降钙素原与APACHEⅡ评分对急性胰腺炎病情严重程度及预后的评估价值

目的:探讨血清降钙素原(PCT)与急性生理学与慢性健康状况评分(APACHE Ⅱ)对急性胰腺炎(AP)患者病情严重程度及预后的评估价值。方法:选取本院2012年5月-2015年5月收治的急性胰腺炎患者280例为研究对象。根据急性胰腺炎患者病情严重程度将其分为低危组(83例)、中危组(102例)和高危组(95例);按患者临床结局将其分为存活组(248例)及死亡组(32例),采用酶联免疫吸附法(ELISA)检测各组血清PCT水平同时记录APACHE Ⅱ评分情况,分别比较PCT水平的差异以及与APACHE Ⅱ评分的相关性,评价血清PCT及APACHEⅡ评分对急性胰腺炎患者病情严重程度及预后的评估价值。结果:低危组、中危组及高危组间血清PCT水平和APACHE Ⅱ评分的差异具有统计学意义(P0.05)。其中,高危组血清PCT水平和APACHE Ⅱ评分最高,中危组次之,低危组最低(P0.05);死亡组PCT水平及APACHE Ⅱ评分显著高于存活组(P0.05)。相关性分析显示血清PCT水平与APACHE Ⅱ评分呈正相关(r=0.64,P0.01)。以PCT2.13 ng/m L为评估急性胰腺炎患者预后不佳界限时,其敏感性和特异性分别79.2%和91.3%;以APACHE Ⅱ评分18.1分为评估急性胰腺炎患者预后不佳界限时,其敏感性和特异性分别为82.7%和90.1%;两者指标串联评估敏感性及特异性分别为86.1%和92.9%,ROC曲线下面积为0.921(95%CI 0.824~0.938)。结论:急性胰腺炎患者血清PCT水平和APACHE Ⅱ评分具有较好的相关性,血清PCT水平越高,APACHEⅡ评分越高,患者病情越严重及预后也越差,二者联合可作为预测急性胰腺炎患者病情严重程度及预后的敏感指标,具有较好的临床应用价值。

Clinical value of Procalcitonin and APACHE II in the Evaluation of Severity and Prognosis of Patients with Acute Pancreatitis

Objective:To investigate the clinical value of serum procalcitonin (PCT) level and Acute Physiology and Chronic Health Evaluation (APACHE II) in the evaluation of severity and prognosis of patients with acute pancreatitis (AP).Methods:A total of 280 patients with acute pancreatitis in our hospital from May 2012 to May 2015 were enrolled in the study. According to the severity of the disease, these patients were divided into the low-risk group (83 cases), moderate-risk group (102 cases) and high-risk group (95 cases). According to clinical outcome, these patients were divided into the survival group (248 cases) and death group (32 cases). The serum level of PCT were measured by enzyme linked immunosorbent assay (ELISA), and APACHE II score was analyzed. The differences of serum PCT levels and APACHE II scores were compared and its correlation with APACHE II score were analyzed, and their correlation with the severity and the prognosis of acute pancreatitis were also assessed.Results:The difference in serum PCT levels and APACHE II scores among low-risk group, moderate-risk group and high-risk group was statistically significant, in which high-risk group was the highest, followed by moderate-risk group, low-risk group was the lowest (P<0.05); Compared the survival group, the death group had higher serumPCT levels and APACHE II score (P<0.05). The PCT level and APACHE II score were positive correlated (r=0. 64, P<0.01). With PCT>2.13 ng/mL considered as the boundary for poor prognosis of acute pancreatitis, the sensitivity was 79.2 %, the specificity was 91.3 %; With APACHE II score>18.1 considered as the boundary for poor prognosis of acute pancreatitis, the sensitivity was 82.7 %, the specificity was 90.1 %; The AUC was 0.921 (95 %CI 0.824~0.938), and the sensitivity was 86.1 %, specificity was 92.9 %when the two cutoff values were both achieved.Conclusion:The serum PCT levels and APACHE II score showed good correlation in acute pancreatitis; When the serum PCT level was higher, APACHE II score was higher, and the prognosis was worse. Combination of serumPCT level and APACHE II score could be used as effective predictors for evaluating the severity and prognosis of AP.