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早期中性粒细胞与淋巴细胞比值联合载脂蛋白A-I对急性胰腺炎严重程度的预测价值

徐劲 彭燕 唐川康

徐劲, 彭燕, 唐川康. 早期中性粒细胞与淋巴细胞比值联合载脂蛋白A-I对急性胰腺炎严重程度的预测价值[J]. 临床肝胆病杂志, 2021, 37(3): 660-665. DOI: 10.3969/j.issn.1001-5256.2021.03.030
引用本文: 徐劲, 彭燕, 唐川康. 早期中性粒细胞与淋巴细胞比值联合载脂蛋白A-I对急性胰腺炎严重程度的预测价值[J]. 临床肝胆病杂志, 2021, 37(3): 660-665. DOI: 10.3969/j.issn.1001-5256.2021.03.030
XU J, PENG Y, TANG CK. Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission[J]. J Clin Hepatol, 2021, 37(3): 660-665. DOI: 10.3969/j.issn.1001-5256.2021.03.030
Citation: XU J, PENG Y, TANG CK. Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission[J]. J Clin Hepatol, 2021, 37(3): 660-665. DOI: 10.3969/j.issn.1001-5256.2021.03.030

早期中性粒细胞与淋巴细胞比值联合载脂蛋白A-I对急性胰腺炎严重程度的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.03.030
基金项目: 

泸州市科技局基金 17246

详细信息
    作者简介:

    徐劲(1989—),女,主要从事胰腺病研究

    通讯作者:

    唐川康,732008116@qq.com

  • 中图分类号: R576

Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission

  • 摘要:   目的  探讨中性粒细胞与淋巴细胞比值(NLR)联合载脂蛋白A-I(ApoA-I)水平对急性胰腺炎(AP)病情严重程度的预测价值。  方法  回顾性研究2015年1月—2019年12月西南医科大学附属医院收治的460例AP患者。其中轻型急性胰腺炎(MAP)250例,中度重型急性胰腺炎(MSAP)166例,重型急性胰腺炎(SAP)44例。收集AP患者的基本资料、实验室指标[入院24 h内的中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、血清TG、血清TC、HDL-C、LDL-C,载脂蛋白包括ApoA-I及ApoB]、系统评分(Ranson、BISAP、MCTSI评分)。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H秩和检验。将单因素分析中有统计学意义的变量进行logistic回归分析。Spearman相关性分析用于评价数据间的相关性。受试者工作特征曲线(ROC曲线)用于评价指标的诊断效能,MedCalc软件检验其效能差异有无统计学意义。  结果  NLR、ApoA-I水平在不同严重程度AP组间差异有统计学意义(χ2=64.124、F=40.277,P值均<0.001)。入院时NLR与亚特兰大分级、Ranson评分、MCTSI评分和BISAP评分呈正相关(r值分别为0.370、0.129、0.260、0.122,P值均<0.05);ApoA-I水平与亚特兰大分级、Ranson评分、MCTSI评分和BISAP评分呈负相关(r值分别为-0.358、-0.220、-0.297、-0.251,P值均<0.05)。NLR是非MAP的独立危险因素[OR=1.104,95%CI:1.070~1.140,P<0.001],ApoA-I是非MAP的独立保护因素(OR=0.138,95%CI:0.070~0.264,P<0.001);NLR是SAP的独立危险因素(OR=1.163,95%CI:1.107~1.222,P<0.001),ApoA-I是SAP的独立保护因素(OR=0.013,95%CI:0.003~0.056,P<0.001)。NLR预测非MAP的AUC=0.700,95%CI:0.656~0.742,P<0.001;ApoA-I预测非MAP的AUC =0.684,95%CI:0.640~0.726,P<0.001,联合预测非MAP的AUC=0.748,95%CI:0.706~0.787,P<0.001。两指标联合对非MAP的预测价值优于单一指标(Z值分别为3.439、2.462,P值均<0.05)。NLR预测SAP的AUC=0.752,95%CI:0.710~0.791,P<0.001;ApoA-I预测SAP的AUC=0.797,95%CI:0.757~0.833,P<0.001,联合预测SAP的AUC =0.857,95%CI:0.822~0.888,P<0.001。两指标联合对SAP的预测价值优于单一指标(Z值分别为3.171、2.630,P值均<0.05)。  结论  入院早期NLR联合ApoA-I可作为预测AP严重程度的良好指标。
  • 图  1  入院NLR及ApoA-I水平预测AP严重程度的ROC曲线

