血清胰蛋白酶原-2和血细胞比容在急性胰腺炎病情评估中的作用
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摘要
背景:我国急性胰腺炎(AP)发病率逐年上升,病死率居高不下,探索可用于判断AP病情严重程度的血液生化指标对AP的诊断和治疗具有重要的临床意义。目的:探讨血清胰蛋白酶原-2(TAT-2)和血细胞比容(HCT)在AP病情严重程度中的预测价值。方法:收集2016年9月—2018年6月江阴市人民医院收治的175例AP患者,根据病情严重程度分为轻度急性胰腺炎(MAP)组、中重度急性胰腺炎(MSAP)组、重度急性胰腺炎(SAP)组,并选取同期健康体检者作为对照组。测定血清TAT-2、HCT,并行BISAP评分、APACHEⅡ评分、Balthazar CT评分。采用ROC曲线分析各指标诊断SAP的价值。结果:四组间TAT-2、HCT、BISAP评分、APACHEⅡ评分、Balthazar CT评分相比差异有统计学意义(P <0. 05)。SAP组TAT-2、HCT明显高于MAP组、MSAP组、对照组(P <0. 05),MSAP组TAT-2、HCT明显高于MAP组、对照组(P <0. 05),MAP组TAT-2、HCT显著高于对照组(P <0. 05)。ROC曲线分析示,TAT-2、HCT以及两者联合预测SAP的敏感性分别为69. 7%、84. 7%、88. 5%,特异性分别为95. 3%、67. 8%、65. 1%,AUC分别为0. 858、0. 783、0. 875。结论:TAT-2、HCT可有效评估AP病情的严重程度,两者联合检测更有助于进一步预测SAP的发生,对于AP的治疗起有重要指导作用。
Background: The incidence of acute pancreatitis( AP) in China is increasing year by year,and the mortality remains high. It is of great significance to explore the blood biochemical parameters which can assess the severity of AP for the diagnosis and treatment of AP. Aims: To explore the value of serum trypsinogen-2( TAT-2) and hematocrit( HCT) in assessing the severity of AP. Methods: A total of 175 cases of AP from September 2016 to June 2018 at Jiangyin People's Hospital were enrolled. Patients were divided into mild acute pancreatitis( MAP) group,moderate severe acute pancreatitis( MSAP) group,severe acute pancreatitis( SAP) group according to the severity of AP. And 76 healthy individuals undergoing physical examination were served as the control group. The levels of serum TAT-2,HCT were detected. BISAP score,APACHEⅡ score,Balthazar CT score were evaluated. Values of different parameters for diagnosing SAP were analyzed by ROC curve. Results: Differences in TAT-2,HCT,BISAP score,APACHEⅡ score,Balthazar CT score were statistically significant among the four groups( P < 0. 05). Serum TAT-2 and HCT in SAP group were significantly higher than those in MAP group,MSAP group and control group( P < 0. 05),serum TAT-2 and HCT in MSAP group were significantly higher than those in MAP group and control group( P < 0. 05),and serum TAT-2 and HCT in MAP group were significantly higher than those in control group( P < 0. 05). ROC curve analysis showed that the sensitivity of TAT-2,HCT and the combination of these two indicators for predicting SAP were 69. 7%,84. 7%,88. 5%,respectively;specificity were 95. 3%,67. 8%,65. 1%,respectively; AUC were 0. 858,0. 783,0. 875,respectively. Conclusions:TAT-2 and HCT can effectively evaluate the severity of AP patients,the combined detection of the two indicators can predict the occurrence of SAP further and play a vital role in treatment of AP.
Background: The incidence of acute pancreatitis( AP) in China is increasing year by year,and the mortality remains high. It is of great significance to explore the blood biochemical parameters which can assess the severity of AP for the diagnosis and treatment of AP. Aims: To explore the value of serum trypsinogen-2( TAT-2) and hematocrit( HCT) in assessing the severity of AP. Methods: A total of 175 cases of AP from September 2016 to June 2018 at Jiangyin People's Hospital were enrolled. Patients were divided into mild acute pancreatitis( MAP) group,moderate severe acute pancreatitis( MSAP) group,severe acute pancreatitis( SAP) group according to the severity of AP. And 76 healthy individuals undergoing physical examination were served as the control group. The levels of serum TAT-2,HCT were detected. BISAP score,APACHEⅡ score,Balthazar CT score were evaluated. Values of different parameters for diagnosing SAP were analyzed by ROC curve. Results: Differences in TAT-2,HCT,BISAP score,APACHEⅡ score,Balthazar CT score were statistically significant among the four groups( P < 0. 05). Serum TAT-2 and HCT in SAP group were significantly higher than those in MAP group,MSAP group and control group( P < 0. 05),serum TAT-2 and HCT in MSAP group were significantly higher than those in MAP group and control group( P < 0. 05),and serum TAT-2 and HCT in MAP group were significantly higher than those in control group( P < 0. 05). ROC curve analysis showed that the sensitivity of TAT-2,HCT and the combination of these two indicators for predicting SAP were 69. 7%,84. 7%,88. 5%,respectively;specificity were 95. 3%,67. 8%,65. 1%,respectively; AUC were 0. 858,0. 783,0. 875,respectively. Conclusions:TAT-2 and HCT can effectively evaluate the severity of AP patients,the combined detection of the two indicators can predict the occurrence of SAP further and play a vital role in treatment of AP.
