摘要
目的探讨炎症因子联合Ranson评分预测急性胰腺炎(AP)严重程度和指导临床治疗的价值。方法根据2012年Atlanta标准将150例AP患者分为轻度组(50例)、中度组(50例)和重度组(50例),比较各组血清炎症因子[白细胞介素(IL)-6、降钙素原(PCT)、C反应蛋白(CRP)、IL-8、IL-10]水平和Ranson评分,并统计各组病死率,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),比较各指标评估器官功能衰竭和病死率的价值。结果3组患者发病12h、24h、48h时的PCT、IL-6、CRP逐渐升高,且随着病情严重程度增加而逐渐增高(P<0.05);3组患者发病24h时的IL-10水平高于发病12h,但发病48h低于发病24h(P<0.05);轻、中、重度组Ranson评分随病情严重程度增加呈递增趋势(P<0.05);重度组病死率(16.0%)高于轻度组(0)和中度组(2.0%,P<0.05)。血清炎症因子中,IL-6评估器官功能衰竭和病死率的AUC>PCT、CRP;CRP评估胰腺坏死的AUC>PCT、IL-6;Ranson评分评估器官功能衰竭和病死率的AUC>PCT、IL-6、CRP;PCT+IL-6+CRP+Ranson评分评估器官功能衰竭、胰腺坏死及病死率AUC均>Ranson评分及任一血清炎症因子。结论IL-6评估AP患者器官功能衰竭、病死率价值较高,CRP评估胰腺坏死价值较高,PCT、IL-6、CRP与Ranson评分系统联合应用可进一步提高对其器官功能衰竭、胰腺坏死、病死率的预测能力,为临床治疗策略的选择提供参考。
Objective To analyze the value of inflammatory factors combined with Ranson scores in predicting the severity of acute pancreatitis(AP) and guiding clinical treatment.Methods According to the 2012 Atlanta standard,150 AP patients were divided into mild group (n=50),moderate group(n=50) and severe group(n=50).Serum inflammatory factors [interleukin(IL)-6,procalcitonin (PCT),C-reactive protein(CRP),IL-8,IL-10] levels,Ranson scores in 3 groups were compared and the mortality rate of each group was counted.Draw the receiver operating characteristics (ROC) curve.The area under the ROC(AUC) of each index was calculated and and the value of each index to assess organ failure and mortality rate was compared.Results PCT,IL-6 and CRP increased gradually at 12h,24h,48h in the three groups,and PCT,IL-6 and CRP increased gradually with the severity of the disease(P<0.05).The IL-10 levels in the three groups were higher at 24h than those at 12h,but the IL-10 levels were lower at 48h than those at 24h(P<0.05).The Ranson scores of the light,moderate and severe groups showed an increasing trend with the increase of the severity of the disease(P<0.05).The mortality rate of severe group was higher than that of mild group(0) and moderate group(2.0%,P<0.05).Among the serum inflammatory factors,the AUCs of IL-6 to evaluate organ failure and mortality rate were larger than that of PCT and CRP.The AUC of CRP to evalute pancreatic necrosis was larger than that of PCT and IL-6.The AUCs of Ranson scores to evaluate organ failure and fatality rate were larger than that of PCT,IL-6 and CRP.The AUCs of PCT+IL-6+CRP+Ranson scores to evaluate organ failure,pancreatic necrosis and fatality rate were larger than those of Ranson score and any serum inflammatory factor.Conclusion IL-6 has higher predictive value for organ failure and mortality rate in AP patients,and CRP has higher predicitvie value for pancreatic necrosis.The combination of PCT,IL-6,CRP and Ranson scores can further improve the predictive ability of organ failure,pancreatic necrosis and mortality rate,which provides a reference for the selection of clinical treatment strategies.
作者
张婧
刁攀娅
苟园园
Zhang Jing;Diao Panya;Gou Yuanyuan.(Department of Gastroenterology, Jiang Jin Central Hospital of Chongqing, Chongqing 40226, China)
出处
《临床内科杂志》
CAS
2019年第9期597-600,共4页
Journal of Clinical Internal Medicine
基金
2019年重庆市江津区科技计划项目(Y2019040).
