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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (08) : 626 -630. doi: 10.3877/cma.j.issn.1674-0785.2021.08.013

所属专题： 急危重症；

临床研究

血清脂肪酶、C反应蛋白、降钙素原预测重症胰腺炎后感染性胰腺坏死的价值分析
陈颖彬1, 李英1, 侯宇1, 陈君1, 黄武峰1, 文惠1, 苏醒1,†()   
  1. 1. 570125　海口，海口市人民医院重症医学科
  • 收稿日期:2021-05-29 出版日期:2021-08-15
  • 通信作者: 苏醒
  • 基金资助:
    海南省卫生计生行业科研项目(19A200164)

Value of serum lipase, C-reactive protein and procalcitonin in prediction of infected pancreatic necrosis after severe pancreatitis

Yingbin Chen1, Ying Li1, Yu Hou1, Jun Chen1, Wufeng Huang1, Hui Wen1, Xing Su1,†()   

  1. 1. Department of Critical Medicine, Haikou People's Hospital, Haikou 570125, China
  • Received:2021-05-29 Published:2021-08-15
  • Corresponding author: Xing Su
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陈颖彬, 李英, 侯宇, 陈君, 黄武峰, 文惠, 苏醒. 血清脂肪酶、C反应蛋白、降钙素原预测重症胰腺炎后感染性胰腺坏死的价值分析[J/OL]. 中华临床医师杂志(电子版), 2021, 15(08): 626-630.

Yingbin Chen, Ying Li, Yu Hou, Jun Chen, Wufeng Huang, Hui Wen, Xing Su. Value of serum lipase, C-reactive protein and procalcitonin in prediction of infected pancreatic necrosis after severe pancreatitis[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 626-630.

目的

分析血清脂肪酶、C反应蛋白（CRP）、降钙素原（PCT）预测重症急性胰腺炎（SAP）后感染性胰腺坏死（IPN）的价值，为临床诊断和治疗工作提供研究依据。

方法

选取2018年12月至2020年12月海口市人民医院收治的132例SAP患者作为研究对象，根据患者是否发生IPN将其分为IPN组（48例）和非IPN组（84例）。比较2组患者的一般资料及入院时的白细胞计数（WBC）、血红蛋白（HB）、血清白蛋白（ALB）、血清淀粉酶、血清脂肪酶、PCT、CRP水平，采用受试者工作特征（ROC）曲线分析血清脂肪酶、PCT、CRP水平诊断SAP合并感染性胰腺坏死的价值。

结果

2组患者入院时WBC、HB及血清ALB、淀粉酶水平差异均无统计学意义（P均＞0.05）；IPN组患者血清脂肪酶、PCT、CRP水平分别为（790.60±294.08）U/L、（11.90±5.67）ng/mL、（292.12±67.97）mg/L，均高于非IPN组的（555.09±213.44）U/L、（5.69±3.34）ng/mL、（204.89±44.15）mg/L，差异均有统计学意义（P均＜0.05）。血清脂肪酶、PCT、CRP水平预测SAP后IPN的ROC曲线下面积（AUCROC）分别为0.727、0.808、0.845（P＜0.05），其中CRP的AUCROC值最高，在cutoff值278.841 mg/L下，其敏感度和特异度分别为60.42%和91.67%。

结论

SAP患者疾病早期的血清脂肪酶、PCT、CRP水平对于辅助预测IPN具有一定价值，但存在敏感度不足的局限，不足以满足临床需求，仍需采用多种指标联合检测以提高预测效率。

关键词: 脂肪酶, C反应蛋白, 降钙素原, 急性重症胰腺炎, 感染性胰腺坏死
Objective

To assess the value of serum lipase, C-reactive protein (CRP) and procalcitonin (PCT) in the prediction of infected pancreatic necrosis (IPN) in patients with severe acute pancreatitis (SAP), to provide a research basis for its clinical diagnosis and treatment.

