Prognostic evaluation of BISAP score combined with YKL-40 and GIP in patients with severe acute pancreatitis
-
摘要: 目的 探讨急性胰腺炎严重程度床边指数(BISAP)评分联合人软骨糖蛋白39(YKL-40)、血清肠抑胃肽(GIP)对于重症急性胰腺炎(SAP)患者的预后评估价值。方法 前瞻性选取2019年6月-2021年11月海南西部中心医院重症医学科收治的SAP患者98例为研究对象(SAP组)，另选取同期海南西部中心医院消化内科收治的轻症急性胰腺炎(MAP)患者91例为MAP组，并同期随机选取于海南西部中心医院体检的90例健康体检者为对照组，比较3组研究对象体内血清YKL-40和GIP水平。将SAP组患者按住院期间预后分为死亡组(31例)和生存组(67例)，比较两组一般资料和实验室指标，SAP死亡的相关高危因素采用logistic回归分析，绘制受试者工作特征(ROC)曲线分析BISAP评分及血清YKL-40、GIP水平预测SAP预后的价值。结果 SAP组患者血清YKL-40、GIP水平高于MAP组和对照组，MAP组患者血清YKL-40、GIP水平高于对照组(P< 0.05); 生存组和死亡组在BISAP评分、尿素氮、血肌酐、血糖、降钙素原(PCT)、C反应蛋白(CRP)、血脂肪酶、YKL-40、GIP水平上差异有统计学意义(P< 0.05); logistic回归分析结果显示，PCT、BISAP评分、YKL-40、GIP是SAP患者死亡的独立相关因素(P< 0.05)。ROC分析显示，BISAP评分、YKL-40、GIP 3个指标联合检测对SAP患者预后的预测价值优于单一指标检测。结论 SAP患者体内血清YKL-40、GIP表达水平异常升高，与SAP患者病情严重程度及预后有一定关系，BISAP评分、血清YKL-40、GIP是SAP患者死亡的独立相关因素，三者联合检测可以提高预测SAP预后的准确性。Abstract: Objective To investigate the prognosis evaluation value of bedside index for severity in acute pancreatitis(BISAP) combined with serum human cartilage glycoprotein-39(YKL-40) and glucose-dependent insulinotropic polypeptide(GIP) in patients with severe acute pancreatitis(SAP).Methods This study was a prospective study. A total of 98 patients with SAP who were admitted to the intensive care unit in Hainan Western Central Hospital from June 2019 to November 2021 were selected as the research subjects(SAP group). In addition, 91 patients with mild acute pancreatitis(MAP) treated in gastroenterology department of Hainan Western Central Hospital in the same period were selected as MAP group. At the same time, 90 healthy people who underwent physical examination in Hainan Western Central Hospital were randomly selected as the control group. And the serum YKL-40 and GIP levels in the three groups were compared. According to the prognosis of SAP patients during hospitalization, they were divided into death group(n=31) and survival group(n=67). The general data and laboratory indexes of the two groups were compared. The related high-risk factors of SAP death were analyzed by logistic regression, and the receiver operating characteristic(ROC) curve was drawn to analyze the value of BISAP score and serum YKL-40 and GIP levels in predicting the prognosis of SAP.Results The serum YKL-40 and GIP levels in patients with SAP were higher than those in MAP and control group, and the serum YKL-40 and GIP levels in patients with MAP were higher than those in control group(P< 0.05). There were significant differences in BISAP score, urea nitrogen, blood creatinine, blood glucose, procalcitonin(PCT), C-reactive protein(CRP), blood lipase, YKL-40 and GIP levels between survival group and death group(P< 0.05). Logistic regression analysis showed that PCT, BISAP score, YKL-40 and GIP were independent related factors of patient death(P< 0.05). ROC analysis showed that BISAP score, YKL-40 and GIP combined test had better prognostic value of prognosis for the patients with SAP than single index test.Conclusion The abnormal increase of serum YKL-40 and GIP expression levels in patients with SAP is related to the severity and prognosis of patients with SAP. BISAP score, serum YKL-40 and GIP are independent related factors of patient death. The combined detection of the three can improve the accuracy in predicting the prognosis of SAP.
