目的 研究糖化血红蛋白(glycated haemoglobin,HbA1c)对急性胰腺炎(acute pancreatitis,AP)危险分层及预后的影响,确定 HbA1c对 AP病情进展的评估能力,以及联合其他相关评分对 AP转归的预测价值.方法 回顾性分析于上海交通大学医学院附属新华医院确诊为 AP 的 233 例患者,将患者依据轻重程度分为轻症组(轻度急性胰腺炎组,mild acute pancreatitis,MAP组)和重症组(中度重症急性胰腺炎/重症急性胰腺炎组,moderately severe acute pancreatitis/severe acute pancreatitis,MSAP/SAP组),根据 HbA1c再分为 HbA1c升高组(HbA1c≥6.5%)和 HbA1c 正常组(HbA1c<6.5%).采用单因素和多因素 Logistic回归分析预测 AP进展的独立危险因素.计算序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、急性胰腺炎严重程度床边指数(bedside index for se-verity in AP,BISAP)评分和计算机断层扫描严重程度指数(computed tomography severity index,CTSI)评分,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,研究 HbA1c、评分系统及两者联合对 AP病情进展的预测价值.结果 多因素 Lo-gistic回归分析结果显示,HbA1c(OR = 1.445,95%CI:1.133～1.845)、C 反应蛋白(C-reactive proten,CRP;OR = 1.008,95%CI:1.002～1.013)、白细胞计数(white blood cell count,WBC;OR =1.089,95%CI:1.006～1.179)是 AP 患者病情进展的独立危险因素,且均产生显著的正向性影响(P<0.05).HbA1c 分别联合 SOFA、BISAP 评分可显著提升预测效能(P<0.05),HbA1c、SOFA、BISAP评分、HbA1c联合SOFA及HbA1c联合BISAP评分的曲线下面积(area under the curve,AUC)分别为 0.667(95%CI:0.585～0.748)、0.870(95%CI:0.826～0.915)、0.733(95%CI:0.666～0.799)、0.906(95%CI:0.868～0.944)及 0.776(95%CI:0.711～0.840).对于 HbA1c≥6.5%的人群,HbA1c(OR =1.718,95%CI:1.098～2.687)是预测 AP 病情进展的正向独立危险因素.结论 HbA1c对 AP病情进展起到显著的促进作用,结合 HbA1c 与 SOFA、BISAP 评分有助于在早期识别 AP 病情进展.对 HbA1c≥6.5%人群严格控制 HbA1c水平对于改善 AP患者预后有重要意义.
Application Value of Glycosylated Hemoglobin in Risk Stratification and Prognosis Evaluation of Acute Pancreatitis
Objective To investigate the effect of glycated haemoglobin(HbA1c)on the risk stratification and prognosis of acute pancreatitis(AP),and determine the function of HbA1c in assessing AP progression and the predictive value of pancreatitis in combina-tion with other relevant scores.Methods A total of 233 patients diagnosed with AP in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively analyzed.According to the severity,the patients were divided into mild disease group(mild acute pancreatitis,MAP)and severe disease group(moderately severe acute pancreatitis/severe acute pancreatitis,MSAP/SAP).According to the HbA1c degree,they were divided into HbA1c elevated group(HbA1c≥6.5%)and HbA1c normal group(HbA1c<6.5%).The in-dependent risk factors predicting the progress of AP were identified using the univariate and multivariate Logistic regression analysis.The sequential organ failure assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHE Ⅱ),bedside index for severity in AP(BISAP)and computed tomography severity index(CTSI)score were calculated,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of HbA1c,scoring system and their combination on the progress of AP.Results Multi-variate Logistic regression analysis showed that HbA1c(OR =1.445,95%CI:1.133-1.845),C-reactive proten(CRP;OR =1.008,95%CI:1.002-1.013),white blood cell count(WBC;OR =1.089,95%CI:1.006-1.179)were independent risk factors for the progression of AP patients,and all had significant positive effects(P<0.05).Moreover,HbA1c combined with SOFA score or BISAP score could significantly improve the prediction efficiency(P<0.05).The area under the curve(AUC)of HbA1c,SOFA score,BISAP score,HbA1c combined with SOFA score and HbA1c combined with BISAP score were0.667(95%CI:0.585-0.748),0.870(95%CI:0.826-0.915),0.733(95%CI:0.666-0.799),0.906(95%CI:0.868-0.944)and 0.776(95%CI:0.711-0.840),re-spectively.For the population with HbA1c≥6.5%,HbA1c(OR = 1.718,95%CI:1.098-2.687)was a positive independent risk factor for predicting the progression of AP.Conclusion HbA1c significantly promoted the progression of AP.Combining HbA1c with SO-FA score and BISAP score can help to identify the progress of AP at early stage.A strict control of HbA1c level in the population with HbA1c≥6.5%is of great significance to improve the prognosis of AP patients.
NETL
NSTL
万方数据
