Role and timing of endoscopy in acute biliary pancreatitis

The role and timing of endoscopy in the setting of acute biliary pancreatitis(ABP) is still being debated. Despite numerous randomized trials have been published,there is an obvious lack of consensus on the indications and timing of endoscopic retrograde cholangiopancreatography(ERCP) in ABP in metaanalyses and nationwide guidelines. The present editorial has been written to clarify the role of endoscopy in ABP. In clinical practice the decision to perform an ERCP is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography(EUS) is not currently a worldwide standard diagnostic procedure early in the course of acute biliary pancreatitis,but it has been shown to be accurate,safe and cost effective in diagnosing biliary obstructions compared with magnetic resonance cholangiopancreatography and ERCP and therefore in preventing unnecessary ERCP and its related complications. Early EUS in ABP allows,if appropriate,immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.

Early endoscopic ultrasonography in acute biliary pancreatitis: A prospective pilot study

AIM: To investigate the clinical usefulness of early endoscopic ultrasonography(EUS) in the management of acute biliary pancreatitis(ABP).METHODS: All consecutive patients entering the emergency department between January 2010 and December 2012 due to acute abdominal pain and showing biochemical and/or radiological findings consistent with possible ABP were prospectively enrolled. Patients were classified as having a low,moderate,or high probability of common bile duct(CBD) stones,according to the established risk stratification. Exclusion criteria were: gastrectomy or patient in whom the cause of biliary obstruction was already identified by ultrasonography. All enrolled patients underwent EUS within 48 h of their admission. Endoscopic retrograde cholangiopancreatography was performed immediately after EUS only in those cases with proven CBD stones or sludge. The following parameters were investigated:(1) clinical: age,sex,fever;(2) radiological: dilated CBD; and(3) biochemical: bilirubin,AST,ALT,g GT,ALP,amylase,lipasis,PCR. Association between presence of CBD stone at EUS and the individual predictors wereassessed by univariate logistic regression. Predictors significantly associated with CBD stones(P < 0.05) were entered in a multivariate logistic regression model.RESULTS: A total of 181 patients with pancreatitis were admitted to the emergency department between January 2010 and December 2012. After exclusion criteria a total of 71 patients(38 females,53.5%,mean age 58 ± 20.12 years,range 27-89 years; 33 males,46.5%,mean age 65 ± 11.86 years,range 41-91 years) were included in the present study. The probability of CBD stones was considered low in 21 cases(29%),moderate in 26(37%),and high in the remaining 24(34%). The 71 patients included in the study underwent EUS,which allowed for a complete evaluation of the target sites in all the cases. The procedure was completed in a mean time of 14.7 min(range 9-34 min),without any notable complications.The overall CBD stone frequency was 44%(31 of 71),with a significant increase from the group at low pretest probability to that at moderate(OR = 5.79,P = 0.01) and high(OR = 4.25,P = 0.03) pretest probability.CONCLUSION: Early EUS in ABP allows,if appropriate,immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.

Endoscopic sphincterotomy in acute biliary pancreatitis:A question of anesthesiological risk

Two consecutive surveys of acute pancreatitis in Italy,based on more than 1000 patients with acute pancreatitis,reported that the etiology of the disease indicates biliary origin in about 60% of the cases.The United Kingdom guidelines report that severe gallstone pancreatitis in the presence of increasingly deranged liver function tests and signs of cholangitis(fever,rigors,and positive blood cultures) requires an immediate and therapeutic endoscopic retrograde cholangiopancreatography(ERCP).These guidelines also recommend that patients with gallstone pancreatitis should undergo prompt cholecystectomy,possibly during the same hospitalization.However,a certain percentage of patients are unfit for cholecystectomy because advanced age and presence of comorbidity.We evaluated the early and longterm results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis.All patients underwent ERCP and were evaluated according to the American Society of Anesthesiology(ASA) criteria immediately before the operative procedure.The severity of acute pancreatitis was positively related to the anesthesiological grade.There was no significant relationship between the frequency of biliopancreatic complications during the follow-up and the ASA grade.The frequency of cholecystectomy was inversely related to the ASA grade and multivariate analysis showed that the ASA grade and age were significantly related to survival.Finally,endoscopic treatment also appeared to be safe and effective in patients at high anesthesiological risk with acute pancreatitis.These results further support the hypothesis that endoscopic sphincterotomy might be considered a definitive treatment for patients with acute biliary pancreatitis and an elevated ASA grade.

