目的 筛选高甘油三酯型急性胰腺炎(hypertriglyceridemic acute pancreatitis,HTGP)重症化的早期危险因素,探索联合预测指标,并评估其临床价值.方法 纳入重庆医科大学附属第二医院 2017 年 1 月至 2020 年 12 月收治的 290 例 HTGP 患者为研究对象,依据病情严重程度分为重症急性胰腺炎(severe acute pancreatitis,SAP)组(n=84)、非 SAP 组(n=206),收集患者的一般资料、实验室检查指标、各项评分(APACHEⅡ评分、Ranson 评分、CTSI 评分和 BISAP 评分)等.通过纳入联合预测指标、脂质蓄积指数(lipid accumulation product,LAP)、CRP、PCT等因素进行多因素 Logistic回归分析;并通过分析其 ROC曲线,进一步评价联合预测指标的临床检验效能.结果 SAP 组腰围、血淀粉酶、TG、LAP 等水平高于非 SAP 组,而 SAP 组年龄水平低于非 SAP 组,差异均有统计学意义(P<0.05);不同 LAP 四分位数样本对于是否重症有显著性差异(P<0.05),LAP 与 SAP 的发生存在高强度相关.Logistic回归分析显示,Ranson、APACHE Ⅱ、CTSI及 LAP 与 SAP 发生风险呈正相关(P<0.05).多因素 Logistic回归分析提示,LAP 分度每增加 1 单位,SAP 发生风险将增加 3.68 倍(OR=3.680,P<0.001);分别绘制 LAP、APACHE Ⅱ评分、Ranson评分、CTSI评分、BISAP评分预测 SAP 发生风险的 ROC 曲线,LAP 预测 SAP 的 AUC 为 0.846(95%CI:0.800～0.893),差异均有统计学意义(P<0.01).结论 HTGP 患者的 LAP 与病情严重程度呈高强度正相关,LAP 对 SAP 有良好的预测价值,联合 LAP、CRP、PCT 能进一步提高其预测效能.
Prediction of severity of hypertriglyceride acute pancreatitis with LAP combined with CRP and PCT
Objective To screen the early risk factors for the aggravation of hypertriglyceridemic acute pancreatitis(HTGP),explore the combined prediction indicators,and evaluate their clinical value.Methods A total of 290 HTGP patients admitted to the Second Affiliated Hospital of Chongqing Medical University from Jan.2017 to Dec.2020 were included as the research subjects and divided into the severe acute pancreatitis(SAP)group(n=84)and the non-SAP group(n=206)according to the severity of the disease.General data,laboratory indicators,and various scores(APACHEⅡ score,Ranson score,CTSI score and BISAP score)of the patients were collected.By including risk fac-tors such as the combined prediction indicators,lipid accumulation product(LAP),CRP and PCT,a multivariate Lo-gistic regression analysis was conducted.And by analyzing its ROC curve,the clinical testing efficacy of the combined prediction indicators was further evaluated.Results The levels of waist circumference(WC),blood amylase,triglyc-eride(TG),and LAP in the SAP group were higher than those in the non-SAP group,while the age level in the SAP group was lower than that in the non-SAP group,and the differences were statistically significant(P<0.05).Different LAP quartile samples showed significant differences in whether they were severe cases(P<0.05),and there was a high-intensity correlation between LAP and the occurrence of SAP.From the Logistic regression analysis,it is known that Ranson,APACHEⅡ,CTSI and LAP were positively correlated with the risk of SAP occurrence,and the results were statistically significant(P<0.05).The multivariate Logistic regression analysis indicated that for every 1-unit increase in the LAP grading,the risk of SAP occurrence would increase by 3.68 times,and the result was statistically significant(OR=3.680,P<0.001).The ROC curves of LAP,APACHEⅡ,Ranson score,CTSI score and BISAP score of the subjects for predicting the risk of SAP occurrence were drawn respectively.The AUC of LAP for predicting SAP was 0.846(95% CI:0.800-0.893),and all the above results were statistically significant(P<0.01).Conclusion The LAP of HTGP patients is highly positively correlated with the severity of the disease.LAP has good predictive value for SAP.Combining LAP with CRP and PCT can further improve the predictive efficacy.
NETL
NSTL
万方数据
