血小板相关参数在急性胰腺炎病情严重程度预测中的相关性研究

金磊; 周淑萍; 曹子君; 杨亚东

doi:10.13201/j.issn.1009-5918.2021.02.006

血小板相关参数在急性胰腺炎病情严重程度预测中的相关性研究

- 1. 安徽理工大学第一附属医院重症医学科(安徽淮南, 232000);
- 2. 安徽理工大学第一附属医院消化内科;
- 3. 黄冈市中心医院重症医学科
基金项目:
安徽高校自然科学研究项目(No:KJ2019A0093)

详细信息

通讯作者: 杨亚东,E-mail:2636751934@qq.com

中图分类号: R657.5

收稿日期: 2020-12-24

Correlation of platelet related parameters in predicting severity of acute pancreatitis

- 1. Department of Intensive Care Medicine, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, Anhui, 232000, China;
- 2. Department of Gastroenterology, The First Affiliated Hospital of Anhui University of Science and Technology;
- 3. Department of Intensive Care Medicine, Huanggang Central Hospital

More Information

Corresponding author: YANG Yadong, E-mail: 2636751934@qq.com

Received Date: 24 December 2020

摘要

摘要: 目的:探讨平均血小板体积(MPV)、血小板分布宽度(PDW)、平均血小板体积与血小板计数绝对值比率(MPV/PLT)和急性胰腺炎(AP)患者病情严重程度的相关性。方法:选取符合《中国急性胰腺炎诊治指南(2019年,沈阳)》诊断标准的90例急性胰腺炎患者作为研究对象(研究组),以同期82例健康体检者作为对照(对照组)。将研究组按照病情严重程度分为轻症组(MAP)、中度重症组(MSAP)、重症组(SAP)。记录患者基本信息及急性胰腺炎严重程度床边指数(BISAP评分),于确诊72 h内取静脉血检测,包括:WBC、RDW、PLT、PDW、MPV、CRP、TBiL、D-Dimer、MPV/PLT、PDW/PLT、血肌酐等。用Logistic回归分析疾病的危险因素。采用Spearman分析进行相关性研究。绘制受试者操作特征(ROC)曲线,评估血小板参数对疾病严重程度预测价值。结果:研究组中MAP 36例、MSAP 29例、SAP 25例。研究组血糖(mmol/L)(10.28±1.02)、PDW(fL)(19.38±3.27)、MPV(fL)(10.80±2.01)、PDW/PLT(0.13±0.03)、MPV/PLT(0.09±0.03)均高于对照组。研究组PLT低于对照组[(150.21±54.78)×10⁹/L vs.(190.12±68.53)×10⁹/L]。研究组中,轻症组的BISAP评分(1.42±0.08)、血糖(6.02±0.97)、PDW(16.76±1.55)、MPV(8.49±1.31)、PDW/PLT(0.09±0.12)、MPV/PLT(0.06±0.01)<中度重症组的BISAP评分(2.35±1.04)、血糖(10.12±1.18)、PDW(20.20±0.95)、MPV(11.01±0.66)、PDW/PLT(0.13±0.01)、MPV/PLT(0.11±0.01)<重症组的BISAP评分(3.13±1.21)、血糖(12.49±1.53)、PDW(23.48±1.25)、MPV(13.52±1.10)、PDW/PLT(0.16±0.02)、MPV/PLT(0.13±0.01);PLT:轻症组(218.44±28.43)×10⁹/L>中度重症组(163.28±17.20)×10⁹/L>重症组(101.28±25.18)×10⁹/L。Logistic回归分析显示,PDW、MPV、MPV/PLT、BISAP评分是急性胰腺炎病情程度的独立危险因素[PDW(OR=3.218,95%CI:2.381~5.193)、MPV(OR=2.341,95%CI:1.010~5.422)、MPV/PLT(OR=1.764,95%CI:0.768~4.052)、BISAP评分(OR=3.104,95%CI:1.261~6.397),均P<0.05]。Spearman相关性分析显示MPV(r=0.781)、PDW(r=0.809)、MPV/PLT(r=0.763)与BISAP评分正相关(均P<0.05)。ROC曲线分析显示,血清MPV预测SAP曲线下面积为0.810(95%CI:0.726~0.871),最佳诊断截点为10.37fL,敏感度为71.2%,特异度83.5%;PDW预测SAP曲线下面积为0.882(95%CI:0.826~0.937),最佳诊断截点为15.18fL,敏感度为88.1%,特异度为86.3%;MPV/PLT预测SAP曲线下面积为0.717(95%CI:0.642~0.792),最佳诊断截点为0.10,敏感度为78.1%,特异度为65.3%。MPV、PDW及MPV/PLT曲线下面积均>0.7,诊断价值较高。其中PDW曲线下面积最大,其诊断价值更高,其评价的敏感度及特异度也更有价值。结论:MPV、PDW、MPV/PLT可能是急性胰腺炎病情严重程度的独立危险因素,对AP病情严重程度有一定预测作用。
- 急性胰腺炎 /
- 平均血小板体积 /
- 血小板分布宽度 /
- 平均血小板体积与血小板计数绝对值比率
Abstract: Objective: To explore the correlation between mean platelet volume(MPV), platelet distribution width(PDW), mean platelet volume to absolute platelet count ratio(MPV/PLT) for the severity of acute pancreatitis.Methods: Ninety patients with acute pancreatitis who met the diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Acute Pancreatitis in China(2019, Shenyang) were selected as the research subjects, and healthy physical controls during the same period were taken as controls. The researched group was divided into MAP group, MSAP group, and SAP group according to the severity of the disease. Patient's basic information and bedside index