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低钠血症对急性胰腺炎患者疾病程度的评估价值
Value of hyponatremia in predicting disease severity of patients with acute pancreatitis
文章发布日期:2020年11月13日  来源:  作者:严永峰,蒋鑫,钟瑞,等  点击次数:3397次  下载次数:41次

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【摘要】:目的 探讨低钠血症在预测急性胰腺炎(AP)疾病严重程度中的价值。方法 收集2019年1月-12月于西南医科大学附属医院就诊的459例AP患者资料,根据患者起病时血清Na+水平,分为低钠血症组(n=123)和非低钠血症组(n=336),分析及对比两组患者的基线资料、并发症、病死率、AP相关评分等。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher检验。采用多因素logistic回归分析中-重症急性胰腺炎(M-SAP)、急性胰周坏死物聚集(ANC)及全身炎症反应综合征(SIRS)的影响因素,受试者工作特征曲线(ROC曲线)用于分析相关指标的评估价值。结果 低钠血症组较非低钠血症组患者年龄小,BMI、合并糖尿病的比例及高脂血症性AP的比例更高(P值均<0.05);低钠血症组患者入院时甘油三酯、血糖、红细胞压积、C反应蛋白、降钙素原、中性粒细胞与淋巴细胞比率、CT严重指数>2分的比例更高(P值均<0.05);低钠血症组患者发生M-SAP或重症急性胰腺炎、急性胰周液体聚集、ANC、SIRS、急性呼吸窘迫综合征、多器官功能衰竭的比例均高于非低钠血症组(P值均<0.05)。多因素logistic回归分析显示低钠血症(OR=5.272,95%CI:2.771~10.029,P<0.001)、年龄(OR=0.976,95%CI:0.956~0.995,P=0.011)、Ranson评分>2分(OR=10.437,95%CI:4.116~26.465,P<0.001)、酒精性AP(OR=3.249,95%CI:1.214~8.694,P=0.019)是发生M-SAP的独立影响因素,4项指标联合预测M-SAP的ROC曲线下面积为0.759;低钠血症(OR=1.931,95%CI:1.007~3.700,P=0.047;OR=3.792,95%CI:2.193~6.556,P<0.001)、Ranson评分>2分(OR=2.621,95%CI:1.304~5.271,P=0.007;OR=5.845,95%CI:3.066~11.143,P<0.001)是患者发生ANC及SIRS的独立危险因素,两项指标联合预测ANC及SIRS的ROC曲线下面积分别为0.677、0.742。结论 低钠血症可以作为一个简便的参考指标,用于AP患者的病情严重程度评估。
【Abstract】:Objective To investigate the value of hyponatremia in predicting the severity of acute pancreatitis (AP). Methods Clinical data were collected from 459 AP patients who attended The Affiliated Hospital of Southwest Medical University from January to December 2019, and according to the serum Na+ level at the time of onset, the patients were divided into hyponatremia group with 123 patients and non-hypernatremia group with 336 patients. The two groups were analyzed and compared in terms of baseline data, complications, mortality rate, and AP-related scores. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The multivariate logistic regression analysis was used to identify the influencing factors for moderate-to-severe AP (M-SAP), acute necrotic collection (ANC), and systemic inflammatory response syndrome (SIRS), and the receiver operating characteristic (ROC) curve was used to evaluate the value of related indices. Results Compared with the non-hyponatremia group, the hyponatremia group had a significantly younger age and significantly higher body mass index and proportion of patients with diabetes, and most patients had hyperlipidemic AP (all P<0.05). Compared with the non-hyponatremia group, the hyponatremia group had significantly higher triglyceride, blood glucose, hematocrit, C-reactive protein, procalcitonin, neutrophil-to-lymphocyte ratio, and proportion of patients with CT severity index >2 on admission (all P<0.05). Compared with the non-hyponatremia group, the hyponatremia group had a significantly higher proportion of patients with M-SAP or SAP, acute peripancreatic fluid accumulation, ANC, SIRS, acute respiratory distress syndrome, and multiple organ failure (all P<0.05). The multivariate logistic regression analysis showed that hyponatremia (odds ratio [OR]=5.272, 95% confidence interval [CI]: 2.771-10.029, P<0.001), age (OR=0.976, 95%CI: 0.956-0.995, P=0.011), Ranson score >2 (OR=10.437, 95%CI: 4.116-26.465, P<0.001, and alcoholic AP(OR=3.249, 95%CI: 1.214-8.694, P=0.019) were independent risk factors for M-SAP, and the combination of these four indices had an area under the ROC curve (AUC) of 0.759; hyponatremia (OR=1.931, 95%CI: 1.007-3.700, P=0.047; OR=3.792, 95%CI: 2.193-6.556, P<0.001) and Ranson score >2 (OR=2.621, 95%CI: 1.304-5.271, P=0.007; OR=5.845, 95%CI: 3.066-11.143, P<0.001) were independent risk factors for ANC and SIRS, and the combination of these two indices had AUCs of 0.677 and 0.742, respectively, in predicting ANC and SIRS. Conclusion Hyponatremia can be used as a simple reference index for evaluating disease severity in patients with AP.
【关键字】:胰腺炎; 低钠血症; 危险因素
【Key words】:pancreatitis; hyponatremia; risk factors
【引证本文】:YAN YF, JIANG X, ZHONG R, et al. Value of hyponatremia in predicting disease severity of patients with acute pancreatitis[J]. J Clin Hepatol, 2020, 36(12): 2765-2770. (in Chinese)
严永峰, 蒋鑫, 钟瑞, 等. 低钠血症对急性胰腺炎患者疾病程度的评估价值[J]. 临床肝胆病杂志, 2020, 36(12): 2765-2770.

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