Early predictive value of neutrophil ratio combined with lactate dehydrogenase in the severity of acute pancreatitis
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摘要: 目的 探讨中性粒细胞比率(Neu%)联合乳酸脱氢酶(LDH)对急性胰腺炎(AP)患者病情严重程度的预测价值。方法 回顾性分析2016年1月—2020年12月我院收治的210例AP患者的临床资料，其中轻症急性胰腺炎(MAP)加中重症急性胰腺炎(MSAP)共189例(MAP+MSAP组)，重症急性胰腺炎(SAP)21例(SAP组)。收集2组患者的基本资料、入院后24 h内实验室指标(包括Neu%、LDH等)。统计分析Neu%、LDH水平与AP患者病情严重程度的相关性。结果 SAP组血清Neu%和LDH水平显著高于MAP+MSAP组，差异有统计学意义(P< 0.001)；logistic回归分析显示，Neu%、LDH是SAP的独立危险因素；受试者工作特征(ROC)曲线分析显示，Neu%和LDH联合检测对SAP的诊断有较高的敏感度(95.24%)和特异度(90.96%)。结论 早期血清Neu%和LDH对AP患者病情严重程度的评估有较大价值。Abstract: Objective To investigate the value of neutrophil ratio(Neu%) combined with lactate dehydrogenase(LDH) level in predicting the severity of acute pancreatitis(AP).Methods A retrospective analysis was performed for 210 patients with AP who were admitted to our hospital from January 2016 to December 2020, among whom 189 had mild acute pancreatitis (MAP) or moderately severe acute pancreatitis (MSAP), and 21 had severe acute pancreatitis (SAP). Related clinical data were collected, including basic information, laboratory markers(Neu%, LDH, etc.), and the correlations between LDH, Neu% and the severity of acute pancreatitis were statistically analyzed.Results ① The serum Neu% and LDH levels in the SAP group were significantly higher than those in the MAP+MSAP group, and the differences were statistically significant (bothP< 0.001); ②Logistic regression analysis showed that Neu% and LDH were independent risk factors for SAP; ③Receiver operating characteristic (ROC) curve analysis showed that the combined detection of Neu% and LDH had high sensitivity(95.24%) and specificity(90.96%) for the diagnosis of SAP.Conclusion Early blood Neu% and LDH are of great value in predicting the severity of acute pancreatitis.
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Key words:
- pancreatitis /
- lactate dehydrogenase /
- neutrophil ratio /
- severity of illness /
- prediction
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表 1 MAP+MSAP组与SAP组临床特征及实验室检查比较
例(%)，M(Q1，Q3) 项目 MAP+MSAP组(n=189) SAP组(n=21) χ2/Z/t P 性别 0.314 0.575 男 109(57.7) 14(66.7) 女 80(42.3) 7(33.3) 年龄/岁 50.05±15.79 58.71±18.30 2.086 0.048 高血压 0.374 0.541 有 43(22.8) 3(14.3) 无 146(77.2) 18(85.7) 心脏病 24.306 < 0.001 有 19(10.1) 11(52.4) 无 170(89.9) 10(47.6) 糖尿病 0.507 0.476 有 45(23.8) 3(14.3) 无 144(76.2) 18(85.7) 吸烟 14.876 < 0.001 有 19(10.1) 9(42.9) 无 170(89.9) 12(57.1) 饮酒 64.655 < 0.001 有 15(7.94) 16(76.2) 无 174(92.1) 5(23.8) 胆石症 2.910 0.088 有 90(48.1) 13(72.8) 无 97(51.9) 5(27.8) 高三酰甘油血症 1.88(0.89，10.7) 1.05(0.91，9.42) -0.894 0.371 WBC/(×109·L-1) 12.2(4.62) 13.7(6.34) 1.005 0.326 RDW/% 13.2(1.33) 13.7(1.36) 1.503 0.146 HCT/% 42.1(4.59) 41.5(9.07) 0.294 0.772 MPV/fL 10.1(9.40，11.5) 10.5(9.50，11.3) -0.299 0.765 Neu/% 81.4(7.10) 90.5(2.83) 11.311 < 0.001 AMS/(U·L-1) 609(228，1705) 622(338，1887) -0.083 0.934 LPSa)/(U·L-1)(n=112) 1089(223，2719) 1537(557，5334) -0.485 0.628 BUNa)/(mmol·L-1)(n=209) 4.97(3.88，6.01) 8.98(5.45，11.9) -4.478 < 0.001 Scra)/(μmmol·L-1)(n=209) 238(183，322) 386(324，512) -5.144 < 0.001 TBiL/(μmmol·L-1) 21.7(16.0，33.1) 32.3(20.1，59.9) -2.042 0.041 ALT/(U·L-1) 45.0(20.8，145.0) 74.5(32.0，261.0) -1.304 0.192 AST/(U·L-1) 37.0(21.1，115.0) 121(64.0，267.0) -3.021 0.003 LDH/(U·L-1) 74.9(63.8，91.0) 186(98.0，277.0) -5.284 < 0.001 注：a)数据有缺失值。 
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表 2 SAP危险因素的多元logistic回归分析
变量 β Wald χ2 OR 95%CI P Neu% 0.918 5.235 2.505 1.141~5.499 0.022 LDH 0.062 5.071 1.064 1.008~1.123 0.024
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表 3 Neu%、LDH及两者联合的ROC曲线分析
指标 AUC 95%CI 最佳约登指数 敏感度/% 特异度/% P Neu% 0.930 0.887~0.961 0.7672 100.00 76.72 < 0.001 LDH 0.852 0.796~0.897 0.6667 66.67 100.00 < 0.001 联合 0.980 0.951~0.995 0.8620 95.24 90.96 < 0.001
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