    注:a,预测非MAP的ROC曲线;b,预测SAP的ROC曲线。

    表  1  AP患者的一般临床资料

    项目 MAP组(n=250) MSAP组(n=166) SAP组(n=44) 统计值 P
    年龄(岁) 50.4±15.3 47.8±13.6 53.1±15.7 F=2.867 0.058
    男性[例(%)] 142(56.8) 101(60.8) 29(65.9) χ2=1.600 0.449
    BMI(kg/m2) 24.8±3.5 24.8±3.6 24.6±4.2 F=0.039 0.962
    病因[例(%)] χ2=18.079 0.021
      胆管性 82(32.8) 54(32.5) 17(38.6)
      高脂血症性 86(34.4) 57(34.3) 12(27.3)
      酒精性 11(4.4) 11(6.6) 6(13.6)
      特发性 26(10.4) 4(2.4) 3(6.8)
      多病因1) 45(18.0) 40(24.1) 6(13.6)
    高血压[例(%)] 56(22.4) 35(21.1) 11(25.0) χ2=0.325 0.850
    糖尿病[例(%)] 43(17.2) 33(19.9) 14(31.8) χ2=5.097 0.078
    脂肪肝[例(%)] 80(32.0) 71(42.8) 22(50.0) χ2=8.116 0.017
    吸烟史[例(%)] 75(30.0) 64(38.6) 14(31.8) χ2=3.334 0.189
    评分
      Ranson评分 0(0~1) 1(0~1) 4(2~4) χ2=123.848 <0.001
      MCTSI评分2) 2(2~2) 4(4~4) 4(4~6) χ2=381.432 <0.001
      BISAP评分3) 0(0~1) 1(0~1) 2(1~3) χ2=120.811 <0.001
    实验室指标
      TC(mmol/L) 5.0(4.1~6.6) 5.3(4.0~8.7) 4.6(3.5~7.2) χ2=4.642 0.098
      TG(mmol/L) 2.4(1.1~6.9) 4.1(1.5~11.1) 2.5(1.5~12.1) χ2=7.836 0.020
      HDL-C(mmol/L) 1.0(0.8~1.4) 0.9(0.7~1.2) 0.9(0.6~1.1) χ2=18.736 <0.001
    LDL-C(mmol/L) 2.5(2.0~3.3) 2.7(1.7~3.7) 2.3(1.3~2.9) χ2=6.774 0.034
      ApoB(g/L) 0.9(0.6~1.1) 0.8(0.5~1.1) 0.8(0.5~1.0) χ2=2.012 0.366
      ApoA-I(g/L) 1.30±0.38 1.12±0.34 0.80±0.25 F=40.277 <0.001
      NEU(109/L) 9.4(6.7~12.3) 11.6(8.7~14.9) 12.6(10.5~16.1) χ2=33.782 <0.001
      LYM(109/L) 1.2(0.8~1.5) 0.9(0.7~1.3) 0.7(0.5~1.0) χ2=42.620 <0.001
      NLR 8.1(5.1~12.5) 13.3(8.0~18.1) 17.6(11.8~25.0) χ2=64.124 <0.001
    注:1)明确存在胆道性、高脂血症性、酒精性等至少两种病因的;2)CT严重程度指数评分;3)AP严重程度床边指数评分。
    下载: 导出CSV

    表  2  实验室指标与各评分系统的相关性

    项目 统计值 亚特兰大分级 Ranson评分 MCTSI评分 BISAP评分
    TG r 0.107 -0.004 0.099 -0.104
    P 0.021 0.928 0.034 0.025
    HDL-C r -0.199 -0.085 -0.143 -0.012
    P <0.001 0.069 0.002 0.795
    ApoA-I r -0.358 -0.220 -0.297 -0.251
    P <0.001 <0.001 <0.001 <0.001
    NEU r 0.271 0.112 0.255 0.143
    P <0.001 0.016 <0.001 0.002
    LYM r -0.293 -0.093 -0.288 -0.064
    P <0.001 0.046 <0.001 0.169
    NLR r 0.370 0.129 0.260 0.122
    P <0.001 0.005 <0.001 0.009
    下载: 导出CSV

    表  3  影响AP严重程度的二分类logistic回归分析

    项目 模型1 模型2
    OR 95%CI P OR 95%CI P
    性别 1.216 0.728~2.031 0.454 0.402 0.146~1.108 0.078
    年龄 0.982 0.966~0.999 0.036 0.998 0.967~1.031 0.923
    BMI 0.980 0.921~1.044 0.536 0.982 0.877~1.100 0.757
    胆管性 2.750 1.304~5.802 0.008 20.314 3.448~119.683 0.001
    高脂血症性 0.765 0.414~1.414 0.727 1.385 0.355~5.406 0.639
    酒精性 5.215 1.790~15.196 0.017 37.901 4.650~308.919 0.001
    特发性 0.568 0.179~1.805 0.337 13.024 0.993~170.792 0.051
    脂肪肝 1.104 0.656~1.859 0.709 1.134 0.420~3.062 0.804
    吸烟史 1.255 0.735~2.143 0.406 0.536 0.192~1.498 0.235
    糖尿病 0.958 0.541~1.696 0.882 1.131 0.449~2.849 0.795
    高血压 1.513 0.882~2.597 0.133 1.839 0.684~4.939 0.227
    TG 1.014 0.967~1.064 0.567 1.042 0.958~1.134 0.334
    ApoA-I 0.138 0.070~0.264 <0.001 0.013 0.003~0.056 <0.001
    NLR 1.104 1.070~1.140 <0.001 1.163 1.107~1.222 <0.001
    下载: 导出CSV
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