常见实验室指标评估高脂血症性胰腺炎严重程度的临床价值研究

Clinical value of common laboratory indicators in assessing the severity of hyperlipidemia pancreatitis

  • 摘要:
    目的 探讨临床常见实验室指标对高脂血症性急性胰腺炎(HLAP)严重程度的评估价值。
    方法 回顾性分析南京医科大学松江临床医学院消化内科收治的151例胰腺炎(AP)患者的临床资料, 其中轻症HLAP 55例(轻症HLAP组),中重症HLAP 44例(中重症HLAP组),中重症胆源性胰腺炎(BAP)52例(中重症BAP组)。比较2组HLAP患者入院48 h内的实验室指标,探讨中重症HLAP的独立危险因素。
    结果 中重症HLAP组单核细胞、单核细胞与淋巴细胞比值(MLR)、载脂蛋白E高于轻症HLAP组,而载脂蛋白A、前白蛋白、白蛋白、白蛋白与球蛋白比值(A/G)、高密度脂蛋白、血清钙水平低于轻症HLAP组,差异有统计学意义(P < 0.05)。多因素二元Logistic回归分析显示,前白蛋白、A/G、高密度脂蛋白、血清钙是中重症HLAP的独立保护因素,单核细胞水平为中重症HLAP的独立危险因素。受试者工作特征(ROC)曲线分析显示,血清钙、A/G、单核细胞、前白蛋白、高密度脂蛋白的曲线下面积(AUC)分别为0.75、0.79、0.71、0.73、0.67;以上指标联合检测的AUC为0.92, 特异度和敏感度分别为0.94、0.73。中重症HLAP组高密度脂蛋白水平低于中重症BAP组,单核细胞水平高于中重症BAP组,差异有统计学意义(P < 0.05)。
    结论 血清钙、A/G、单核细胞、前白蛋白、高密度脂蛋白为中重症HLAP的独立预测指标,联合检测可进一步提升对高脂血症性胰腺炎严重程度的临床评估价值。

     

    Abstract:
    Objective To investigate the value of common clinical laboratory indicators on the severity of hyperlipidemia acute pancreatitis (HLAP).
    Methods The clinical data of 151 acute pancreatitis (AP) patients admitted to Gastroenterology Department of Songjiang Clinical College of Medicine of Nanjing Medical University were retrospectively analyzed, including 55 cases of mild HLAP (mild HLAP group), 44 cases of moderate or severe HLAP(moderate or severe HLAP group), and 52 cases of moderate or severe biliogenic acute pancreatitis (BAP) (moderate or severe BAP group). The laboratory indexes of HLAP in the two groups were compared within 48 h after admission, and the independent risk factors of moderate and severe HLAP were explored.
    Results The monocyte, monocyte to lymphocyte ratio (MLR), apolipoprotein E levels of the moderate or severe HLAP group were higher than those in the mild HLAP group, while apolipoprotein A, prealbumin, albumin-to-globulin ratio(A/G), high density lipoprotein cholesterol (HDL) and serum calcium levels were lower than those in the mild group (P < 0.05). The analysis of multvariate binary Logistic regression model showed that prealbumin, A/G, high density lipoprotein and serum calcium were independent protective factors for moderate or severe HLAP, and monocyte was an independent risk factor for moderate or severe HLAP. Receiver operating characteristic (ROC) curve analysis showed that the areas under the curve (AUC) of serum calcium, A/G, monocyte, prealbumin and high density lipoprotein of moderate or severe HLAP were 0.75, 0.79, 0.71, 0.73, 0.67, respectively. The AUC of their combined detection was 0.92, with the specialty and sensitivity of 94.3% and 72.5%. The level of high density lipoprotein level in moderate or severe HLAP group was lower than that in moderate or severe BAP group, and the level of monocyte was higher than that in moderate or severe BAP group (P < 0.05).
    Conclusion Serum calcium, A/G, monocyte, prealbumin, and high density lipoprotein cholesterol are independent predictors of moderate or severe HLAP, and their combined prediction can further enhance the clinical evaluation value for the prognosis of severity of HLAP.

     

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