摘要
目的 探究C-反应蛋白(CRP)和中性粒细胞-淋巴细胞比率(NLR)对不同原因引起的不同严重程度急性胰腺炎(AP)的预测价值方法 回顾性地将于2019年5月—2021年5月在安徽医科大学第二附属医院就诊的139例AP患者入组作为研究对象,依据AP患者的严重程度将所有研究对象分为中重症急性胰腺炎(MSAP)组和重症急性胰腺炎(SAP)组,MSAP组中有110例患者,SAP组中有29例患者。收集所有研究对象入院时的一般资料,并在AP发病后48 h内采集外周血标本,统计分析白细胞(WBC)、CRP水平以及NLR。通过受试者工作特征曲线评估WBC、CRP、NLR对不同病因AP严重程度的预测能力。结果 在Ranson评分、APACHEⅡ评分以及实验室检查结果方面,SAP组患者的Ranson评分、APACHEⅡ评分显著高于MSAP组患者(P<0.05)。基于AP严重程度分组的基础上,根据患者的病因再次进行分组。除MSAP组和SAP组胆源性胰腺炎的NLR水平未发现明显差异外,SAP组不同病因患者的WBC水平、CRP水平以及NIR水平均明显高于MSAP组患者(P<0.05)。ROC曲线对胆源性AP患者分析中,CRP的预测价值最大,曲线下面积(AUC)为0.998,预测胆源性AP患者SAP的最佳CRP临界值为180.415 mg/L。对于酒精性AP患者,NLR的预测价值最大AUC=0.987,最佳NLR临界值为8.610。对于高脂血性AP患者,NLR的预测价值最大AUC=0.967,最佳NLR临界值为8.605。因此CRP诊断胆源性AP患者SAP的效能最大,而NLR诊断酒精性AP和高脂血症性AP患者SAP的效能最大。结论 CRP和NLR对不同病因引起的SAP具有预测价值,CRP能特异性地预测胆源性AP患者出现SAP,而NLR能特异性地预测酒精性AP和高脂血症性AP患者出现SAP的情况。
Objective To study the predictive value of C-reactive protein(CRP)and neutrophil-lymphocyte ratio(NLR)for moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)with different causes.Methods A retrospective analysis was conducted with 139 patients who admitted to the Second Affiliated Hospital of Anhui Medical University from May 2019 to May 2021.All patients were divided into MSAP(110 cases)group and SAP(29 cases)group.The white blood cells(WBC),CRP,NLR were analyzed within the 48 hours in all patients.The predictive value of WBC,CRP,and NLR in patients with different causes was assessed in two groups.Results The Ranson and APACHE II scores of patients in SAP group were significantly higher than those in MSAP group(P<0.05).The levels of WBC,CRP and NIR in the SAP group were significantly higher than those in the MSAP group(P<0.05).Except for the biliary pancreatitis,there was no significant difference in the level of NLR between the MSAP group and the SAP group.In the analysis of ROC curve for patients with biliary pancreatitis,CRP had the highest predictive value,with an area under curve(AUC)of 0.998.The optimal cut-off value of CRP for predicting in patients with biliary pancreatitis was 180.415 mg/L.For patients with alcoholic pancreatitis,the maximum predictive value of NLR was AUC of 0.987,and the best NLR cut-off value was 8.610.For patients with hyperlipidemic pancreatitis,the maximum predictive value of NLR was AUC of 0.967,and the best NLR cut-off value was 8.605.Conclusion CRP and NLR have predictive value for SAP.CRP can effectively predict in patients with severe biliary pancreatitis,and NLR can effectively predict severe alcoholic pancreatitis hyperlipidemic pancreatitis.
作者
汪海平
李贺
WANG Haiping;LI He(Department of Emergency Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei Anhui 230601,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第8期1069-1073,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
安徽省重点研究与开发计划项目(编号:201904a07020066)。