of acute pancreatitis severity(BISAP score) were recorded, and venous blood tests within 72 hours of diagnosis were taked, including WBC, RDW, PLT, PDW, MPV, CRP, TBiL, D-Dimer, MPV/PLT, PDW/PLT, serum creatinine, etc. Logistic regression was used to analyze the risk factors of the disease, Spearman analysis was used for correlation study. The receiver operating characteristic curve(ROC) was applied to evaluate the predictive value of platelet parameters to the severity of the disease.Results: Ninety patients with acute pancreatitis and eighty-two healthy controls were enrolled. There were 36 mild cases, 29 moderately severe cases and 25 severe cases of acute pancreatitis patients. Blood glucose(10.28±1.02) mmol/L, PDW(19.38±3.27) fL, MPV(10.80±2.01) fL, PDW/PLT(0.13±0.03), MPV/PLT(0.09±0.03) of the study group were higher than those in the healthy control group. The PLT(150.21±54.78)×10⁹/L of the studied group was lower than that in the healthy control group(190.12±68.53)×10⁹/L. In the study group, the BISAP scores(1.42±0.08), blood glucose(6.02±0.97), PDW(16.76±1.55), MPV(8.49±1.31), PDW/PLT(0.09±0.12), MPV/PLT(0.06±0.01) of the MAP group <the BISAP scores(2.35±1.04), blood glucose(10.12±1.18), PDW(20.20±0.95), MPV(11.01±0.66), PDW/PLT(0.13±0.01), MPV/PLT(0.11±0.01) of the MSAP group <the BISAP scores(3.13±1.21), blood glucose(12.49±1.53), PDW(23.48±1.25), MPV(13.52±1.10), PDW/PLT(0.16±0.02), MPV/PLT(0.13±0.01) of the SAP group; PLT: the MAP group(218.44±28.43)>the MSAP group(163.28±17.20)>the SAP group(101.28±25.18). The logistic regression analysis showed that PDW(OR=3.218, 95%CI: 2.381-5.193), MPV(OR=2.341, 95%CI: 1.010-5.422), MPV/PLT(OR=1.764, 95%CI: 0.768-4.052), and BISAP scores(OR=3.104, 95%CI: 1.261-6.397) were independent risk factors for the severity of acute pancreatitis(P<0.05). Spearman correlation analysis showed that MPV(r=0.781), PDW(r=0.809), MPV/PLT(r=0.763) were positively correlated with BISAP scores(P<0.05). ROC curve analysis showed that the area under the curve for MPV to predict the SAP was 0.810(95%CI: 0.726-0.871), the best diagnostic cut-off point was 10.37 fL, the sensitivity was 71.2%, and the specificity was 83.5%. The area under the curve for PDW to predict the SAP was 0.882(95%CI: 0.826-0.937), the best diagnostic cut-off point was 15.18 fL, the sensitivity was 88.1%, and the specificity was 86.3%. The area under curve for MPV/PLT to predict the SAP is 0.717(95%CI: 0.642-0.792), the best diagnostic cut-off point was 0.10, the sensitivity was 78.1%, and the specificity was 65.3%. The area under the MPV, PDW, and MPV/PLT curves were all larger than 0.7, which was of high diagnostic value. Among them, The area under the curve for PDW was the largest, which had higher diagnostic value, sensitivity and specificity.Conclusion: MPV, PDW, MPV/PLT may be independent risk factors for the severity of acute pancreatitis, and have a certain predictive effect on the severity of the disease.
- acute pancreatitis /
- mean platelet volume /
- platelet distribution width /
- mean platelet volume to absolute platelet count ratio(MPV/PLT)

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参考文献(30)

