血清乳酸脱氢酶和淀粉酶表达与重症急性胰腺炎患者短期预后的相关性

The correlation of serum LDH and AMY with short-term prognosis in the patients with severe acute pancreatitis

目的探讨血清乳酸脱氢酶(LDH)和淀粉酶(AMY)表达与重症急性胰腺炎患者短期预后的相关性。方法回顾性收集2019年3月至2024年2月阜阳市人民医院确诊并接受治疗的143例重症急性胰腺炎患者资料,根据患者入院2周内存活情况分为预后良好组(n=111)和预后不良组(n=32)。比较不同短期预后患者入院时血清LDH和AMY表达及其他资料,通过限制性立方样条法分析血清LDH和AMY表达与重症急性胰腺炎患者短期预后的关系,通过交互作用分析血清LDH和AMY表达对重症急性胰腺炎患者短期预后预测的交互作用,并绘制受试者工作特征(ROC)曲线及决策曲线分析血清LDH和AMY预测重症急性胰腺炎患者短期预后的价值。结果预后不良组患者入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及血清LDH和AMY水平高于预后良好组(P<0.05)。经限制性立方样条法分析,结果显示,重症急性胰腺炎患者短期预后不良风险与入院时血清LDH和AMY表达呈正向线性剂量-反应关系(P<0.05),当血清LDH≥510.05 U/L,AMY≥712.89 U/L时,患者短期预后不良风险随二者表达的增加而升高。经交互作用分析,血清LDH和AMY对重症急性胰腺炎患者短期预后不良存在正向交互作用,二者同时高表达(LDH≥510.05 U/L,AMY≥712.89 U/L)时患者短期预后不良风险是二者同时低表达(LDH<510.05 U/L,AMY<712.89 U/L)时的19.421倍。绘制ROC曲线,结果显示,血清LDH和AMY单独及联合预测重症急性胰腺炎患者短期预后受试者工作特征曲线下面积(AUC)均>0.7,有一定的预测价值,联合预测价值高于LDH和AMY单独预测(P均<0.05)。绘制决策曲线,结果显示,当阈值在0~0.04和0.07~1.00区间时,血清LDH和AMY联合预测重症急性胰腺炎患者短期预后不良风险的净收益率优于血清LDH和AMY单独预测,二者联合预测的最大净收益率为0.224。结论重症急性胰腺炎患者短期预后与血清LDH和AMY异常表达有关,二者可用于重症急性胰腺炎患者短期预后不良风险预测,且联合预测净收益率更理想。

Objective To explore the correlation of the expression of serum lactate dehydrogenase(LDH)and amylase(AMY)with the short-term prognosis in the patients with severe acute pancreatitis.Methods A retrospective study was conducted to collect the data from 143 patients with severe acute pancreatitis who were diagnosed and treated in Fuyang People′s Hospital from March 2019 to February 2024.According to the patient′s survival status within 2 weeks of admission,the patients were divided into a good prognosis group(n=111)and a poor prognosis group(n=32).The serum LDH,AMY expression and other data of patients with different short-term prognosis at admission were compared.The relationship of serum LDH and AMY expression with short-term prognosis in the patients with severe acute pancreatitis was analyzed by restricted cubic spline method.The interaction of serum LDH and AMY expression on short-term prognosis of patients with severe acute pancreatitis was analyzed.The receiver operating characteristic(ROC)curve and decision curve analysis were drawn to analyze the value of serum LDH and AMY in predicting short-term prognosis of patients with severe acute pancreatitis.Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,serum LDH and AMY levels were higher in the poor prognosis group than in the good prognosis group at admission(P<0.05).After restricted cubic spline analysis,the results showed a positive linear dose-response relationship between the risk of short-term poor prognosis in the patients with severe acute pancreatitis and the expression of serum LDH and AMY at admission(P<0.05).When serum LDH≥510.05 U/L and AMY≥712.89 U/L,the risk of short-term poor prognosis in the patients increased with the increase of their expression.The interaction analysis found that serum LDH and AMY had a positive interaction effect on short-term poor prognosis in the patients with severe acute pancreatitis.The risk of short-term poor prognosis in the patients with high expression(LDH≥510.05 U/L,AMY≥712.89 U/L)were 19.421 times higher than those with low expression(LDH<510.05 U/L,AMY<712.89 U/L).The ROC curve was plotted,and the results showed that serum LDH and AMY alone and in combination predicted the short-term prognosis of patients with severe acute pancreatitis with both the area under curve(AUC)>0.7,indicating a certain predictive value.The value of combined prediction was higher than that of LDH and AMY alone(all P<0.05).Decision curve analysis was drawn,and the results showed that when the threshold was in the range of 0-0.04 and 0.07-1.00,the combined prediction model of serum LDH and AMY had a better net benefit rate in predicting the short-term adverse prognosis risk of severe acute pancreatitis patients than serum LDH and AMY alone.The maximum net benefit rate predicted by the combination of LDH and AMY was 0.224.Conclusions The short-term prognosis of patients with severe acute pancreatitis is related to abnormal expression of serum LDH and AMY,which can be used for predicting the risk of short-term poor prognosis in the patients with severe acute pancreatitis,and net benefit rate of the combination prediction is more ideal.