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Value of neutrophil-lymphocyte ratio combined with apolipoprotein A-I level in predicting the severity of acute pancreatitis in the early stage after admission
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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。 -
关键词:
- 胰腺炎 /
- 中性粒细胞与淋巴细胞比值 /
- 载脂蛋白A-I /
- 疾病严重程度指数
Abstract:Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) combined with apolipoprotein A-I (ApoA-I) level in predicting the severity of acute pancreatitis (AP). Methods A retrospective analysis was performed for 460 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2015 to December 2019, among whom 250 had mild acute pancreatitis (MAP), 166 had moderate-severe acute pancreatitis, and 44 had severe acute pancreatitis (SAP). Related clinical data were collected, including basic information, laboratory markers (neutrophil count, lymphocyte count, serum triglyceride, serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, and apolipoprotein B), and scores (Ranson, BISAP, and MCTSI). A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups; a logistic regression analysis was performed for the variables with statistical significance in univariate analysis; a Spearman correlation analysis was performed 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 NLR and ApoA-I level between the groups with different severities of AP (χ2= 64.124, F=40.277, P < 0.001). On admission, NLR was positively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=0.370, 0.129, 0.260, and 0.122, all P < 0.05), and ApoA-I level was negatively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=-0.358, -0.220, -0.297, and -0.251, all P < 0.05). NLR was an independent risk factor for non-MAP (odds ratio [OR]=1.104, 95% confidence interval [CI]: 1.070-1.140, P < 0.001), while ApoA-I was an independent protective factor against non-MAP (OR=0.138, 95% CI: 0.070-0.264, P < 0.001); NLR was an independent risk factor for SAP (OR=1.163, 95% CI: 1.107-1.222, P < 0.001), while ApoA-I was an independent protective factor against SAP (OR=0.013, 95% CI: 0.003-0.056, P < 0.001). NLR had an area under the ROC curve (AUC) of 0.700 (95% CI: 0.656-0.742, P < 0.001) in predicting non-MAP; ApoA-I had an AUC of 0.684 (95% CI: 0.640-0.726, P < 0.001) in predicting non-MAP; NLR combined with ApoA-I had an AUC of 0.748 (95%CI: 0.706-0.787, P < 0.001) in predicting non-MAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting non-MAP (Z=3.439 and 2.462, both P < 0.05). NLR had an AUC of 0.752 (95% CI: 0.710-0.791, P < 0.001) in predicting SAP; ApoA-I had an AUC of 0.797 (95% CI: 0.757-0.833, P < 0.001) in predicting SAP; NLR combined with ApoA-I had an AUC of 0.857 (95% CI: 0.822-0.888, P < 0.001) in predicting SAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting SAP (Z=3.171 and 2.630, both P < 0.05). Conclusion NLR combined with ApoA-I can be used as a good indicator for predicting the severity of AP in the early stage after admission. -
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值 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。 
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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值 0.107 -0.004 0.099 -0.104 P值 0.021 0.928 0.034 0.025 HDL-C r值 -0.199 -0.085 -0.143 -0.012 P值 ＜0.001 0.069 0.002 0.795 ApoA-I r值 -0.358 -0.220 -0.297 -0.251 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 NEU r值 0.271 0.112 0.255 0.143 P值 ＜0.001 0.016 ＜0.001 0.002 LYM r值 -0.293 -0.093 -0.288 -0.064 P值 ＜0.001 0.046 ＜0.001 0.169 NLR r值 0.370 0.129 0.260 0.122 P值 ＜0.001 0.005 ＜0.001 0.009
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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值 OR 95%CI P值 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
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