Machine learning-based decision tool for selecting patients with idiopathic acute pancreatitis for endosonography to exclude a biliary aetiology

BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30%of patients with idiopathic acute pancreatitis(IAP).As recurrent biliary pancreatitis can be prevented,the underlying aetiology of IAP should be established.AIM To develop a machine learning(ML)based decision tool for the use of endosonography(EUS)in pancreatitis patients to detect sludge and microlithiasis.METHODS We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and 2020.Patients who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were excluded.We trained supervised ML classifiers using H_(2)O.ai automatically selecting the best suitable predictor model to predict microlithiasis/sludge.The predictor model was further validated in two independent retrospective cohorts from two tertiary care centers(117 patients).RESULTS Twenty-eight categorized patients’variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84[95%confidence interval(CI):0.791-0.9185],positive predictive value of 0.84,and negative predictive value of 0.80 in the identification cohort(218 patients).In the validation cohort,the robustness of the prediction model was confirmed with an accuracy of 0.76(95%CI:0.673-0.8347),positive predictive value of 0.76,and negative predictive value of 0.78(117 patients).CONCLUSION We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.

Triglyceride levels and apolipoprotein E polymorphism in patients with acute pancreatitis

BACKGROUND:Hypertriglyceridemia is an unusual cause of acute pancreatitis and sometimes considered to be an epiphenomenon.This study aimed to investigate the clinical and analytical features and the APOE genotypes in patients with acute pancreatitis and severe hypertriglyceridemia.METHODS:We undertook a one-year,prospective study of patients with acute pancreatitis whose first laboratory analysis on admission to the emergency department included measurement of serum triglycerides.The APOE genotype was determined and the patients answered an established questionnaire within the first 24 hours concerning their alcohol consumption,the presence of co-morbidities and any medications being taken.The patients’ progression,etiological diagnosis,hospital stay and clinical and radiological severity were all recorded.RESULTS:Hypertriglyceridemia was responsible for 7 of 133 cases of pancreatitis (5%);the remaining cases were of biliary (53%),idiopathic (26%),alcoholic (11%) or other (5%) origin.Compared with these remaining cases,the patients with hypertriglyceridemia were significantly younger,had more relapses,and more often had diabetes mellitus.They usually consumed alcohol or consumed it excessively on the days before admission.Also,the ε4 allele of the APOE gene was more common in this group (P<0.05).CONCLUSION:One of 20 episodes of acute pancreatitis is caused by hypertriglyceridemia and it is linked to genetic (ε4 allele) and comorbid factors such as diabetes and,especially,alcohol consumption.

Role of endoscopic ultrasound during hospitalization for acute pancreatitis

Endoscopic ultrasound(EUS)is often used to detect the cause of acute pancreatitis(AP)after the acute attack has subsided.The limited data on its role during hospitalization for AP are reviewed here.The ability of EUS to visualize the pancreas and bile duct,the sonographic appearance of the pancreas,correlation of such appearance to clinical outcomes and the impact on AP management are analyzed from studies.The most important indication for EUS appears to be for detection of suspected common bile duct and/or gall bladder stones and microlithiasis.Such an approach might avoid diagnostic endoscopic retrograde cholangio-pancreatography with its known complications.The use of EUS during hospitalization for AP still appears to be infrequent but may become more frequent in future.

Pathophysiology of severe gallstone pancreatitis:A new paradigm

Severe gallstone pancreatitis(GSP)refractory to maximum conservative therapy has wide clinical variations,and its pathophysiology remains controversial.This Editorial aimed to investigate the pathophysiology of severe disease based on Opie’s theories of obstruction,the common channel,and duodenal reflux and describe its types.Severe GSP might be a hybrid disease with pathology polarized between acute cholangitis with mild pancreatitis(biliary type)and necrotizing pancreatitis uncomplicated with biliary tract disease(pancreatic type),in which hepatobiliary and pancreatic lesion severity is inversely related to the presence or absence of impacted ampullary stones.Severe GSP is caused by stones that are persistently impacted at the ampulla with biliopancreatic obstruction(biliary type),and probably,stones that are either temporarily lodged at the duodenal orifice or passed into the duodenum,thereby permitting reflux of bile or possible duodenal contents into the pancreas(pancreas type).When the status of the stones and the presence or absence of impacted ampullary stones with biliopancreatic obstruction are determined,the clinical course and outcome can be predicted.Gallstones represent the main cause of acute pancreatitis globally,and clinicians are expected to encounter GSP more often.Awareness of the etiology and pathogenesis of severe disease is mandatory.

