新亚特兰大分类下生化指标预测急性胰腺炎严重度的价值

摘要

Objective To investigate the value of biochemical factors in predicting the severity of acute pancreatitis ( AP) based on revised Atlanta classification.Methods The clinical data of patients diagnosed as AP from Apr.2014 to Aug.2014 were analyzed retrospectively.According to the revised Atlanta classification, all patients were graded mild AP ( MAP) , moderately severe AP ( MSAP) or severe AP ( SAP) .Univariate and multivariate analysis were used to evaluate the value of indexes to predict the severity of AP.Results Eighty-seven patients with AP and 26 control subjects were enrolled in the present study.Fifty-four patients (62.1%) were classified as MAP, 23 patients (26.4%) were MSAP and 10 patients (11.5%) were SAP.Univariate and multivariate analysis showed that the albumin ( ALB) , red blood cell volume distribution width-coefficient of variation ( RDW-CV ) , C-reactive protein ( CRP ) levels at 48 hours were independent predictors for disease severity of AP.ROC curve analysis showed that only the AUC of CRP was more than 0.8, the optimum CRP level cut-off points for MAP or MSAP/SAP was 57.9 mg/L, with a sensitivity, specificity of 75.8%, 94.4%respectively.Conclusion Based on revised Atlanta classification, CRP levels at 48 hours remains the most useful in predicting the severity of AP.ALB and RDW-CV may be predictive factors.%目的：基于急性胰腺炎（ acute pancreatitis，AP）新亚特兰大分类，重新评价常用的生化指标对AP严重度的预测价值。方法回顾性分析2014年4月－2014年8月因AP入院患者的临床资料，参照新亚特兰大分类，将患者分为轻症AP（ MAP）、中重症AP（MSAP）及重症AP（SAP）。通过单因素及多因素分析评价各指标对预测AP严重度的价值。结果87例AP患者和26名健康对照者纳入本研究。54例（62．1％）为MAP，23例（26．4％）为MSAP，10例（11．5％）为SAP。单因素及多因素分析显示：入院48 h白蛋白、红细胞体积分布宽度－变异系数、C反应蛋白是预测AP严重度的独立因素。 ROC曲线分析显示，只有C反应蛋白的曲线下面积＞0．8，鉴别MAP与MSAP／SAP时C反应蛋白最佳界值为57．9 mg／L，敏感性和特异性分别为75．8％和94．4％。结论当采用亚特兰大修正标准进行AP分类时，住院48 h C反应蛋白仍是预测疾病严重程度非常有价值的指标。血清白蛋白、红细胞体积分布宽度－变异系数对预测疾病严重度也可能有价值。