摘要
目的:探讨毛细血管渗漏指数(CLI)在急性重症胰腺炎(SAP)合并急性肺损伤(ALI)病人病情预测及预后评估中的价值。方法:选取78例SAP病人作为研究对象,根据是否合并急性肺损伤分为非ALI组40例和ALI组38例,根据病人入院28 d存活情况分为存活组45例和死亡组33例。分析SAP病人的临床基线资料;采用Pearson相关分析评价CLI与急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、改良CT严重程度指数(MCTSI)及乳酸的相关性;使用ROC曲线分析CLI对SAP合并ALI发生和28 d死亡风险的预测;采用Kaplan-Meier生存曲线分析不同CLI水平危险分层下的累积生存率。结果:ALI组病人C反应蛋白(CRP)、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于非ALI组(P<0.05~P<0.01);ALI组病人血清白蛋白(ALB)水平明显低于非ALI组(P<0.01)。存活组与死亡组性别差异无统计学意义(P>0.05);死亡组病人年龄、CRP、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于存活组(P<0.05~P<0.01);死亡组病人ALB水平明显低于存活组(P<0.01)。SAP病人入院时CLI与APACHEⅡ评分、MCTSI及乳酸均呈明显正相关关系(P<0.01)。CLI对预测SAP合并ALI和28 d死亡的ROC曲线下面积分别为0.802(95%CI:0.705~0.899)和0.758(95%CI:0.651~0.865);最佳截断值分别为0.517和0.394,对应的CLI为9.335和9.770,敏感度分别为84.20%和72.70%,特异度分别为67.50%和67.70%。基于9.552为最新最佳截断值进行Kaplan-Meier生存曲线分析,结果显示,CLI>9.552组的28 d累积生存率明显低于CLI≤9.552组(P<0.01)。结论:CLI可以早期预测SAP合并ALI的发生,并且在评估病人预后方面发挥重要价值,特别对于CLI>9.552的SAP病人其短期死亡风险更高,需要临床医生予以重点关注。
Objective:To explore the value of capillary leakage index(CLI)in predicting the condition and evaluating the prognosis of patients with severe acute pancreatitis(SAP)complicated with acute lung injury(ALI).Methods:A total of 78 SAP patients were selected as the study subjects,and divided into non-ALI group(n=40)and ALI group(n=38)based on whether acute lung injury occured.According to the 28-day survival status of the patients,they were divided into survival group(n=45)and death group(n=33).The clinical baseline data of SAP patients were analyzed;the correlation between CLI and acute physiology and chronic health evaluation scoring system(APACHEⅡ),modified CT severity index(MCTSI),and lactate was evaluated using Pearson correlation analysis;the prediction of CLI on the occurrence of ALI and risk of 28-day mortality was analyzed by ROC curve;the cumulative survival rate under different risk stratification levels of CLI was analyzed with Kaplan-Meier survival curve.Results:The C-reactive protein(CRP),CLI,lactate level,MCTSI,and APACHEⅡscores of patients in the ALI group were higher than those in the non-ALI group(P<0.05 to P<0.01);the serum albumin(ALB)level of patients in the ALI group was significantly lower than that in the non-ALI group(P<0.01).There was no statistically significant difference in gender between the survival group and the death group(P>0.05);the age,CRP,CLI,lactate level,MCTSI,and APACHEⅡscores of patients in the death group were higher than those in the survival group(P<0.05 to P<0.01);the ALB level of patients in the death group was significantly lower than that in the survival group(P<0.01).There was a significant positive correlation between CLI and APACHEⅡscore,MCTSI,and lactate level of SAP patients at admission(P<0.01).The area under the ROC curve of CLI for predicting SAP complicated with ALI and 28-day mortality was 0.802(95%CI:0.705-0.899)and 0.758(95%CI:0.651-0.865),respectively;the optimal cutoff values were 0.517 and 0.394,with corresponding CLI values of 9.335 and 9.770,sen
作者
杜杰
徐志鹏
郑传明
张太哲
王振杰
DU Je;XU Zhi-peng;ZHENG Chuan-ming;ZHANG Tai-zhe;WANG Zhen-jie(Department of Emergency Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)
出处
《蚌埠医学院学报》
CAS
2023年第7期892-895,共4页
Journal of Bengbu Medical College
基金
安徽省高校自然科学研究重点项目(KJ2019A0385)
蚌埠医学院自然科学研究重点项目(2020byzd108)
安徽省蚌埠市科技创新指导类项目(20200336)。
