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

钟瑞; 徐欢; 彭燕; 严永峰; 蒋鑫; 汪敏; 付文广; 汤小伟

doi:10.3969/j.issn.1001-5256.2020.03.032

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

DOI: 10.3969/j.issn.1001-5256.2020.03.032

1. 西南医科大学附属医院消化内科
2. 西南医科大学附属医院营养科
3. 西南医科大学附属医院肝胆外科

基金项目:

泸州市科技局基金(17246)；泸州市三方联合基金(Z1437)；西南医科大学附属医院科研基金(07037);西南医科大学附属医院博士启动基金(16229)；

详细信息

中图分类号: R576
计量
- 文章访问数: 1206
- HTML全文浏览量: 63
- PDF下载量: 190
- 被引次数: 0
出版历程
- 收稿日期: 2019-09-23
- 出版日期: 2020-03-20

Value of serum apolipoprotein A1 versus apolipoprotein B-to-apolipoprotein A1 ratio in predicting severe acute pancreatitis

Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

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）,Ap...
- 胰腺炎 /
- 载脂蛋白B类 /
- 载脂蛋白A-I /
- 危险因素
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 Med Calc 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( Apo B/A1) ratio between the patients with different severities of acute pancreatitis( F = 46. 290,χ2= 9. 130,both P < 0. 05). Apo B/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). Apo B/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). Apo B/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.
- pancreatitis /
- apolipoproteins B /
- apolipoprotein A-I /
- risk factors

HTML全文

参考文献(22)

[1] LEPPANIEMI A,TOLONEN M,TARASCONI A,et al. 2019WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg,2019,14(1):27.

[2] BANKS PA,BOLLEN TL,DERVENIS C,et al. Classification of acute pancreatitis—2012:Revision of the Atlanta classification and definitions by international consensus[J]. Gut,2013,62(1):102-111.

[3] PENG YS,CHEN YC,TIAN YC,et al. Serum levels of apolipoprotein A-I and high-density lipoprotein can predict organ failure in acute pancreatitis[J]. Crit Care,2015,19(1):88.

[4] ZHONG L,LI Q,JIANG Y,et al. The ApoB/ApoAI ratio is associated with metabolic syndrome and its components in a Chinese population[J]. Inflammation,2010,33(6):353.

[5] ENKHMAA B,ANUURAD E,ZHANG Z,et al. Usefulness of apolipoprotein B/apolipoprotein A-I ratio to predict coronary artery disease independent of the metabolic syndrome in African Americans[J]. Am J Cardiol,2010,106(9):1264-1269.

[6] JI HH,JUNG S,CHO SK,et al. Predictive value of apolipoprotein B and A-I ratio in severe acute pancreatitis[J]. J Gastroenterol Hepatol,2018,33(2):548-553.

[7] WU J,WANG Y,LI H,et al. Serum apolipoprotein B-toapolipoprotein AI ratio is independently associated with disease severity in patients with acute pancreatitis[J]. Sci Rep,2019,9(1):7764.

[8] GARG PK,SINGH VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology,2019,156(7):2008-2023.

[9] JAHANGIRI DA. HDL and the acute phase response[J]. Curr Opin Endocrinol,2010,17(2):156.

[10] BOSQUESPADILLA FJ,VAZQUEZELIZONDO G,GONZALEZSANTIAGO O,et al. Hypertriglyceridemia-induced pancreatitis and risk of persistent systemic inflammatory response syndrome[J]. Am J Med Sci,2015,349(3):206-211.

[11] ZHOU CL,ZHANG CH,ZHAO XY,et al. Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis[J]. Clin Chim Acta,2018,476:139-145.

[12] NAWAZ H,KOUTROUMPAKIS E,EASLER J,et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis[J]. Am J Gastroenterol,2015,110(10):1497-1503.

[13] GAO F,YAN Z,ZHANG J. The relationship between the level of triglyceride and the severity of acute hypertriglyceridemia pancreatitis[J]. J Clin Hepatol,2018,34(11):2360-2363.(in Chinese)高峰，闫真，张杰．甘油三酯水平与急性高甘油三酯血症性胰腺炎严重程度的关系[J]．临床肝胆病杂志，2018,34(11):2360-2363.

[14] VUILLEUMIER N,DAYER JM,von ECKARDSTEIN A,et al.Pro-or anti-inflammatory role of apolipoprotein A-I in high-density lipoproteins?[J]. Swiss Med Wkly,2013,143(10):w13781.

[15] SIRNIO P,VAYRYNEN JP,KLINTRUP K,et al. Decreased serum apolipoprotein AI levels are associated with poor survival and systemic inflammatory response in colorectal cancer[J].Sci Rep,2017,7(1):5374.

[16] FARAJ M,MESSIER L,BASTARD JP,et al. Apolipoprotein B:A predictor of inflammatory status in postmenopausal overweight and obese women[J]. Diabetologia,2006,49(7):1637-1646.

[17] HE WH,LYU NH,ZHENG X,et al. Comparison of APACHE II,Ranson,BISAP and CTSI scores based on large sample database to predict the severity of acute pancreatitis in the early stage[J]. Chin J Pancreatol,2019,19(3):172-176.(in Chinese)何文华，吕农华，郑西，等．基于大样本数据库比较APACHEⅡ、Ranson、BISAP和CTSI评分在早期预测急性胰腺炎病情严重程度[J]．中华胰腺病杂志，2019,19(3):172-176.

[18] LI D,LIU FK,WANG GX. Predictive value of RDW,MPV combined inflammatory indicators,PCT,APACHEII score in acute pancreatitis[J]. J Clin Exp Med,2019,18(18):1943-1947.(in Chinese)李丹，刘凤奎，王国兴．RDW、MPV联合炎症指标、PCT及APACHEII评分对急性胰腺炎病情的预测价值[J]．临床和实验医学杂志，2019,18(18):1943-1947.

[19] YAN YY,ZHANG J,JIN EH. Study on the application of modified CT and MR severity indices in patients with acute pancreatitis[J]. J Clin Exp Med,2018,17(10):1037-1039.(in Chinese)闫媛媛，张洁，靳二虎．改良CT和MR严重指数在急性胰腺炎诊断中的应用研究[J]．临床和实验医学杂志，2018,17(10):1037-1039.

[20] VASUDEVAN S,GOSWAMI P,SONIKA U,et al. Comparison of various scoring systems and biochemical markers in predicting the outcome in acute pancreatitis[J]. Pancreas,2018,47(1):65-71.

[21] KHANNA AK,MEHER S,PRAKASH S,et al. Comparison of Ranson,Glasgow,MOSS,SIRS,BISAP,APACHE-II,CTSI Scores,IL-6,CRP,and procalcitonin in predicting severity,organ failure,pancreatic necrosis,and mortality in acute pancreatitis[J]. HPB Surg,2013,2013:367581.

[22] CHO JH,KIM TN,CHUNG HH,et al. Comparison of scoring systems in predicting the severity of acute pancreatitis[J].World J Gastroenterol,2015,21(8):2387-2394.

施引文献

资源附件(0)

访问统计