Biliary stone causing afferent loop syndrome and pancreatitis

We report the case of an 84-year-old female who had a partial gastrectomy with Billroth-Ⅱ anastomosis 24 years ago for a benign peptic ulcer who now presented an acute pancreatitis secondary to an afferent loop syndrome. The syndrome was caused by a gallstone that migrated through a cholecystoenteric fistula. This is the first description in the literature of a biliary stone causing afferent loop syndrome.

Withered branch-like changes of intrahepatic bile ducts:a rare complication of acute severe biliary pancreatitis

Secondary sclerosing cholangitis(SSC)is a chronic biliary disease characterized by inflammatory responses,fibrous occlusion,strictures,and progressive destruction of intrahepatic and/or extrahepatic bile ducts,which may lead to cholestasis and cirrhosis(1).Well-described causes of SSC include infectious,ischemic,toxic,immunologic,congenital disorders and so on(2,3).Here,we presented a rare case of sclerosing cholangitis secondary to acute severe biliary pancreatitis.

Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

AIM: To investigate the frequency and risk factors for acute pancreatitis after pancreatic guidewire placement (P-GW) in achieving cannulation of the bile duct during endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: P-GW was performed in 113 patients in whom cannulation of the bile duct was difficult. The success rate of biliary cannulation, the frequency and risk factors of post-ERCP pancreatitis, and the frequency of spontaneous migration of the pancreatic duct stent were investigated. RESULTS: Selective biliary cannulation with P-GW was achieved in 73% of the patients. Post-ERCP pancreatitis occurred in 12% (14 patients: mild, 13; moderate, 1). Prophylactic pancreatic stenting was attempted in 59% of the patients. Of the 64 patients who successfully underwent stent placement, three developed mild pancreatitis (4.7%). Of the 49 patients without stent placement, 11 developed pancreatitis (22%: mild, 10; moderate, 1). Of the five patients in whom stent placement was unsuccessful, two developed mild pancreatitis. Univariate and multivariate analyses revealed no pancreatic stenting to be the only significant risk factor for pancreatitis. Spontaneous migration of the stent was observed within two weeks in 92% of the patients who had undergone pancreatic duct stenting.CONCLUSION: P-GW is useful for achieving selective biliary cannulation. Pancreatic duct stenting after P-GW can reduce the incidence of post-ERCP pancreatitis, which requires evaluation by means of prospective randomized controlled trials.

Utility of endoscopic ultrasound in pancreatitis:A review

The close proximity of the endoscopic ultrasound probe to the pancreas results in superior spatial resolution compared to CT scan and MRI. In addition, endoscopic ultrasound (EUS) is a minimally invasive procedure that does not share the relatively high complication rate of ERCP. Due to these advantages, EUS has evolved into an important technique to assess pancreatobiliary disease. This review will discuss the role of EUS in patients with pancreatitis. The indications can be divided into acute pancreatitis and chronic pancreatitis. In acute pancreatitis, EUS is used to determine the etiology; in suspected chronic pancreatitis it is helpful to establish the diagnosis. Lastly, this review will discuss biliary pancreatitis with suspicion for persistent choledocholithiasis.

Early vs late cholecystectomy in mild gall stone pancreatitis: Anupdated meta-analysis and review of literature

BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.

Therapeutic effects of endoscopic therapy combined with enteral nutrition on acute severe biliary pancreatitis

Background Acute severe biliary pancreatitis （ASBP） is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects and reduce the expenditure of ASBP treatment.Methods One hundred and five patients diagnosed with ASBP were referred to our department from January 2004 to July 2009. Diagnosis was based on the 2007 criteria of the Chinese Society of Surgery. Patients were divided into two groups; the E group： 50 patients who underwent endoscopic retrograde choledochopancreatography （ERCP） ＋ endoscopic sphincterotomy （EST） ＋ endoscopic lithotripsy basket （ESR） ＋endoscopic retrograde biliary drainage （ERBD）and enteral nutrition （EN）, and the R group： 55 patients who underwent traditional treatment without ERCP. Subsequently,subjective symptoms, signs, biochemical analysis, serum endotoxin, tumor necrosis factor a, grades by computed tomography （CT）, cost of hospitalization and length of stay were compared between the two groups.Results All enrolled patients complied well with all therapeutic regimens. Endoscopic therapy that combined EN could significantly improve symptoms, clinical signs, laboratory values, tumor necrosis factor a and endotoxin while significantly reducing hospital expenditure and length of hospital stay. The experimental findings revealed that there were obvious advantages in the E group compared with the R group.Conclusions Endoscopic therapy combined with EN is an effective, safe and economic therapeutic regimen of ASBP.