-
-
表 1 3组患者血清YKL-40、GIP水平分析
X±S 指标 对照组(90例) MAP组(91例) SAP组(98例) F P YKL-40/(ng·L-1) 25.37±5.61 48.37±10.261) 75.16±15.671)2) 468.444 < 0.001 GIP/(ng·L-1) 267.35±56.78 305.67±67.891) 478.65±85.381)2) 234.135 < 0.001 与对照组比较，1)P < 0.05; 与MAP比较，2)P < 0.05。 
下载: 导出CSV
表 2 生存组和死亡组一般资料比较
指标 生存组(67例) 死亡组(31例) t/χ2 P 年龄/岁 55.28±5.75 64.39±6.18 7.123 < 0.001 性别/例 0.811 0.368 男 39 21 女 28 10 病因诊断/例(%) 0.300 0.584 胆源性 42(62.69) 17(54.84) 酒精性 11(16.41) 6(19.35) 暴饮暴食 7(10.45) 5(16.13) 其他 7(10.45) 3(9.68) BISAP评分/分 2.37±0.83 4.16±0.75 10.226 < 0.001
下载: 导出CSV
表 3 生存组和死亡组实验室指标及YKL-40、GIP水平比较
X±S 指标 生存组(67例) 死亡组(31例) t/χ2 P 白细胞计数/(×109·L-1) 13.69±2.61 14.67±3.36 1.574 0.119 血小板计数/(×109·L-1) 181±43 167±36 1.349 0.180 血细胞比容/% 39.0±6.0 36.0±5.0 2.524 0.013 尿素氮/(mmol·L-1) 6.87±2.32 12.35±2.91 10.014 < 0.001 血肌酐/(μmol·L-1) 80.65±25.78 178.62±39.62 14.653 < 0.001 血糖/(mmol·L-1) 13.85±2.69 11.26±2.83 4.278 < 0.001 血钙/(mmol·L-1) 1.92±1.17 1.97±1.23 0.039 0.969 血钾/(mmol·L-1) 4.35±1.89 4.28±1.73 0.181 0.857 血钠/(mmol·L-1) 139.62±58.67 137.28±55.36 0.028 0.978 纤维蛋白原/(g·L-1) 3.73±1.37 3.65±1.23 0.277 0.782 血胆汁酸/U 4567.39±1862.78 5162.17±2137.62 1.332 0.186 血淀粉酶/(U·L-1) 741.39±58.62 747.38±60.57 0.466 0.643 血脂肪酶/(U·L-1) 437.51±56.21 589.62±63.75 11.297 < 0.001 PCT/(μg·L-1) 2.27±0.56 3.53±0.92 8.372 < 0.001 CRP/(mg·L-1) 57.68±15.76 63.65±18.21 3.001 0.003 YKL-40/(ng·L-1) 72.63±11.86 80.62±13.87 2.937 0.004 GIP/(ng·L-1) 453.26±80.93 532.65±106.78 4.070 0.000
下载: 导出CSV
表 4 患者死亡影响因素的logistic分析
因素 赋值 β SE Wald χ2 P OR 95%CI 常数 - 0.179 0.092 3.794 0.051 - - PCT 1=≥3 μg/L，0=否 1.082 0.477 5.147 0.023 2.952 1.159~7.521 YKL-40 1=≥75 ng/L，0=否 0.290 0.136 4.583 0.032 1.337 1.025~1.744 GIP 1=≥500 ng/L，0=否 1.048 0.374 7.860 0.005 2.853 1.371~5.938 BISAP评分 1=≥3分，0=否 1.302 0.313 17.272 0.000 3.678 1.990~6.798
下载: 导出CSV
表 5 BISAP评分、血清YKL-40、GIP水平预测SAP死亡的价值分析
指标 阈值 灵敏度 特异度 准确度 AUC 95%CI YKL-40 75 ng/L 0.742 0.716 0.724 0.723 0.502~0.944 GIP 500 ng/L 0.645 0.597 0.612 0.620 0.268~0.969 BISAP评分 3分 0.710 0.746 0.735 0.733 0.553~0.910 联合检测 - 0.839 0.806 0.816 0.811 0.642~0.985
下载: 导出CSV
-
[1] Gliem N, Ammer-Herrmenau C, Ellenrieder V, et al. Management of Severe Acute Pancreatitis: An Update[J]. Digestion, 2021, 102(4): 503-507. doi: 10.1159/000506830
[2] 郭振科, 李新. HAP评分联合BISAP评分及D-二聚体检测对重症急性胰腺炎有较高的预后评估价值[J]. 内科急危重症杂志, 2022, 28(1): 58-60. https://www.cnki.com.cn/Article/CJFDTOTAL-NKJW202201014.htm
[3] Luo Y, Li Z, Ge P, et al. Comprehensive Mechanism, Novel Markers and Multidisciplinary Treatment of Severe Acute Pancreatitis-Associated Cardiac Injury-A Narrative Review[J]. J Inflamm Res, 2021, 14(12): 3145-3169.
