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急性生理学与慢性健康状况评分系统Ⅱ评分联合血清糖化血红蛋白、乳酸脱氢酶水平评估急性胰腺炎患者病情严重程度及预后的价值

Values of the Acute Physiology and Chronic Health Evaluation Ⅱ score combined with serum glycated hemoglobin and lactate dehydrogenase in evaluating the severity and prognosis of patients with acute pancreatitis

    摘要
  • 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-HbA1c=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 Evaluation 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 determine 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-densitylipoprotein 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). Triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum calcium, MCTSI score, HbA1c, LDH, and APACHE Ⅱ score were factors influencing poor prognosis in patients 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 sensitivity 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 Ⅱ 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.

     

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