摘要
目的探讨高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)及非高脂血症性急性胰腺炎(non-hyperlipidemic acute pancreatitis,NHLAP)的临床特点及血清淀粉样蛋白A(serum amyloid A,SAA)对其严重程度的预测价值。方法选取2018年1月至2021年7月湖州市第一人民医院收治的急性胰腺炎(acute pancreatitis,AP)患者710例进行回顾性分析,其中HLAP患者为研究组(n=187),NHLAP患者为对照组(n=523)。分析患者的性别、年龄、体质量指数、血尿淀粉酶等临床资料及SAA水平,评估SAA对HLAP、NHLAP疾病严重程度的预测价值。结果HLAP组的血淀粉酶(amylase,AMY)、尿AMY水平均低于NHLAP组,HLAP组三酰甘油(triglyceride,TG)水平高于NHLAP组,差异均有统计学意义(P<0.05)。HLAP组胰腺坏死/脓肿发生率、中度AP(moderately severe acute pancreatitis,MSAP)占比及住院时长均高于NHLAP组,轻度AP(mild acute pancreatitis,MAP)比例低于NHLAP组,差异均有统计学意义(P<0.05);两组重度AP(severe acute pancreatitis,SAP)占比比较,差异无统计学意义(P>0.05)。SAP患者SAA水平显著高于同组MSAP、MAP患者(P<0.05),MSAP患者SAA水平显著高于同组MAP患者(P<0.05),Spearman秩相关性分析,入院1d时,SAA水平与HLAP、NHLAP严重程度均呈显著正相关(γ=0.367、0.385,P<0.05)。HLAP组MAP患者入院3d时SAA水平显著高于NHLAP组(P<0.05);入院3d、6d时两组SAA水平比较,差异无统计学意义(P>0.05)。HLAP组MSAP及SAP患者入院1~4d、6d时,SAA水平均显著高于NHLAP组(P<0.05)。入院第2天SAA对预测HLAP组SAP的受试者操作特征曲线下面积达0.887,敏感度为92.48%,特异性为82.17%;NHLAP组曲线下面积达0.843,敏感度为78.19%,特异性为86.46%,具有较好的预测较能。结论SAA对于AP严重程度的早期预测具有较高价值,但HLAP与NHLAP临床特点存在差异,SAA在预测HLAP及NHLAP重症化的临界值应有所差异。
Objectives To investigate the clinical characteristics of hyperlipidemic acute pancreatitis(HLAP)and non-hyperlipidemic acute pancreatitis(NHLAP)and the predictive value of serum amyloid A(SAA)on their severity.Methods A total of 710 patients with acute pancreatitis(AP)admitted to Huzhou First People's Hospital from January 2018 to July 2021 were selected for retrospective analysis,with HLAP patients as the study group(n=187)and NHLAP patients as the control group(n=523).Patients'clinical data such as gender,age,body mass index,blood and urine amylase and SAA levels were analyzed to assess the predictive value of SAA on the severity of HLAP and NHLAP disease.Results The HLAP group had lower blood amylase(AMY)and urine AMY levels,and higher triglyceride(TG)levels than that in the NHLAP group,with statistically significant differences(P<0.05).The incidence of pancreatic necrosis/abscess,moderately severe pancreatitis(MSAP)and length of stay were all higher in the HLAP group than those in the NHLAP group,and the proportion of mild acute pancreatitis(MAP)was lower than that in the NHLAP group,and the differences were statistically significant(P<0.05).The difference was not statistically significant when comparing the proportion of severe AP(severe acute pancreatitis,SAP)in the two groups(P>0.05).SAA levels in SAP patients were significantly higher than those in MSAP and MAP patients in the same group(P<0.05),and SAA levels in MSAP patients were significantly higher than those in MAP patients in the same group(P<0.05),and Spearman's analysis showed that at 1 day of admission,SAA levels were significantly correlated with the severity of HLAP and NHLAP(γ=0.367、0.385,P<0.05).SAA levels were significantly higher in the HLAP group than those in the NHLAP group at 3 days of admission(P<0.05);the differences were not statistically significant between the two groups at 3 days and 6 days of admission(P>0.05).The SAA levels were significantly higher in the HLAP group than those in the NHLAP group at 1 to 4 and 6 days(P<0.05).The area under the receiver operator characteristic curve of SAA on 2nd day of admission for predicting SAP in the HLAP group reached 0.887,with a sensitivity of 92.48% and specificity of 82.17%;the area under the curve in the NHLAP group reached 0.843,with a sensitivity of 78.19% and specificity of 86.46%,with better predictive better performance.Conclusion SAA has a high value in the early prediction of the severity of AP.However,there are differences in the clinical features of HLAP and NHLAP,and the thresholds for SAA in predicting HLAP and NHLAP resurgence should be different.
作者
邱雷
危贵君
QIU Lei;WEI Guijun(Department of Gastroenterology,Huzhou First People’s Hospital,Huzhou 313000,Zhejiang,China)
出处
《中国现代医生》
2023年第11期52-56,共5页
China Modern Doctor