Why are we performing fewer cholecystectomies for mild acute biliary pancreatitis?Trends and predictors of cholecystectomy from the National Readmissions Database(2010–2014)

Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better outcomes.In this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day readmission.Methods:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and 2014.Differences in cholecystectomy rates were computed on the basis of various characteristics.We conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same admission.Results:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with sphincterotomy.We observed a decreasing trend in both procedures during the study period(P<0.001).In multivariate analysis,odds of 30-day readmission were reduced for patients undergoing ERCP with sphincterotomy(odds ratio,0.78;95%confidence interval,0.74–0.84)or cholecystectomy(odds ratio,0.37;95%confidence interval,0.35–0.39).Conclusions:For patients with MABP,cholecystectomy or ERCP with sphincterotomy during the index admission decreased the risk of 30-day readmission.Despite this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study period.Further research is needed to understand the implications and reasons underlying this deviation from guidelines.

ERCP治疗ABP细胞因子及小肠黏膜COX-2蛋白研究

目的探讨经内镜逆行性胰胆管造影术（ERCP）介入治疗对急性胆源性胰腺炎（ABP）患者血清细胞因子及小肠黏膜环氧化酶-2（COX-2）蛋白表达的影响作用及其相关性。方法根据有无器官功能障碍或局部并发症、Ranson评分〈或≥3分、CT分级分为轻症急性胰腺炎（MAP）和重症急性胰腺炎（SAP）两组。分别提取两组ERCP术前及术后1周患者血液及小肠黏膜组织，应用酶联免疫吸附测定法（ELISA）及免疫组化技术分别检测血清细胞因子IL-6及十二指肠黏膜COX-2蛋白表达。结果30例ABP患者，经ERCP内镜治疗后，术后1周较术前生化指标明显改善（P〈0．01）；两组30例ABP患者，血清IL-6表达SAP组明显高于MAP纽（P〈0．01），经ERCP内镜治疗术后1周较术前患者血清IL-6表达明显降低（P〈0．05）；两组30例ABP患者，术前十二指肠黏膜COX-2蛋白表达SAP组明显高于MAP组（P〈0．05），经ERCP内镜治疗术后1周较术前COX-2蛋白表达明显降低（P〈0．05）。结论ABP患者经ERCP介入治疗后临床表现及生化指标明显改善。ABP患者重症者较轻症者血清IL-6及小肠黏膜COX-2蛋白高表达，经ERCP介入治疗术后血清IL-6及小肠黏膜COX一2蛋白表达降低。

Role of pancreatic endoscopic ultrasonography in 2010

Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are:(1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo-and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pan-creatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand,new therapeutic options are available due to EUS,such as pancreatic cyst drainage and celiac plexus neurolysis,offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.

急诊十二指肠镜联合早期肠内营养治疗老年急性胆源性胰腺炎(ABP)效果及并发症分析

目的分析急性胆源性胰腺炎老年患者接受急诊十二指肠镜、早期肠内营养联合医治效果及其并发症影响。方法整群选取2014年2月—2016年5月于该院医治的104例老年ABP患者临床资料,按医治方式不同分为两组,每组52例,单行急诊十二指肠镜医治对照组,在其基础上联合早期肠内营养治疗观察组,对比两组医治效果与并发症情况。结果观察组医治后发热、腹痛、后背胀痛等症状改善时长均比对照组短,差异有统计学意义(P<0.05);观察组治疗后血AMY、WBC、TBIL、PLT、CRP、TNF-α水平均比对照组优,差异有统计学意义(P<0.05);观察组治疗后并发症总发生率7.69%比对照组23.08%低,差异有统计学意义(P<0.05)。结论老年急性胆源性胰腺炎患者经急诊十二指肠镜、早期肠内营养联合治疗后,可有效改善临床症状,调衡患者机体环境,减低并发症风险,是安全、有效的医治方案。

Early versus delayed laparoscopic cholecystectomy in uncomplicated biliary colic: An observational study

