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Received:February 03, 2021 Published Online:October 20, 2021
Received:February 03, 2021 Published Online:October 20, 2021
中文摘要: 目的 探讨急性胰腺炎床旁严重程度指数（BISAP）联合中性粒细胞/淋巴细胞计数比值（NLR）在急性胰腺炎(AP)严重程度早期预测中的价值。
方法 收集2018年12月至2020年12月在空军军医大学第986医院消化内科诊治的160例AP患者的病例资料进行横断面回顾性研究，共计纳入150例，按照病情严重程度分为重症急性胰腺炎(SAP,重症)组20例，非重症组130例。评估患者入院24 h内的BISAP评分，收集并计算患者入院24 h内的NLR，通过绘制受试者工作特征(ROC)曲线，研究BISAP评分、NLR以及BISAP 评分联合NLR对AP严重程度的预测价值。
结果（1）共入组连续住院的AP患者150例，两组均以男性构成比较高；非重症组的病因依次为胆源性99例(76.15%)、脂源性27例（20.77%）、酒精性3例（2.31%）、特发性1例（0.77%）；重症组的病因依次为胆源性16例（80.00%）、脂源性3例（15.00%）、酒精性1例（5.00%）；两组患者在性别、年龄、高血压病、糖尿病、吸烟、饮酒、发病原因、红细胞计数、白蛋白水平以及结局方面比较差异均无统计学意义（ P ＞0.05）；重症组NLR、BISAP评分高于非重症组（ P ＜0.01）；两组呼吸频率、冠心病史、白细胞计数、血尿素氮、hs-CRP水平、住院天数比较差异有统计学意义（ P ＜0.01， P ＜0.05）。（2）NLR、BISAP评分预测评估SAP分别取约登指数最大值为0.492、0.589时，其最佳截断值分别为7.88、2.00，敏感度分别为100.00%、65.00%，特异度分别为49.23%、93.85%；二者联合预测评估SAP取约登指数最大值为0.950时，其敏感度为95.00%、特异度为100.00%。NLR、BISAP评分单独及二者联合预测评估SAP的AUC分别为0.678、0.834和0.975，BISAP评分联合NLR预测效能最高。
结论 与BISAP评分系统及NLR单独评估相比较，BISAP评分联合NLR在AP严重程度早期预测评估中的价值更高。
中文关键词: 急性胰腺炎 急性胰腺炎床旁严重程度指数 中性粒细胞/淋巴细胞计数比值 预测价值
Abstract:Objective To explore the value of bedside index for severity of acute pancreatitis (BISAP) combined with neutrophil/lymphocyte count ratio (NLR) in the early prediction of acute pancreatitis (AP).
Methods Out of 160 AP patients treated in the
Gastroenterology
Department of the 986th Hospital from December 2018 to December 2020 and selected for a cross-sectional retrospective study, 150 patients were enrolled and divided into severe acute pancreatitis group ( n =20, SAP group) and non-SAP group( n =130) according to the severity of AP. BISAP score and NLR within 24 hours of admission were evaluated. By drawing the receiver operating characteristic (ROC) curve, the predictive values of BISAP score, NLR and BISAP score combined with NLR on AP severity were analyzed.
Results
AP was more common in males in both groups. The etiology analysis showed 99 cases of biliary origin (76.15%), 27 cases of lipid origin (20.77%), 3 cases of alcoholic origin (2.31%) and 1 case of idiopathic origin (0.77%) in non-SAP group, and 16 cases of biliary origin (80.00%), 3 cases of lipid origin (15.00%) and 1 case of alcoholic origin (5.00%) in SAP group. There was no significant difference in gender, age, history of hypertension and diabetes, smoking, drinking, cause of disease, red blood cell count, albumin level and patients outcome ( P >0.05),but there were statistical differences in respiration rate, history of coronary heart disease, leukocyte count, levels of blood urea nitrogen and hs-CRP and hospital stay between two groups（ P ＜0.01， P ＜0.05）. NLR and BISAP score in SAP group were significantly higher than those in non-SAP group ( P <0.01). Taking the maximum values of Yoden index as 0.492 and 0.589 respectively, the cut-off values of NLR and BISAP for predicting SAP were 7.88 and 2.00, the sensitivity was 100.00% and 65.00%, and the specificity was 49.23% and 93.85% respectively. When the maximum value of Yodan index was 0.950, the sensitivity and specificity of BISAP score combined with NLR for predicting SAP were 95.00% and 100.00%,respectively. The AUCs of NLR, BISAP score and BISAP score combined with NLR to predict SAP were 0.678, 0.834, 0.975, respectively. BISAP score combined with NLR had the highest predictive performance for SAP.
Conclusion
In the early prediction and evaluation of AP severity, BISAP score combined with NLR is more valuable than BISAP score alone and NLR alone.
keywords: Acute pancreatitis Bedside index for severity of acute pancreatitis Neutrophil-lymphocyte ratio Predictive value
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基金项目:国家自然科学基金项目（8176100564）
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