[1]	王霆,丁俊华,姜岱山,等.改良胰岛素给药方案对重症急性胰腺炎血糖波动和预后的影响[J].临床急诊杂志,2020,21(12):996-999.
[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》编委会,《中华消化杂志》编委会.中国急性胰腺炎诊治指南(2019年,沈阳)[J].临床肝胆病杂志,2019,35(12):2706-2711.
[3]	Papadopoulos VP,Filippou DK,Mimidis KP.Mean platelet volume in acute pancreatitis:a systematic review and meta-analysis[J].Ann Gastroenterol,2020,33(4):398-404.
[4]	冯燕,罗志刚.RDW、NLR联合MPV对老年急性胰腺炎持续性器官衰竭患者的预测[J].中国老年学杂志,2020,40(4):785-788.
[5]	孙备,李冠群.急性胰腺炎临床研究进展与展望[J].中国实用外科杂志,2020,40(2):171-175,179.
[6]	Leppaniemi A,Tolonen M,Tarasconi A,et al.2019 WSES guidelines for the management of severe acute pancreatitis[J].World J Emerg Surg,2019,14:27.
[7]	李孝全,莫静欣.中药大黄对重症急性胰腺炎肺损伤大鼠肺泡巨噬细胞凋亡的影响[J].中国免疫学杂志,2020,36(15):1839-1843.
[8]	姜雷,李超,刘琳琳,等.老年重症颅脑外伤患者早期强化肠内营养的应用效果分析[J].临床急诊杂志,2018,19(4):207-211.
[9]	张强,郑能.血清穿透素-3和D-二聚体对重症急性胰腺炎的预测价值研究[J].临床急诊杂志,2020,21(11):876-880.
[10]	Bakogiannis C,Sachse M,Stamatelopoulos K,et al.Platelet-derived chemokines in inflammation and atherosclerosis[J].Cytokine,2019,122:154157.
[11]	杨旭颖,刘凤华.血小板生成素和血小板特异性抗体在SLE合并血小板减少中的作用[J].临床血液学杂志,2020,33(10):671-673,677.
[12]	Pogorzelska K,Kretowska A,Krawczuk-Rybak M,et al.Characteristics of platelet indices and their prognostic significance in selected medical condition-a systematic review[J].Adv Med Sci,2020,65(2):310-315.
[13]	王明镜,胡晓梅,邓中阳,等.免疫性血小板减少症的免疫机制研究进展[J].临床血液学杂志,2017,30(9):725-728.
[14]	Zusso M,Lunardi V,Franceschini D,et al.Ciprofloxacin and levofloxacin attenuate microglia inflammatory response via TLR4/NF-κB pathway[J].J Neuroinflammation,2019,16(1):148.
[15]	Dib P,Quirino-Teixeira AC,Merij LB,et al.Innate immune receptors in platelets and platelet-leukocyte interactions[J].J Leukoc Biol,2020,108(4):1157-1182.
[16]	Dehghani T,Panitch A.Endothelial cells,neutrophils and platelets:getting to the bottom of an inflammatory triangle[J].Open Biol,2020,10(10):200161.
[17]	Vardon-Bounes F,Ruiz S,Gratacap MP,et al.Platelets Are Critical Key Players in Sepsis[J].Int J Mol Sci,2019,20(14).
[18]	Omar M,Tanriverdi O,Cokmert S,et al.Role of increased mean platelet volume(MPV)and decreased MPV/platelet count ratio as poor prognostic factors in lung cancer[J].Clin Respir J,2018,12(3):922-929.
[19]	Molina F,Del Moral ML,La Rubia M,et al.Are Patients With Fibromyalgia in a Prothrombotic State?[J].Biol Res Nurs,2019,21(2):224-230.
[20]	Samuel D,Bhat AN,Prabhu VM.Platelet Indices as Predictive Markers of Prognosis in Critically Ill Patients:A Prospective Study[J].Indian J Crit Care Med,2020,24(9):817-822.
[21]	Zeng L,Cai X,Chen J,et al.Role of mean platelet volume in hypertriglyceridemia-induced acute pancreatitis during pregnancy[J].BMC Pregnancy Childbirth,2020,20(1):592.
[22]	曹锡煌.血小板分布宽度对重症急性胰腺炎预后的价值[J].中国实用医药,2020,15(28):26-28.
[23]	Zhu N,Shu H,Jiang W,et al.Mean platelet volume and mean platelet volume/platelet count ratio in nonvalvular atrial fibrillation stroke and large artery atherosclerosis stroke[J].Medicine(Baltimore),2020,99(28):e21044.
[24]	Iida H,Kaibori M,Matsui K,et al.Ratio of mean platelet volume to platelet count is a potential surrogate marker predicting liver cirrhosis[J].World J Hepatol,2018,10(1):82-87.
[25]	Liu Z,Li X,Zhang M,et al.The role of Mean Platelet Volume/platelet count Ratio and Neutrophil to Lymphocyte Ratio on the risk of Febrile Seizure[J].Sci Rep,2018,8(1):15123.
[26]	Sayed SZ,Mahmoud MM,Moness HM,et al.Admission platelet count and indices as predictors of outcome in children with severe Sepsis:a prospective hospital-based study[J].BMC Pediatr,2020,20(1):387.
[27]	Li Y,Zhang J,Zou J.Evaluation of four scoring systems in prognostication of acute pancreatitis for elderly patients[J].BMC Gastroenterol,2020,20(1):165.
[28]	Arif A,Jaleel F,Rashid K.Accuracy of BISAP score in prediction of severe acute pancreatitis[J].Pak J Med Sci,2019,35(4):1008-1012.
[29]	Zheng L,Hong W,Geng W,et al.A comparison of the BISAP score and Amylase and BMI(CAB)score versus for predicting severe acute pancreatitis[J].Acta Gastroenterol Belg,2019,82(3):397-400.
[30]	Hagjer S,Kumar N.Evaluation of the BISAP scoring system in prognostication of acute pancreatitis-A prospective observational study[J].Int J Surg,2018,54:76-81.