摘要
背景急性胰腺炎(acute pancreatitis,AP)是国内常见急腹症.部分患者存在血清视黄醇结合蛋白(retinol-binding protein,RBP)降低的现象,但其临床意义尚不明确.目的探究RBP与AP严重程度和相关并发症的关系.方法回顾性分析2018年入东部战区总医院的AP患者(发病7天内)的临床资料.根据血清RBP水平将患者分为RBP正常组(normal retinol-binding protein,NRBP)和RBP降低组(low retinol-binding protein,LRBP),比较两组基线特征、AP严重程度、临床预后等.通过Logistic回归分析探究局部并发症的独立危险因素.绘制受试者工作曲线,评估RBP对AP相关并发症的预测效能.结果共纳入176例患者,其中NRBP组41人、LRBP组135人.LRBP组AP严重程度显著高于NRBP组(轻症:15.6%比39.0%,中重症:53.3%比29.3%,重症:31.1%比31.7%;P<0.05).LRBP组急性坏死组织积聚比例70.4%,显著高于NRBP组的52.1%(P<0.05).血清RBP水平在有局部并发症的患者中显著低于无局部并发症患者[24.00(15.00,27.50)mg/L比12.00(9.00,22.00)mg/L,P<0.05].RBP预测局部并发症的曲线下面积值为0.708(95%CI:0.615-0.801),最佳截断点为15.5 mg/L,灵敏度为60.4%,特异性为75.7%.RBP降低是局部并发症的独立危险因素(OR=5.306,P=0.003,95%CI:1.771-15.896).结论急性期血清RBP水平能较好的预测AP局部并发症的发生,但与全身炎症反应和远隔脏器衰竭无显著相关性.
BACKGROUND Acute pancreatitis is a common acute abdomen in China.There is a decrease of serum retinol-binding protein(RBP)in some patients,but its clinical significance is not clear.AIM To explore the relationship between serum RBP and the severity and complications of AP.METHODS The clinical data of AP patients admitted to Jinling Hospital in 2018 within 7 days of onset were analyzed retrospectively.The enrolled patients were divided into either a normal RBP(NRBP)group or a low RBP(LRBP)group according to the serum RBP level.The baseline characteristics,severity,and prognosis of disease were compared between the two groups.Logistic regression analysis was used to explore the independent risk factors for local complications.Receiver operating characteristic(ROC)curve was drawn to evaluate the performance of serum RBP in predicting complications.RESULTS A total of 176 patients were enrolled,including 41 in the NRBP group and 135 in the LRBP group.The severity of AP in the LRBP group was significantly more severe than that of the NRBP group(MAP:15.6%vs 39.0%,MSAP:53.3%vs 29.3%,SAP:31.1%vs 31.7%;P<0.05).The incidence of acute necrotic collection was 70.4%in the LRBP group,significantly higher than that(52.1%)of the NRBP group(P<0.05).The serum level of RBP in patients with local complications was significantly lower than that in patients without(24.00(15.00,27.50)mg/L vs 12.00(9.00,22.00)mg/L,P<0.05).The AUC of serum RBP for predicting local complications was 0.708(95%CI:0.615-0.801)and the cut-off value was 15.5 mg/L with a sensitivity 60.4%and specificity 75.7%.The decrease of serum RBP was an independent risk factor for local complications(OR=5.306,P=0.003,95%CI:1.771-15.896).CONCLUSION The level of serum RBP in the acute phase could predict the occurrence of local complications of AP,but has no significant correlation with systemic inflammatory response and remote organ failure.
作者
董小武
魏梅
马楠
陆蓥蓥
谢晓纯
施笑蕾
董杰
马孝杰
李百强
童智慧
李维勤
Xiao-Wu Dong;Mei Wei;Nan Ma;Ying-Ying Lu;Xiao-Chun Xie;Xiao-Lei Shi;Jie Dong;Xiao-Jie Ma;Bai-Qiang Li;Zhi-Hui Tong;Wei-Qin Li(Department of Critical Care Medicine,Jinling Clinical Medical College of Nanjing Medical University,Nanjing 210002,Jiangsu Province,China;Department of Critical Care Medicine,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu Province,China;Department of Critical Care Medicine,Jinling Clinical Medical College of Southeast University,Nanjing 210002,Jiangsu Province,China)
出处
《世界华人消化杂志》
CAS
2021年第15期873-879,共7页
World Chinese Journal of Digestology
关键词
急性胰腺炎
视黄醇结合蛋白
局部并发症
系统并发症
Acute pancreatitis
Retinol-binding protein
Local complications
System complications
