实验室指标和评分系统对急性胰腺炎患者病情严重程度及早期预后的评估价值

张娟; 章润叶; 杨淑洁; 谢荣裕

doi:10.13201/j.issn.1009-5918.2021.01.011

实验室指标和评分系统对急性胰腺炎患者病情严重程度及早期预后的评估价值

- 南通大学附属如皋医院重症监护室(江苏如皋, 226500)
基金项目:
江苏省卫生计生委2016年度青年科研课题(No:Q201612)

详细信息

通讯作者: 章润叶,E-mail:ggdm123nt@163.com

中图分类号: R657.51

收稿日期: 2020-07-16

Evaluation value of laboratory indexes and scoring system on the severity and early prognosis of patients with acute pancreatitis

- Intensive Care Unit, Rugao Hospital, Nantong University, Rugao, Jiangsu 226500, China

More Information

Corresponding author: ZHANG Runye, E-mail: ggdm123nt@163.com

Received Date: 16 July 2020

摘要

摘要: 目的:探讨中性粒细胞与淋巴细胞比值(NLR)、血尿素氮(BUN)、红细胞分布宽度(RDW)与BISAP评分、Ranson评分、SOFA评分、APACHEⅡ评分对急性胰腺炎(AP)患者病情严重程度及28 d病死率的预测价值。方法:回顾性纳入2016年1月—2019年9月期间在我院住院治疗的AP患者151例,根据病情严重程度分为轻症急性胰腺炎(MAP)组、中度重症急性胰腺炎(MSAP)组、重症急性胰腺炎(SAP)组,对患者基础资料、实验室指标及不同评分系统的差异进行分析,通过ROC曲线分别计算各指标预测SAP及AP患者28 d病死率的临界值、AUC等。结果:①MAP、MSAP、SAP3组间的NLR、BUN、RDW、BISAP评分、Ranson评分、SOFA评分、APACHEⅡ评分比较,差异均有统计学意义(均P<0.01)。②死亡组NLR、BUN、RDW、BISAP评分、Ranson评分、SOFA评分、APACHEⅡ评分均显著高于生存组,差异均有统计学意义(均P<0.05)。③NLR、BUN、RDW、BISAP评分、Ranson评分、SOFA评分及APACHEⅡ评分,预测SAP的AUC分别为0.761、0.768、0.914、0.928、0.830、0.830、0.837,预测AP患者28 d病死率的AUC分别为0.760、0.843、0.949、0.817、0.751、0.934、0.814。④实验室指标中,RDW相比NLR、BUN对SAP、AP患者28 d病死率的预测价值更好。评分系统中,BISAP评分对SAP的预测价值更好,SOFA评分对AP患者28 d病死率的预测价值更好。结论:NLR、BUN、RDW、BISAP评分、Ranson评分、SOFA评分、APACHEⅡ评分对SAP及AP患者28 d病死率均有预测价值。实验室指标中,RDW对AP患者病情严重程度及预后的预测价值更好;评分系统中,BISAP评分对AP患者病情严重程度预测价值更好,SOFA评分对AP患者预后的预测价值更好。
- 急性胰腺炎 /
- 评分系统 /
- 严重程度 /
- 预后
Abstract: Objective: To investigate the neutrophil-lymphocyte ratio(NLR), blood urea nitrogen(BUN), red blood cell distribution width(RDW) and BISAP score, Ranson score, SOFA score, and APACHE Ⅱ score in patients with acute pancreatitis(AP).Predictive value of severity and 28-day mortality.Methods: A total of 151 patients with AP who were hospitalized in Rugao Hospital, Nantong University from January 2016 to September 2019 were retrospectively included.They were divided into mild acute pancreatitis(MAP) group and moderate severe acute pancreatitis(MSAP) according to their severity) Group, severe acute pancreatitis(SAP) group, analysis of the patient's basic data, laboratory indicators and differences in different scoring systems, using ROC curve to calculate the indicators to predict the 28-day mortality threshold and AUC of SAP and AP patients respectively Wait.Results:①There were significant differences in NLR, BUN, RDW, BISAP score, Ranson score, SOFA score, and APACHE Ⅱ score between the three groups of MAP, MSAP, and SAP(all P<0.01).②NLR, BUN, RDW, BISAP score, Ranson score, SOFA score, and APACHE Ⅱ score in the death group were significantly higher than those in the survival group, and the differences were statistically significant(all P<0.05).③NLR, BUN, RDW, BISAP score, Ranson score, SOFA score, and APACHE Ⅱ score.The predicted AUC of SAP is 0.761, 0.768, 0.914, 0.928, 0.830, 0.830, 0.837, and the 28-day mortality rate of AP patients is predicted.The AUCs are 0.760, 0.843, 0.949, 0.817, 0.751, 0.934, and 0.814, respectively.④ Among laboratory indicators, RDW has better predictive value of 28-day mortality for SAP and AP patients than NLR and BUN.In the scoring system, BISAP score has a better predictive value for SAP, and SOFA score has a better predictive value for 28-day mortality of AP patients.Conclusion: NLR, BUN, RDW, BISAP score, Ranson score, SOFA score, APACHE Ⅱ score have predictive value for 28-day mortality of SAP and AP patients.Among laboratory indicators, RDW has a better predictive value for the severity and prognosis of AP patients; in the scoring system, BISAP score has a better predictive value for AP patients' disease severity, and SOFA score has a better predictive value for AP patients' prognosis.
- acute pancreatitis /
- scoring system /
- severity /
- prognosis

