摘要
目的 探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、血清糖化血红蛋白(HbA1c)、乳酸脱氢酶(LDH)对急性胰腺炎(AP)患者病情及预后的评估价值.方法 将2019年8月-2022年5月本院治疗的120例AP患者根据病情严重程度分为轻症组(n=33)、中度重症组(n=52)和重症组(n=35),根据预后分为生存组(n=86)和死亡组(n=34).采用Pearson法分析AP患者APACHE Ⅱ评分与血清HbA1c、LDH水平的相关性;采用Logistic回归分析明确AP患者预后的影响因素;采用受试者工作特征(ROC)曲线分析APACHE Ⅱ评分、HbA1c、LDH对AP预后的评估价值.结果 轻症组、中度重症组、重症组患者血清甘油三酯、HbA1c、LDH、APACHE Ⅱ评分、改良CT严重指数(MCTSI)评分逐渐增高,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙逐渐降低,差异均有统计学意义(P＜0.05).AP患者APACHE Ⅱ评分、MCTSI评分与血清HbA1c、LDH水平均呈正相关(P＜0.05).甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血钙、MCTSI评分、HbA1c、LDH、APACHE Ⅱ评分是AP患者预后不良的影响因素(P＜0.05).APACHE Ⅱ评分联合血清HbA1c、LDH水平预测AP患者预后不良的曲线下面积为0.930,敏感度为91.18％,特异度为83.72％,优于各自单独预测(Z联合检测-HbA1e=3.511、Z联合检测-LDH=4.798、Z联合检测-APACHe Ⅱ 评分=2.134,P＜0.001、P＜0.001、P=0.033).结论 血清 HbA1c、LDH 水平与病情严重程度密切相关,二者联合APACHE Ⅱ评分对AP患者预后有较好的预测价值.
Abstract
Objective To investigate the values of the Acute Physiology and Chronic Health E-valuation Ⅱ(APACHE Ⅱ)score,serum glycated hemoglobin(HbA1c)and lactate dehydrogenase(LDH)in evaluating the severity and prognosis of patients with acute pancreatitis(AP).Methods A total of 120 patients with AP treated in the hospital from August 2019 to May 2022 were divided into mild group(n=33),moderately severe group(n=52),and severe group(n=35)according to the severity of the disease,and were also divided into survival group(n=86)and death group(n=34)based on prognosis.Pearson method was used to analyze the correlations of APACHE Ⅱ score with serum HbA1c and LDH levels in patients with AP;the Logistic regression analysis was used to deter-mine the influencing factors of prognosis in patients with AP;the receiver operating characteristic(ROC)curve was used to evaluate the predictive values of APACHE Ⅱ score,HbA1c and LDH for the prognosis of AP.Results The levels of serum triglycerides,HbA1c,LDH,APACHE Ⅱ score,and the Modified CT Severity Index(MCTSI)score gradually increased while high-densitylipopro-tein cholesterol,low-density lipoprotein cholesterol,and serum calcium gradually decreased in the mild,moderately severe,and severe groups(P＜0.05).APACHE Ⅱ score and MCTSI score were positively correlated with serum HbA1c and LDH levels in patients with AP(P＜0.05).Triglycer-ides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,serum calcium,MCTSI score,HbA1c,LDH,and APACHE Ⅱ score were factors influencing poor prognosis in pa-tients with AP(P＜0.05).The area under the curve for predicting poor prognosis in patients with AP by the combination of APACHE Ⅱ score,serum HbA1c and LDH levels was 0.930,with a sen-sitivity of 91.18％and a specificity of 83.72％,which was superior to each factor alone(Zcombined-HbA1c=3.511,Zcombined-LDH=4.798,Zcombined-APACHE U score=2.134,P＜0.001,P＜0.001,P=0.033).Conclusion Serum HbA1c and LDH levels are closely related to the severity of the disease,and their combination with APACHE Ⅱ score has good predictive value for the prognosis of patients with AP.
基金项目
湖北省荆门市科技计划项目(2018YDKY020)
国家科技期刊平台
NSTL
万方数据