analyze the risk factors of secondary pancreatic infection in elderly patients with severe acute pancreatitis(SAP)and observe the predictive value of acute physiological and chronic health scoreⅡ(APACHEⅡ),intercellular cell adhesion molecule⁃1(ICAM⁃1),peripheral blood inflammation indicators.Methods The retrospective analysis included 50 elderly SAP patients with secondary pancreatic infection and 50 elderly SAP patients without secondary pancreatic infection from March 2020 to March 2023,and were divided into the observation group and control group.Baseline data and APACHEⅡ,serum ICAM⁃1,neutrophil⁃lymphocyte ratio(NLR),interleukin(IL⁃8),and C⁃reactive protein(CRP)levels were compared between the two groups at admission.The factors affecting secondary pancreatic infection in elderly SAP patients were analyzed,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the indicators for secondary pancreatic infection in elderly SAP patients.Results Comorbid diabetes(P=0.013),receiving mechanical ventilation(P=0.015),time of bowel dysfunction(>3 d)(P=0.041),duration of central venous retention(>6 d)(P=0.041),and time of fasting(>3 d)(P=0.001)were the independent risk factors for secondary pancreatic infections in elderly patients with SAP.Patients in the observation group had a higher APACHEⅡscore(t=8.150),ICAM⁃1(t=18.828),and NLR(t=16.737),IL⁃8(t=6.161),CRP(t=7.848)levels and were all significantly higher than those of the control group(all P<0.05).The area under the curve(AUC)of individual and combined tests were 0.872,0.775,0.805,0.769,0.851 and 0.952,respectively,and the comparisons showed that the AUC of the combined tests were higher than those of each individual test(P<0.05).Conclusions Secondary pancreatic infection in elderly SAP patients had high expression of APACHEⅡscore,serum ICAM⁃1,NLR,serum IL⁃8 and CRP level.All these indicators had high diagnostic value.Combined detection could improve the sensitivity and specificity of detection.