高脂血症急性胰腺炎中重度病情的危险因素及凝血功能指标的诊断价值研究

Study on the risk factors of moderate and severe hyperlipidemic acute pancreatitis and the diagnostic value of coagulation function indexes

目的通过凝血功能角度分析高脂血症急性胰腺炎(HLAP)与C反应蛋白(CRP)和急性生理学和慢性健康状况评价(APACHE)Ⅱ评分的相关性及其对中重度HLAP的影响。方法本研究为回顾性病例对照研究,选取2019年4月至2023年12月厦门大学附属翔安医院急诊医学科收治的104例HLAP患者,男66例,女38例,年龄(49.31±5.33)岁,年龄范围为34~70岁。根据急性胰腺炎严重程度将患者分为中重度HLAP组(n=38)与轻度HLAP组(n=66)。采用单因素及多因素logistic回归分析筛选影响中重度HLAP的危险因素,采用Spearman相关系数评价CRP、APACHEⅡ评分与D-二聚体、凝血酶原时间(PT)、活化部分凝血酶时间、纤维蛋白原(FIB)之间的相关性,采用受试者操作特征曲线分析各危险因素和联合指标的诊断效能。结果中重度HLAP组患者D-二聚体[1.48(1.38,1.62)μg/ml]、PT[14.54(14.28,14.79)s]、FIB[4.20(3.87,4.46)g/L]、CRP[110.04(81.43,128.14)mg/L]、APACHEⅡ评分[8.83(7.19,10.49)分]高于轻度HLAP组患者[1.34(1.19,1.41)μg/ml、14.09(13.77,14.39)s、3.83(3.57,4.05)g/L、33.91(21.75,53.78)mg/L、4.83(3.67,6.07)分],差异有统计学意义(P<0.05)。logistic回归分析结果显示,高D-二聚体(OR=11.531,95%CI:6.862~56.447)、长PT(OR=7.787,95%CI:2.661~22.791)、高FIB(OR=4.308,95%CI:1.284~14.461)、高CRP(OR=1.162,95%CI:1.071~1.260)、高APACHEⅡ评分(OR=2.298,95%CI:1.659~3.185)是影响中重度HLAP发生的独立危险因素(P<0.05)。CRP与D-二聚体(r=0.370)、PT(r=0.395)、FIB(r=0.347)呈正相关(P<0.05),APACHEⅡ评分与D-二聚体(r=0.408)、PT(r=0.241)、FIB(r=0.293)呈正相关(P<0.05)。D-二聚体、PT、FIB均可对中重度HLAP有较高的诊断效能(曲线下面积为0.782、0.723、0.641),且联合检测诊断效能更高(曲线下面积为0.881)。结论高D-二聚体、高FIB和长PT是影响中重度HLAP发生的独立危险因素,与CRP及APACHEⅡ评分呈正相关,对中重度HLAP具有较高的诊断效能,联合检测优于单独评价。

Objective To analyze the correlation between hyperlipidemic acute pancreatitis(HLAP),C-reactive protein(CRP),and acute physiology and chronic health evaluation(APACHE)Ⅱscores from the perspective of coagulation function,and their impact on moderate-to-severe HLAP.Methods This study was a retrospective case-control study,a total of 104 HLAP patients admitted to the department of Emergency Medicine in Xiang′An Hospital of Xiamen University from April 2019 to December 2023,including 66 males and 38 females,aged(49.31±5.33)years old,the age ranging from 34 to 70 years old.Patients were divided into moderate-to-severe HLAP group(n=38)and mild HLAP group(n=66)according to the severity of acute pancreatitis.Univariate and multivariate logistic regression analyses were used to identify risk factors affecting moderate-to-severe HLAP.Spearman′s correlation coefficient was employed to evaluate the correlation between CRP,APACHEⅡscores,and D-dimer,prothrombin time(PT),activated partial thromboplastin time and fibrinogen(FIB),receiver operator characteristic curve analysis was used to assess the diagnostic performance of various risk factors and combined indicators.Results The moderate-to-severe HLAP group had significantly higher levels of D-dimer[1.48(1.38,1.62)μg/ml],PT[14.54(14.28,14.79)s],FIB[4.20(3.87,4.46)g/L],CRP[110.04(81.43,128.14)mg/L],and APACHEⅡscores[8.83(7.19,10.49)points]compared to the mild HLAP group[1.34(1.19,1.41)μg/ml,14.09(13.77,14.39)s,3.83(3.57,4.05)g/L,33.91(21.75,53.78)mg/L,4.83(3.67,6.07)points],the differences were statistically significant(P<0.05).Logistic regression analysis revealed that high D-dimer(OR=11.531,95%CI:6.862 to 56.447),prolonged PT(OR=7.787,95%CI:2.661 to 22.791),high FIB(OR=4.308,95%CI:1.284 to 14.461),high CRP(OR=1.162,95%CI:1.071 to 1.260),and high APACHEⅡscores(OR=2.298,95%CI:1.659 to 3.185)were independent risk factors for moderate-to-severe HLAP(P<0.05).CRP was positively correlated with D-dimer(r=0.370),PT(r=0.395),and FIB(r=0.347,P<0.05).APACHEⅡscores were positively correlated with D-dimer(r=0.408),PT(r=0.241),and FIB(r=0.293,P<0.05).D-dimer,PT,and FIB showed high diagnostic performance for moderate-to-severe HLAP(their area under the curve were 0.782,0.723,and 0.641),with combined detection providing even higher diagnostic efficiency(its area under the curve was 0.881).Conclusions High D-dimer,high FIB,and prolonged PT were independent risk factors for moderate-to-severe HLAP,positively correlated with CRP and APACHEⅡscores,they have high diagnostic performance for moderate-to-severe HLAP,with combined detection being superior to individual evaluation.