摘要
目的 探讨改良CT严重指数(MCTSI)、CT严重指数(CTSI)、平均血小板体积(MPV)、高迁移率族蛋白-1(HMGB-1)、乙酰胆碱酯酶(AChE)活性与急性胰腺炎(AP)患者病情及预后的关系.方法 选取220 例AP患者,根据病情将其分为轻症急性胰腺炎(MAP)组(n=63)、中重症急性胰腺炎(MSAP)组(n=85)和重症急性胰腺炎(SAP)组(n=72).所有患者行MCTSI、CTSI评分,同时检测血清MPV、HMGB-1、AChE水平,采用Pearson法验证各指标的相关性.随访3 个月,依据预后分组,比较不同预后AP患者MCTSI、CTSI评分及MPV、HMGB-1、AChE差异,采用受试者工作特征(ROC)曲线分析上述指标对AP预后的预测价值.结果 三组MCTSI、CTSI评分、MPV、HMGB-1、AChE比较,差异均有统计学意义(F分别=34.90、154.62、230.50、92.35、101.20,P均＜0.05),SAP组MCTSI、CTSI评分、MPV、HMGB-1明显高于MSAP组和MAP组(LSD-t分别=8.32、11.43、15.16、24.66、17.50、30.24、14.32、18.28,P均＜0.05),AChE明显低于MSAP组和MAP组(LSD-t分别=13.08、19.79,P均＜0.05).AP患者MCTSI、CTSI评分分别与MPV、HMGB-1呈正相关(r分别=0.21、0.21、0.18、0.25,P均＜0.05),与AChE呈负相关(r分别=-0.33、-0.34,P均＜0.05).预后不良组MCTSI、CTSI评分、MPV、HMGB-1高于预后良好组,AChE低于预后良好组,差异均有统计学意义(t分别=10.66、5.63、24.15、7.02、-14.54,P均＜0.05).ROC曲线显示,MCTSI、CTSI、MPV、HMGB-1、AChE联合预测AP患者不良预后的ROC曲线下面积(AUC)为0.91(95%CI 0.86～0.94),高于各指标单独预测(Z分别=2.78、3.39、2.78、2.44、2.89,P均＜0.05).结论 AP患者随着病情加重,MCTSI、CTSI评分及MPV、HMGB-1显著升高,AChE活性降低,联合检测MCTSI、CTSI、MPV、HMGB-1、AChE对AP患者病情及预后评估均有较高的应用价值.
Abstract
Objective To investigate the relationship of modified CT severity index(MCTSI),CT severity index(CT-SI),mean platelet volume(MPV),high mobility group box 1(HMGB-1),and acetylcholinesterase(AChE)activity with the condition and prognosis of patients with acute pancreatitis(AP).Methods A total of 220 patients with AP were di-vided into mild AP(MAP)group(n=63),moderate to severe AP(MSAP)group(n=85),and severe AP(SAP)group(n=72).MCTSI score and CTSI scores were recorded.Serum MPV,HMGB-1 and AChE levels were measured.The correla-tion of these indicators was analyzed by Pearson.All of the patients were followed up for 3 months.The MCTSI score,CT-SI score,MPV,HMGB-1 and AChE levels were compared among patients with different prognosis.The prognostic value of above-mentioned indicators was analyzed using the receiver operating characteristic(ROC)curve.Results The dif-ferences in MCTSI,CTSI scores,MPV,HMGB-1,and AChE among the three groups were statistically significant(F= 34.90,154.62,230.50,92.35,101.20,P＜0.05).The MCTSI,CTSI scores,MPV,and HMGB-1 scores in the SAP group were significantly higher than those in the MSAP and MAP groups(LSD-t=8.32,11.43,15.16,24.66,17.50,30.24,14.32,18.28,P＜0.05),while AChE was significant-ly lower than those in the MSAP and MAP groups(LSD-t=13.08,19.79,P＜0.05).Correlation analysis results showed that MCTSI score and CTSI score were positively correlated with MPV and HMGB-1(r=0.21,0.21,0.18,0.25,P＜0.05),and negatively correlated with AChE(r=-0.33,-0.34,P＜0.05).The MCTSI,CTSI scores,MPV,and HMGB-1 in the poor prognosis group were higher than those in the good prognosis group(t=10.66,5.63,24.15,7.02,P＜0.05),while AChE was lower than that in the good prognosis group(t=-14.54,P＜0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of MCTSI score combined with CTSI score,MPV,HMGB-1 and AChE for predicting poor prognosis of patients with AP was 0.91(95%CI 0.86-0.94),larger than that of single prediction(Z=2.78,3.39,2.78,2.44,2.89,P＜0.05).Conclusion With the aggravation of AP,MCTSI score,CTSI score,MPV,and HMGB-1 significantly increase,and AChE activity de-creases.The combination of MCTSI score,CTSI score,MPV,HMGB-1,and AChE is helpful for condition assessment and prognosis of patients with AP.
维普
万方数据