外周血单核细胞与淋巴细胞比值与急性胰腺炎严重程度及预后关系研究

Study on the relationship of monocyte-to-lymphocyte ratio with severity and prognosis of acute pancreatitis

[目的]分析外周血单核细胞与淋巴细胞比值(MLR)与急性胰腺炎(AP)严重程度及预后的关系。[方法]纳入2015年6月～2018年6月于我院诊治的AP患者191例,收集临床资料,随访并记录患者住院期间持续性器官功能不全或死亡预后不良情况。采用Pearson分析外周血MLR水平与AP患者急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性;采用Cox比例风险回归模型分析AP患者预后不良的独立预测因素;采用Kaplan-Meier曲线比较不同MLR水平AP患者累积无预后不良事件生存率;采用受试者工作特征(ROC)曲线,探索MLR水平对AP患者预后不良的预测效能。[结果](1)AP患者MLR水平与APACHEⅡ评分正相关(P<0.01)。(2)三酰甘油、MLR、APACHEⅡ评分是AP患者预后不良的独立预测因素。(3)Kaplan-Meier曲线示,低MLR患者累积无预后不良事件生存率显著高于高MLR患者(P<0.01)。(4)MLR水平预测AP患者预后不良的ROC曲线下面积为0.736,最佳截断值为0.39,灵敏度为72.69%,特异度为82.61%。[结论]AP患者外周血MLR水平与AP严重程度呈正相关,且是AP患者预后不良的独立预测因素,在临床工作中可辅助细化AP患者危险分层管理,临床应用价值高。

[Objective]This study aimed to investigate the relationship of monocyte to lymphocyte ratio(MLR)level with the severity and prognosis of acute pancreatitis(AP).[Methods]191patients with AP admitted at Civil Aviation General Hospital from June 2015 to June 2018 were enrolled in this study.Clinical and follow-up data including persistent dysfunction and any poor prognoses during hospitalization were recorded.Pearson correlation analyses were used to study the correlation between MLR levels and Acute Physiology and Chronic Health Status ScoreⅡ(APACHEⅡ)scores in AP patients.The Coxproportional hazard regression model was used to analyze the independent predictors of poor prognosis in AP patients.Kaplan-Meier curve was used to compare the survival rates of non-prognostic adverse events in patients with different MLR levels.The receiver operating characteristic(ROC)curve was used to explore the efficacy of MLR level in predicting poor prognosis in patients with AP.[Results](1)Linear analysis revealed that the level of MLR was positively correlated with APACHEⅡscore in patients with AP(P<0.01);(2)Multivariate Coxanalysis demonstrated that triglyceride,and MLR,and APACHE Ⅱ score were the independent predictive factors of poor prognosis in patients with AP.(3)Kaplan-Meier curve showed that the cumulative non-prognostic adverse event rate of the low MLR group was significantly higher than that of the high MLR group(P<0.01).(4)ROC curve exhibited that the area under the curve was 0.736 for MLR predicting poor prognosis,with a cut-off value of 0.39,a sensitivity of 72.69%and a specificity of 82.61%.[Conclusion]The level of MLR was positively correlated with the severity of AP,and an independent predictor of poor prognosis in patients of AP which could be used for risk-stratifying AP patients with high clinical value.