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血清载脂蛋白A1和载脂蛋白B/A1比值对重型急性胰腺炎的预测价值
Value of serum apolipoprotein A1 versus apolipoprotein B-to-apolipoprotein A1 ratio in predicting severe acute pancreatitis
文章发布日期:2020年02月17日  来源:  作者:钟瑞,徐欢,彭燕,等  点击次数:308次  下载次数:54次

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【摘要】:目的 探索与发现能早期预测重型急性胰腺炎(SAP)的血脂指标,并评估其预测价值。方法 回顾性分析2017年1月-2019年1月西南医科大学附属医院收治的425例急性胰腺炎(AP)患者的临床资料,其中轻型急性胰腺炎(MAP)229例,中度重型急性胰腺炎(MSAP)161例,SAP 35例,收集所有患者在入院最初24 h内血脂相关数据。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多因素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 载脂蛋白A1(ApoA1)、ApoB/A1在不同严重程度的AP组间差异有统计学意义(F=46.290、χ2=9.130,P值均<0.05)。ApoB/A1与亚特兰大分级、Ranson评分、MCTSI评分、BISAP评分呈正相关(r值分别为0.296、0.129、0.303、0.284,P值均<0.05),ApoA1与亚特兰大分级、Ranson评分、MCTSI评分、BISAP评分呈负相关(r值分别为-0.407、-0.176、-0.338、-0.285,P值均<0.05)。ApoB/A1为SAP的独立危险因素[比值比(OR)=4.493,95%可信区间(95%CI):1.399~14.427,P=0.012],ApoA1为SAP的独立保护因素(OR=0.004,95%CI:0~0.034,P<0.001),ApoB/A1预测SAP的ROC曲线下面积(AUC)为0.763 (95%CI:0.675~0.851,P<0.001),ApoA1预测SAP的 AUC为0.862(95%CI:0.809~0.916,P<0.001),ApoA1的诊断价值更高(Z=2.183,P=0.029)。结论 血清ApoB/A1与ApoA1对SAP均有预测价值,且ApoA1优于ApoB/A1。
【Abstract】:Objective To investigate the blood lipid parameters for the early prediction of severe acute pancreatitis (SAP) and their predictive value. Methods A retrospective analysis was performed for the clinical data of 425 patients with acute pancreatitis (AP) who were admitted to The Affiliated Hospital of Southwest Medical University from January 2017 to January 2019, among whom there were 229 patients with mild acute pancreatitis (MAP), 161 patients with moderate-severe acute pancreatitis (MSAP), and 35 patients with severe acute pancreatitis (SAP). Blood lipid levels were collected for all patients within the first 24 hours after admission. A one-way analysis of variance and the Kruskal-Wallis H test were used for comparison of continuous data between multiple groups. A logistic regression analysis was used for the variables with statistical significance determined by the univariate analysis. The Spearman correlation was used to investigate the correlation between data. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of indices, and MedCalc software was used to investigate whether there was a significant difference in diagnostic efficiency. Results There were significant differences in apolipoprotein A1(ApoA1) and apolipoprotein B-to-apolipoprotein A1(ApoB/A1) ratio between the patients with different severities of acute pancreatitis (F=46.290, χ2=9.130, both P<0.05). ApoB/A1 ratio was positively correlated with Atlanta grade, Ranson score, MCTSI score, and BISAP score (r=0.296, 0.129, 0.303, and 0.284, all P<0.05). ApoA1 was negatively correlated with Atlanta grade, Ranson score, MCTSI score, and BISAP score (r=-0.407, -0.176, -0.338, and -0.285, all P<0.05). ApoB/A1 ratio was an independent risk factor for SAP (odds ratio=4.493, 95% confidence interval [CI]: 1.399-14.427, P=0.012), while ApoA1 was an independent protective factor for SAP (odds ratio=0.004,95%CI:0-0.034,P<0.001). ApoB/A1 ratio had an area under the ROC curve(AUC) of 0.763 (95%CI: 0.675-0.851, P<0.001) in predicting SAP, and ApoA1 had an AUC of 0.862 (95%CI: 0.809-0.916, P<0.001) in predicting SAP, suggesting that ApoA1 had a higher diagnostic value (Z=2.183, P=0.029). Conclusion Both serum ApoB/A1 ratio and ApoA1 have a certain value in predicting SAP, and ApoA1 has a higher predictive value than ApoB/A1 ratio.
【关键字】:胰腺炎; 载脂蛋白B类; 载脂蛋白A-I; 危险因素
【Key words】:pancreatitis; apolipoproteins B; apolipoprotein A-I; risk factors
【引证本文】:ZHONG R, XU H, PENG Y, et al. Value of serum apolipoprotein AI versus apolipoprotein B-to-apolipoprotein AI ratio in predicting severe acute pancreatitis[J]. J Clin Hepatol, 2020, 36(3): 631-635. (in Chinese)
钟瑞, 徐欢, 彭燕, 等. 血清载脂蛋白A1和载脂蛋白B/A1比值对重型急性胰腺炎的预测价值[J]. 临床肝胆病杂志, 2020, 36(3): 631-635.

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