HTML全文

参考文献(19)

[1]	Petrov MS,Yadav D.Global epidemiology and holistic prevention of pancreatitis[J].Nat Rev Gastroenterol Hepatol,2019,16(3):175-184.
[2]	中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2019年,沈阳)[J].中华消化杂志,2019,39(11):721-730.
[3]	Tee YS,Fang HY,Kuo IM,et al.Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis[J].Medicine(Baltimore),2018,97(7):9654.
[4]	Vasudevan S,Goswami P,Sonika U,et al.Comparison of Various Scoring Systems and Biochemical Markers in Predicting the Outcome in Acute Pancreatitis[J].Pancreas,2018,47(1):65-71.
[5]	Zahorec R.Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill[J].Bratisl Lek Listy,2001,102(1):5-14.
[6]	Felderbauer P,Müller C,Bulut K,et al.Pathophysiology and treatment of acute pancreatitis:new therapeutic targets--a ray of hope?[J].Basic Clin Pharmacol Toxicol,2005,97(6):342-350.
[7]	Wittel UA,Rau B,Gansauge F,et al.Influence of PMN leukocyte-mediated pancreatic damage on the systemic immune response in severe acute pancreatitis in rats[J].Dig Dis Sci,2004,49(7-8):1348-1357.
[8]	Cho SK,Jung S,Lee KJ,et al.Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis[J].BMC Gastroenterol,2018,18(1):18.
[9]	Wang Y,Fuentes HE,Attar BM,et al.Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis[J].Pancreatology,2017,17(6):893-897.
[10]	Pavlov P,Uchikov P,Murdzheva M,et al.Main lymphocyte populations and their subpopulations in patients with acute pancreatitis studied in the course of disease[J].Khirurgiia(Sofiia),2001,57(5-6):4-11.
[11]	Hong W,Lin S,Zippi M,et al.High-Density Lipoprotein Cholesterol,Blood Urea Nitrogen,and Serum Creatinine Can Predict Severe Acute Pancreatitis[J].Biomed Res Int,2017,2017:1648385.
[12]	Chen HZ,Ji L,Li L,et al.Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis[J].Medicine(Baltimore),2017,96(30):e7487.
[13]	Zhang T,Liu H,Wang D,et al.Predicting the Severity of Acute Pancreatitis With Red Cell Distribution Width at Early Admission Stage[J].Shock,2018,49(5):551-555.
[14]	Goyal H,Awad H,Hu ZD.Prognostic value of admission red blood cell distribution width in acute pancreatitis:a systematic review[J].Ann Transl Med,2017,5(17):342.
[15]	Hu ZD,Wei TT,Zhong RQ.Red blood cell distribution:an index without additional cost in estimating the prognosis of acute pancreatitis[J].Clin Chem Lab Med,2016,54(12):e389-e390.
[16]	Orfanu AE,Popescu C,Leuştean A,et al.The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients[J].J Crit Care Med(Targu Mures),2017,3(3):105-110.
[17]	Chandra S,Murali A,Bansal R,et al.The Bedside Index for Severity in Acute Pancreatitis:a systematic review of prospective studies to determine predictive performance[J].J Community Hosp Intern Med Perspect,2017,7(4):208-213.
[18]	Zhang W,Hu J,Yao B,et al.Evaluation of Early Prognostic Factors of Mortality in Patients with Acute Pancreatitis:A Retrospective Study[J].Gastroenterol Res Pract,2017,2017:8363561.
[19]	Adam F,Bor C,Uyar M,et al.Severe acute pancreatitis admitted to intensive care unit:SOFA is superior to Ranson’s criteria and APACHE Ⅱ in determining prognosis[J].Turk J Gastroenterol,2013,24(5):430-435.