摘要
目的:比较血液标志物及胰腺外炎症CT评分(extrapancreatic inflammation on CT score,EPIC)对急性胰腺炎(acute pancreatitis,AP)严重性的早期预测价值.方法:对2010-09/2011-09住院的96例AP患者首个24h内的临床、实验室及CT资料进行分析.临床上重症急性胰腺炎(severe acute pancreatitis,SAP)的标准为:死亡或持续器官衰竭及/或入住ICU,及/或手术治疗.对重症急性胰腺炎组及轻症急性胰腺炎(mild acute pancreatitis,MAP)组患者血液标志物及胰腺外炎症CT评分进行t检验,血液标志物及EPIC预测AP严重性的相关性检验及预测AP严重性的ROC分析,并计算预测敏感性、阳性预测值及准确度.结果:MAP76例,SAP20例.重症患者的血液标志物及胰腺外炎症CT评分均明显较轻症患者的大[白细胞:(15.16±5.06)×109/Lvs(11.05±1.76)×109/L,中性粒细胞与淋巴细胞比值:18.95±12.13vs6.63±3.44,高敏C-反应蛋白:58.35mg/L±20.47mg/Lvs28.59mg/L±12.92mg/L,D-二聚体:1596.95μg/L±1409.05μg/Lvs412.52μg/L±316.66μg/L,胰腺外炎症CT评分:3.30±0.86vs1.50±0.96,P=0.000].白细胞、中性粒细胞与淋巴细胞比值、高敏C-反应蛋白、D-二聚体及胰腺外炎症CT评分与AP严重性的Spearman相关系数(rs)分别为0.419、0.571、0.568、0.434及0.61(P=0.000).白细胞、中性粒细胞与淋巴细胞比值、高敏C-反应蛋白、D-二聚体及胰腺外炎症CT评分对AP严重性预测的曲线下面积分别为0.798(0.670-0.925)、0.906(0.830-0.981)、0.904(0.838-0.970)、0.808(0.638-0.938)以及0.917(0.851-0.983);预测敏感性分别为70.00%、85.00%、85.00%、75.00%及85.00%;阳性预测值分别为58.33%、73.91%、51.52%、48.39%及72.00%;预测准确度分别为83.33%、90.63%、80.21%、78.13%及90.63%.结论:白细胞及D-二聚体对AP严重性的预测价值中等,中性粒细胞与淋巴细胞比值、高敏C-反应蛋白及胰腺外炎症CT评分的预测价值较高,其中中性粒细胞与淋巴细胞比值和胰腺外炎症CT评分预测的准确度最高,胰腺外炎症CT评分与AP严重性的相关系数最大,其预测AP严重性的受试者曲线下面积最大.
AIM：To compare the value of blood markers and extrapancreatic inflammation on CT score（EPIC） in early prediction of the severity of acute pancreatitis（AP）.METHODS：The clinical,laboratory and CT data obtained on admission（within 24 h of hospitalization） for 96 patients with AP who were hospitalized from September 2010 to September 2011 were analyzed.Severe AP（SAP） was def ined as the presence of one or more of the following signs：mortality,persistent organ failure and/or admission ICU,and/or operation.Blood markers and EPIC were compared between SAP group and mild AP（MAP） using the t test.The correlation between blood markers,EPIC and severity of AP was analyzed.The value of bloodmarkers and EPIC in predicting the severity of AP was assessed using receiver operation curve analysis.The sensitivity,positive predictive value and accuracy were also studied.RESULTS：There were 20 patients with SAP and 76 patients with MAP.The levels of blood markers and EPIC in the SAP group were signif icantly higher than those in the MAP group [white blood cell（WBC）：（15.16 ± 5.06） × 109/L vs（11.05 ± 1.76） × 109/L,neutrophil-lymphocyte ratio（NLR）：18.95 ± 12.13 vs 6.63 ± 3.44,high-sensitivity C-reactive protein（hs-CRP）：58.35 mg/L ± 20.47 mg/L vs 28.59 mg/L ± 12.92 mg/L,D-dimer（DD）：1596.95 μg/L ± 1409.05 μg/L vs 412.52 μg/L ± 316.66 μg/L,EPIC：3.30 ± 0.86 vs 1.50 ± 0.96,all P = 0.000].The Spearman correlation coeff icients（rs） between severity of AP and WBC,NLR,hs-CRP,DD and EPIC were 0.419,0.571,0.568,0.434 and 0.613,respectively（all P = 0.000）.The area under the curve（AUC） of WBC,NLR,hsCRP,DD and EPIC in predicting the severity of AP were 0.798（0.670-0.925）,0.906（0.830-0.981）,0.904（0.838-0.970）,0.808（0.638-0.938） and 0.917（0.851-0.983）,respectively.The predictive sensitivities were 70.00%,85.00%,85.00%,75.00% and 85.00%;the positive predictive values were 58.33%,73.91%,51.52%,48.39% and 72.00%;and the accuracies were 83.33%,90.63%,80.21%,78.13% and 90.63%,respectively.CONCLUSION：WBC and DD have a moderate value in predicting the severity of AP,while NLR,hs-CRP,and EPIC have a much higher value.
出处
《世界华人消化杂志》
CAS
北大核心
2012年第11期969-974,共6页
World Chinese Journal of Digestology
关键词
标志物
胰腺外炎症CT评分
急性胰腺炎
严重性
预测
Marker
Extrapancreatic inflammation on CT score
Acute pancreatitis
Severity
Prediction