[4] Baldacci F, Lista S, Palermo G, et al. The neuroinflammatory biomarker YKL-40 for neurodegenerative diseases: advances in development[J]. Expert Rev Proteomics, 2019, 16(7): 593-600. doi: 10.1080/14789450.2019.1628643
[5] Mygind ND, Iversen K, Køber L, et al. The inflammatory biomarker YKL-40 at admission is a strong predictor of overall mortality[J]. J Intern Med, 2013, 273(2): 205-216. doi: 10.1111/joim.12006
[6] Beaudry JL, Drucker DJ. Proglucagon-Derived Peptides, Glucose-Dependent Insulinotropic Polypeptide, and Dipeptidyl Peptidase-4-Mechanisms of Action in Adipose Tissue[J]. Endocrinology, 2020, 161(1): bqz029. doi: 10.1210/endocr/bqz029
[7] Zeng L, Xi F, Yang Y, et al. Relationship between levels of serum gastric inhibitory polypeptide(GIP), soluble interleukin-2 receptor(sIL-2R), and soluble triggering receptor expressed on myeloid cells-1(sTREM-1) and disease condition and prognosis of patients with severe acute pancreatitis[J]. Ann Palliat Med, 2021, 10(6): 6786-6792. doi: 10.21037/apm-21-1231
[8] 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, 沈阳)[J]. 中华胰腺病杂志, 2019, 19(5): 321-331. doi: 10.3760/cma.j.issn.1674-1935.2019.05.001
[9] 张嘉, 赵涛, 曹荣格, 等. BISAP、APACHE Ⅱ和Ranson评分在预测急性胰腺炎严重程度的比较[J]. 中国普通外科杂志, 2014, 23(9): 1176-1181. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201409006.htm
[10] Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis[J]. Lancet, 2020, 396(10252): 726-734. doi: 10.1016/S0140-6736(20)31310-6
[11] Silva-Vaz P, Abrantes AM, Castelo-Branco M, et al. Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice[J]. Int J Mol Sci, 2020, 21(1): 338. doi: 10.3390/ijms21010338
[12] 贺元, 廖明芳, 曲乐丰. YKL-40在炎症性疾病中的作用及其信号通路研究进展[J]. 医学研究生学报, 2016, 29(8): 883-888. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201608023.htm
[13] Frías JP. Tirzepatide: a glucose-dependent insulinotropic polypeptide(GIP)and glucagon-like peptide-1(GLP-1) dual agonist in development for the treatment of type 2 diabetes[J]. Expert Rev Endocrinol Metab, 2020, 15(6): 379-394. doi: 10.1080/17446651.2020.1830759
[14] 郭志国, 辛毅. 急性胰腺炎发病机制研究新观点[J]. 中国全科医学, 2018, 21(20): 2400-2403. doi: 10.3969/j.issn.1007-9572.2018.00.076
[15] 李智琼, 孙承谋, 朱玲娜, 等. MP-IgM、YKL-40、APOCI和IL-6在儿童支原体肺炎治疗及预后中的意义[J]. 标记免疫分析与临床, 2019, 26(4): 576-579. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY201904009.htm
[16] 李影, 朱妍, 张真稳. 肠促胰岛素在能量代谢中的作用及其机制的研究进展[J]. 中国糖尿病杂志, 2016, 24(2): 181-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGTL201602025.htm
[17] Shen D, Wang D, Ning C, et al. Prognostic factors of critical acute pancreatitis: A prospective cohort study[J]. Dig Liver Dis, 2019, 51(11): 1580-1585. doi: 10.1016/j.dld.2019.04.007
[18] 贾雷, 于新颖. BISAP评分联合血常规MPV、NLR、MLR预测急性胰腺炎病情严重程度的价值[J]. 空军医学杂志, 2021, 37(3): 240-243. doi: 10.3969/j.issn.2095-3402.2021.03.015
[19] 聂兰, 吴清明, 徐娅, 等. 早期预测急性胰腺炎病情严重程度的研究进展[J]. 华南国防医学杂志, 2019, 33(6): 437-439. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201906022.htm
[20] 石欣荣, 吴倩, 程雪. 可溶性致癌抑制因子2、心型脂肪酸结合蛋白评估重症急性胰腺炎患者早期心肌损伤及预后的价值[J]. 广西医学, 2020, 42(9): 1088-1091. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202009009.htm
-
图(1)
表(5)
计量
- 文章访问数: 1038
- PDF下载数: 534
- 施引文献: 0