引文
1 Senapati D, Debata PK, Jenasamant SS, et al. A prospective study of the Bedside Index for Severity in Acute Pancreatitis(BISAP)score in acute pancreatitis:an Indian perspective[J]. Pancreatology,2014,14(5):335-339.
2 余贤恩.急性胰腺炎流行病学及严重性预测评估研究进展[J].胃肠病学和肝病学杂志,2015,24(2):234-237.
3 崔婷婷,曹建彪,张莉,等.血清胰蛋白酶原-2与急性胰腺炎严重程度分析[J].中国热带医学,2013,13(6):746-748.
4 Koutroumpakis E,Wu BU,Bakker OJ,et al. Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis:A Post Hoc Analysis of Three Large Prospective Databases[J]. Am J Gastroenterol,2015,110(12):1707-1716.
5 王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013年,上海)[J].胃肠病学,2013,18(7):428-433.
6 冷芳,杨力,常志刚,等.急性胰腺炎分类——2012:亚特兰大分类和定义修订的国际共识[J].临床肝胆病杂志,2013,29(4):322-328.
7 Wu BU,Johannes RS,Sun X,et al. The early prediction of mortality in acute pancreatitis:a large population-based study[J]. Gut,2008,57(12):1698-1703.
8 Larvin M,McMahon MJ. APACHE-Ⅱscore for assessment and monitoring of acute pancreatitis[J]. Lancet,1989,2(8656):201-205.
9 Balthazar EJ. Acute pancreatitis:assessment of severity with clinical and CT evaluation[J]. Radiology,2002,223(3):603-613.
10 Hamada S,Masamune A,Shimosegawa T. Management of acute pancreatitis in Japan:Analysis of nationwide epidemiological survey[J]. World J Gastroenterol,2016,22(28):6335-6344.
11 Khanna AK,Meher S,Prakash S,et al. Comparison of Ranson,Glasgow,MOSS,SIRS,BISAP,APACHE-Ⅱ,CTSI Scores,IL-6,CRP,and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis[J]. HPB Surg,2013,2013:367581.
12 张翔,王雅纯,黎昌炫,等.急性胰腺炎患者血清降钙素原,白细胞介素-6,肿瘤坏死因子-α动态监测及临床意义[J].中国急救复苏与灾害医学杂志,2016,10(8):791-794.
13 王俊,冯志松,凌颖,等.血清ACh E活性在急性胰腺炎病情及预后评估中的意义[J].胃肠病学和肝病学杂志,2017,26(4):449-453.
14 王毅,曾祝伦,谯雅嘉,等.胰蛋白酶原-2在急性胰腺炎诊断中的应用[J].重庆医学,2002,31(5):408-410.
15 江从庆,艾中立,刘志苏,等.重症急性胰腺炎的早期危险因素—血液浓缩[J].中国实用外科杂志,2001,21(11):666-667.
2 余贤恩.急性胰腺炎流行病学及严重性预测评估研究进展[J].胃肠病学和肝病学杂志,2015,24(2):234-237.
3 崔婷婷,曹建彪,张莉,等.血清胰蛋白酶原-2与急性胰腺炎严重程度分析[J].中国热带医学,2013,13(6):746-748.
4 Koutroumpakis E,Wu BU,Bakker OJ,et al. Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis:A Post Hoc Analysis of Three Large Prospective Databases[J]. Am J Gastroenterol,2015,110(12):1707-1716.
5 王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013年,上海)[J].胃肠病学,2013,18(7):428-433.
6 冷芳,杨力,常志刚,等.急性胰腺炎分类——2012:亚特兰大分类和定义修订的国际共识[J].临床肝胆病杂志,2013,29(4):322-328.
7 Wu BU,Johannes RS,Sun X,et al. The early prediction of mortality in acute pancreatitis:a large population-based study[J]. Gut,2008,57(12):1698-1703.
8 Larvin M,McMahon MJ. APACHE-Ⅱscore for assessment and monitoring of acute pancreatitis[J]. Lancet,1989,2(8656):201-205.
9 Balthazar EJ. Acute pancreatitis:assessment of severity with clinical and CT evaluation[J]. Radiology,2002,223(3):603-613.
10 Hamada S,Masamune A,Shimosegawa T. Management of acute pancreatitis in Japan:Analysis of nationwide epidemiological survey[J]. World J Gastroenterol,2016,22(28):6335-6344.
11 Khanna AK,Meher S,Prakash S,et al. Comparison of Ranson,Glasgow,MOSS,SIRS,BISAP,APACHE-Ⅱ,CTSI Scores,IL-6,CRP,and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis[J]. HPB Surg,2013,2013:367581.
12 张翔,王雅纯,黎昌炫,等.急性胰腺炎患者血清降钙素原,白细胞介素-6,肿瘤坏死因子-α动态监测及临床意义[J].中国急救复苏与灾害医学杂志,2016,10(8):791-794.
13 王俊,冯志松,凌颖,等.血清ACh E活性在急性胰腺炎病情及预后评估中的意义[J].胃肠病学和肝病学杂志,2017,26(4):449-453.
14 王毅,曾祝伦,谯雅嘉,等.胰蛋白酶原-2在急性胰腺炎诊断中的应用[J].重庆医学,2002,31(5):408-410.
15 江从庆,艾中立,刘志苏,等.重症急性胰腺炎的早期危险因素—血液浓缩[J].中国实用外科杂志,2001,21(11):666-667.