Objective:Biliary colic is a condition treated with laparoscopic cholecystectomy.However,the outcomes of surgery depend on early or delayed time points.Few research findings reported no benefits of early over delayed,on contra,other reported benefits.This study aims to compare the benefits associated with early and delayed laparoscopic cholecystectomy among uncomplicated biliary colic patients.Methods:This observational study included patients with right upper abdominal pain and abdominal ultrasound showing cholelithiasis.Patients who were admitted at the first and second visits(within 6 weeks of the first visit)were assigned to the early and delayed groups,respectively.All participants were followed up for one-week postsurgery.The diagnosis of the patient,postoperative hospital stay,duration of surgery and complications were noted and compared primarily.Results:A total of 80 patients were included,40 each in the early group and delayed group.The patients in the two groups had comparable mean ages(40.55±13.12 y vs.40.45±12.06 y,p=0.972).The early group had more female patients(72.5%vs.45.0%,p=0.012).The duration of hospital stay(2.18±0.38 d vs.2.68±1.04 d,p=0.009)and duration of surgery(61.63±3.64 min vs.71.13±16.19 min,p=0.001)were found to be significantly different between the early and delayed groups.Only 1(2.5%)patient in both groups was converted to open cholecystectomy.Recurrent biliary colic requiring hospital admission was seen in 1(2.5%)patient and 6(15.0%)patients,acute cholecystitis in 2(5.0%)and 6(15.0%),biliary pancreatitis in 1(2.5%)and 2(5.0%),and obstructive jaundice in 1(2.5%)and 1(2.5%)in the early and delayed groups,respectively,with insignificant differences(p>0.05).Conclusion:Early laparoscopic cholecystectomy decreases the operating time and duration of hospital stay.In terms of postoperative complications,our study did not find any significant difference between the groups.

超声引导下引流术对SABP患者的临床观察

目的观察超声引导下经皮肝穿刺胆囊置管引流对急性重症胆源性胰腺炎患者症状及危重病评分、生化指标的影响效果,以期探讨该治疗措施的有效性及安全性。方法回顾性分析我科收治的68例急性重症胆源性胰腺炎患者相关资料,对治疗前、治疗后3d患者主要临床症状的改善情况、危重病评分变化情况(包括APACHEⅡ、Balthazar CT以及MODS评分)、生化指标改善情况,以及患者穿刺后发生并发症的情况进行观察。结果所有患者均成功在超声引导下经皮肝穿刺胆囊置管引流术,68例患者在治疗3d后均自感腹痛、腹胀、恶心、发热、呼吸困难等主要临床症状较治疗前明显缓解。与治疗前比较,治疗后的APACHEⅡ、Balthazar CT、MODS评分以及WBC、PCT、CRP、AMS、LIP以及TBIL均降低明显,差异具统计学意义(P<0.05)。治疗后患者共出现并发症3例(4.41%),均经治疗后缓解。结论超声引导下经皮肝穿刺胆囊置管引流可有效改善急性重症胆源性胰腺炎患者的症状,降低危重病评分,改善生化指标,安全性较好,具有临床推广价值。

中性粒细胞与淋巴细胞比值早期预测急性胆源性胰腺炎严重程度和胰腺坏死的价值

目的:评估中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对急性胆源性胰腺炎(acute biliary pancreatitis,ABP)严重程度和胰腺坏死(pancreatic necrosis,PN)的预测价值。方法:纳入290例ABP患者并在急性胰腺炎发作24 h内收集血液样本用于血常规及相关生化指标检测。通过受试者工作特性(receiver operating characteristic,ROC)曲线分析确定NLR预测重症急性胰腺炎(severe acute pancreatitis,SAP)和PN的最佳临界值。采用不同浓度牛磺胆酸钠溶液诱导大鼠ABP模型,并在造模后1、3、5、7、14 d收集血液和胰腺组织,比较各组的NLR。结果:ROC曲线分析显示NLR对SAP具有预测性能[曲线下面积(area under curve,AUC):0.944,95%可信区间(confidence interval,CI):0.915~0.973,P <0.001],最佳临界值为13.38(灵敏度80.0%、特异度83.2%)。NLR对PN也有较好的预测价值,AUC为0.910(95%CI:0.861~0.958,P <0.001),诊断的最佳临界值为9.265(灵敏度97.1%、特异度72.7%)。在大鼠ABP模型中,NLR在AP发病早期即可升高,并与AP和PN的严重程度相关。结论:在ABP发病后的24 h内,NLR可以作为早期预测其严重程度及PN的有力指标。