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目的:探讨血清降钙素原(PCT)与急性生理学与慢性健康状况评分(APACHE Ⅱ)对急性胰腺炎(AP)患者病情严重程度及预后的评估价值。方法:选取本院2012年5月-2015年5月收治的急性胰腺炎患者280例为研究对象。根据急性胰腺炎患者病情严重程度将其分为低危组(83例)、中危组(102例)和高危组(95例);按患者临床结局将其分为存活组(248例)及死亡组(32例),采用酶联免疫吸附法(ELISA)检测各组血清PCT水平同时记录APACHE Ⅱ评分情况,分别比较PCT水平的差异以及与APACHE Ⅱ评分的相关性,评价血清PCT及APACHEⅡ评分对急性胰腺炎患者病情严重程度及预后的评估价值。结果:低危组、中危组及高危组间血清PCT水平和APACHE Ⅱ评分的差异具有统计学意义(P<0.05)。其中,高危组血清PCT水平和APACHE Ⅱ评分最高,中危组次之,低危组最低(P<0.05);死亡组PCT水平及APACHE Ⅱ评分显著高于存活组(P<0.05)。相关性分析显示血清PCT水平与APACHE Ⅱ评分呈正相关(r=0.64,P<0.01)。以PCT>2.13 ng/m L为评估急性胰腺炎患者预后不佳界限时,其敏感性和特异性分别79.2%和91.3%;以APACHE Ⅱ评分>18.1分为评估急性胰腺炎患者预后不佳界限时,其敏感性和特异性分别为82.7%和90.1%;两者指标串联评估敏感性及特异性分别为86.1%和92.9%,ROC曲线下面积为0.921(95%CI 0.824~0.938)。结论:急性胰腺炎患者血清PCT水平和APACHE Ⅱ评分具有较好的相关性,血清PCT水平越高,APACHEⅡ评分越高,患者病情越严重及预后也越差,二者联合可作为预测急性胰腺炎患者病情严重程度及预后的敏感指标,具有较好的临床应用价值。
Objective: To evaluate the value of serum procalcitonin (PCT), acute physiology and chronic health status score (APACHE Ⅱ) in evaluating the severity and prognosis of patients with acute pancreatitis (AP). Methods: A total of 280 patients with acute pancreatitis admitted to our hospital from May 2012 to May 2015 were enrolled in this study. The patients with acute pancreatitis were divided into low risk group (n = 83), intermediate risk group (n = 102) and high risk group (n = 95) according to the severity of their illness. Patients were divided into survival group (248 cases) (32 cases). ELISA was used to detect serum PCT levels in each group and APACHE Ⅱ scores were recorded. The differences of PCT levels and APACHE Ⅱ scores were compared between the two groups to evaluate the serum PCT and APACHE Ⅱ scores Evaluation of the severity and prognosis of patients with acute pancreatitis. Results: There was significant difference in serum PCT level and APACHE Ⅱ score between low risk group, intermediate risk group and high risk group (P <0.05). Among them, the serum PCT level and APACHE Ⅱ score of the high risk group were the highest, followed by the middle risk group and lowest risk group (P <0.05). The PCT level and APACHE Ⅱ score in the death group were significantly higher than those in the survival group (P <0.05). Correlation analysis showed a positive correlation between serum PCT level and APACHE II score (r = 0.64, P <0.01). When PCT> 2.13 ng / m L was used to assess the poor prognosis of patients with acute pancreatitis, the sensitivity and specificity were 79.2% and 91.3%, respectively. APACHE Ⅱ score> 18.1 was used to assess the poor prognosis of patients with acute pancreatitis , The sensitivity and specificity were 82.7% and 90.1% respectively. The sensitivity and specificity of the two methods were 86.1% and 92.9% respectively. The area under the ROC curve was 0.921 (95% CI 0.824-0.938). Conclusion: There is a good correlation between serum PCT level and APACHE Ⅱ score in patients with acute pancreatitis. The higher serum PCT level and the higher APACHE Ⅱ score, the more severe the patients and the worse the prognosis. The combination of the two can be used as a prediction of acute pancreatitis Patients with the severity and prognosis of sensitive indicators, has good clinical value.