Methods

A total of 132 SAP patients treated at the Haikou People's Hospital from December 2018 to December 2020 were selected as the study subjects. According to whether IPN occurred, the patients were divided into either an IPN group (48 cases) or a non-IPN group (84 cases). The general data and the levels of white blood cells (WBCs), hemoglobin (HB), albumin (ALB), serum amylase, serum lipase, PCT, and CRP were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of serum lipase, PCT, and CRP levels in the prediction of IPN after SAP.

Results

The differences of WBCs, HB, ALB and amylase between the two groups were not statistically significant (P＞0.05), but the levels of serum lipase, PCT, and CRP in the IPN group were [(790.60±294.08) U/lL, (11.90±5.67) ng/ml, and (292.12±67.97) mg/L, respectively] were significantly higher than those of the non-IPN group [(555.09±213.44) U/L, (5.69±3.34) ng/ml, and (204.89±44.15) mg/L, respectively; P＜0.05]. The area under ROC curve (AUCROC) values of serum lipase, PCT, and CRP levels in the diagnosis of IPN after SAP were 0.727, 0.808, and 0.845, respectively (P＜0.05), among which the AUC of CRP was the highest, with a sensitivity of 60.42% and of 91.67% at the cutoff value of 278.841 mg/L.

Conclusion

Serum lipase, PCT, and CRP levels in early stage of SAP have appreciated value for auxiliary prediction of IPN, but they are limited by a low sensitivity, which is not enough to meet clinical needs. Multiple indicators should still be used to improve the prediction efficiency.

Key words: Lipase, C-reactive protein, Procalcitonin, Acute severe pancreatitis, Infected pancreatic necrosis
表1 2组重症急性胰腺炎患者一般资料比较
组别 例数 年龄（岁，
x¯
±s）		 性别［例（%）］ 病因［例（%）］ 糖尿病［例（%）］ 高血压［例（%）］
男 女 胆源性 非胆源性
IPN组 48 54.46±8.63 30（62.5） 18（37.5） 29（60.42） 19（39.58） 20（41.67） 22（45.83）
非IPN组 84 53.18±8.04 47（55.95） 37（44.05） 48（57.14） 36（42.86） 29（34.52） 32（38.10）
统计值 t=0.857 χ2=0.539 χ2=0.135 χ2=0.668 χ2=0.757
P值 0.102 0.463 0.714 0.414 0.384
表2 2组重症急性胰腺炎患者入院实验室指标比较（
xˉ
±s）
项目 IPN组（48例） 非IPN组（84例） t值 P值
WBC（×10Q9/L） 13.15±3.87 12.89±3.95 0.366 0.635
HB（g/L） 115.53±13.05 117.71±15.23 -0.832 0.106
ALB（g/L） 36.46±4.41 36.85±4.56 -0.478 0.529
淀粉酶（U/L） 706.68±221.16 682.24±225.69 0.603 0.398
脂肪酶（U/L） 790.60±294.08 555.09±213.44 4.864 ＜0.001
PCT（ng/mL） 11.90±5.67 5.69±3.34 6.931 ＜0.001
CRP（mg/L） 292.12±67.97 204.89±44.15 7.982 ＜0.001
表3 血清脂肪酶、PCT、CRP水平预测重症急性胰腺炎后感染性胰腺坏死的ROC曲线分析
检测指标 AUCROC 标准误 P值 AUCROC的95%置信区间 cutoff值 敏感度（%） 特异度（%）
脂肪酶 0.727 0.047 ＜0.001 0.635~0.820 913.641 U/L 37.50 98.81
PCT 0.808 0.042 ＜0.001 0.726~0.890 11.248 ng/ml 58.33 97.62
CRP 0.845 0.036 ＜0.001 0.774~0.916 278.841 mg/L 60.42 91.67
图1 血清脂肪酶、PCT、CRP水平预测重症急性胰腺炎后感染性胰腺坏死的受试者工作特征曲线注：PCT为降钙素原；CRP为C反应蛋白
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