摘要
背景中性粒细胞与淋巴细胞比值(NLR)、血小板计数与淋巴细胞比值(PLR)在预测胰腺炎严重程度上已被证实有一定意义,但目前探讨NLR、PLR对胆源性急性胰腺炎(BAP)及并发肝损伤的诊断及预测价值的研究较少。目的探讨NLR、PLR与BAP病情程度及并发急性肝损伤(ALI)的相关性。方法选取2019年3月至2021年3月就诊于南昌大学第二附属医院急诊科收治的142例BAP患者,按照亚特兰大分类将患者分为轻症(MAP)/中度重症急性胰腺炎(MSAP)组(n=98)、重症急性胰腺炎(SAP)组(n=44);根据肝功能是否损伤分为ALI组(n=92)与无ALI组(n=50),其中ALI组再分为肝细胞型肝损伤亚组(n=1)、胆管细胞型肝损伤亚组(n=16)和混合型肝损伤亚组(n=75)。收集患者一般情况及临床资料,通过绘制受试者工作特征(ROC)曲线及二元Logistic回归分析探究NLR、PLR对BAP严重程度及并发ALI的预测价值。结果MAP/MSAP组NLR、PLR均低于SAP组(P<0.05)。ALI组NLR、PLR均高于无ALI组(P<0.05)。胆管细胞型肝损伤亚组、混合型肝损伤亚组NLR、PLR比较,差异均无统计学意义(P>0.05)。NLR、PLR及二者联合预测SAP的ROC曲线下面积分别为0.809、0.667、0.809;NLR、PLR及二者联合预测BAP发生ALI的ROC曲线下面积分别为0.774、0.767、0.806;NLR、PLR及二者联合预测BAP发生胆管细胞型肝损伤的ROC曲线下面积分别为0.813、0.742、0.861;NLR、PLR及二者联合预测BAP发生混合型肝损伤的ROC曲线下面积分别为0.763、0.770、0.794。二元Logistic回归分析结果显示,NLR升高是SAP的危险因素〔OR=1.184,95%CI(1.102,1.271),P<0.001〕;NLR和PLR升高是BAP发生ALI的危险因素〔OR=1.140,95%CI(1.050,1.238),P=0.002;OR=1.007,95%CI(1.001,1.013),P=0.023〕;NLR升高是BAP发生胆管细胞型肝损伤的危险因素〔OR=1.184,95%CI(1.054,1.331),P=0.004〕;NLR和PLR升高是BAP发生混合型肝损伤的危险因素〔OR=1.120,95%CI(1.120,1.221),P=0.011;OR=1.007,95%CI(1.001,1.013),P=0.034〕。结论NLR升高是SAP的危险因素,NLR和PLR升高是BAP发生ALI的危险因素,且NLR的预测价值优于PLR,联合检测效果更好。
Background Neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)have proved to have a certain significance in predicting the severity of pancreatitis,however,at present,there are few relevant studies on the diagnostic and predictive value of NLR and PLR for liver injury in biliary acute pancreatitis(BAP).Objective To explore the correlation between NLR and PLR in the severity of BAP and the concurrent acute liver injury(ALI).Methods A total of 142 patients with BAP admitted to Emergency Department of the Second Affiliated Hospital of Nanchang University from March 2019 to March 2021 were selected and divided into mild(MAP)/moderately(MSAP)group(n=98)and severe(SAP)group(n=44)according to Atlanta classification.According to whether the liver function is damaged or not,they were divided into ALI group(n=92)and non-ALI group(n=50).The ALI group was further divided into hepatocyte type liver injury subgroup(n=1),bile duct type liver injury subgroup(n=16)and mixed type liver injury subgroup(n=75).The general condition and clinical data of patients were collected,and the predictive value of NLR and PLR on the severity of BAP and concurrent ALI was explored by the ROC curve and binary Logistic regression analysis.Results The NLR and PLR in MAP/MSAP group were lower than those in SAP group(P<0.05).The NLR and PLR in ALI group were higher than those in non-ALI group(P<0.05).There was no significant difference in NLR and PLR between bile duct type liver injury subgroup and mixed type liver injury subgroup(P>0.05).The area under the ROC curve of NLR,PLR and their joint prediction of SAP was 0.809,0.667,0.809,respectively.The area under the ROC curve of NLR,PLR and their joint prediction of ALI in BAP was 0.774,0.767,0.806,respectively.The area under the ROC curve of NLR,PLR and their joint prediction of the occurrence of cholangiocytic liver injury in BAP was 0.813,0.742,0.861,respectively.The area under ROC curve of NLR,PLR and their joint prediction of mixed liver injury in BAP was 0.763,0.770 and 0.794 respectively.The results of binary Logistic regression analysis showed that elevated NLR was a risk factor for SAP〔OR=1.184,95%CI(1.102,1.271),P<0.001〕.Elevated NLR and PLR were the risk factors for ALI in BAP〔OR=1.140,95%CI(1.050,1.238),P=0.002;OR=1.007,95%CI(1.001,1.013),P=0.023〕;elevated NLR was a risk factor for bile duct cell liver injury in BAP〔OR=1.184,95%CI(1.054,1.331),P=0.004〕.Elevated NLR and PLR were risk factors for mixed liver injury in BAP〔OR=1.120,95%CI(1.120,1.221),P=0.011;OR=1.007,95%CI(1.001,1.013),P=0.034〕.Conclusion Elevated NLR is a risk factor for SAP,elevated NLR and PLR are the risk factors for ALI in BAP.The predictive value of NLR on the severity of BAP and concurrent ALI is better than PLR,and the combined detection effect is better.
作者
廖国豪
程斌
余红雨
熊上
徐丽
吴利东
张桦
杜航
LIAO Guohao;CHENG Bin;YU Hongyu;XIONG Shang;XU Li;WU Lidong;ZHANG Hua;DU Hang(Emergency Department,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Emergency Department,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中国全科医学》
CAS
北大核心
2022年第12期1449-1454,共6页
Chinese General Practice
基金
江西省卫健委普通科技计划(20195216)。
