上海交通大学学报(医学版)

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中性粒细胞与淋巴细胞比值在亚特兰大新分类标准下预测急性胰腺炎严重程度的价值

周天昀,潘婷婷,刘嘉琳,瞿洪平   

  1. 上海交通大学 医学院附属瑞金医院重症医学科, 上海 200025
  • 出版日期:2016-07-28 发布日期:2016-08-31
  • 通讯作者: 瞿洪平, 电子信箱: hongpingqu0412@hotmail.com。
  • 作者简介:周天昀(1990—), 男, 硕士生; 电子信箱: zhouty0316@163.com。

Value of the neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis based on the Revised Atlanta Classification

ZHOU Tian-yun, PAN Ting-ting, LIU Jia-lin, QU Hong-ping   

  1. Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2016-07-28 Published:2016-08-31

摘要:

目的 探讨中性粒细胞与淋巴细胞比值(NLR)在亚特兰大新分类标准下预测急性胰腺炎严重程度的价值。方法 回顾性分析118例急性胰腺炎患者的临床资料,按亚特兰大新分类标准将其分为轻度急性胰腺炎(MAP)、中度急性胰腺炎(MSAP)及重度急性胰腺炎(SAP)3组,观察各组的血NLR水平在入院后第1天、第7天及出院时的动态变化以及在各个时间点上的组间差异。评估NLR与APACHEII评分、住ICU天数、住院天数的相关性,并采用受试者工作特征(ROC)曲线比较NLR、血尿素氮(BUN)、APACHEII评分及NLR联合BUN预测急性胰腺炎严重程度的有效性。结果 在入院后第1天及第7天,NLR的水平依次为SAP组>MSAP组>MAP组(P=0.000)。 NLR水平与APACHEII评分、住ICU天数、住院天数呈正相关(分别为r=0.577,P=0.000;r=0.527,P=0.000;r=0.597,P=0.000)。NLR在预测中度与重度急性胰腺炎时的曲线下面积与APACHEII评分无统计学差异,但优于BUN(0.876±0.032 vs 0.873±0.031,P=0.944;0.876±0.032 vs 0.660±0.050,P=0.000);预测重度急性胰腺炎时,NLR与APACHEII评分及BUN均无统计学差异(0.794±0.053 vs 0.892±0.033,P=0.118;0.794±0.053 vs 0.745±0.064,P=0.560),将NLR与BUN联合后可增加曲线下面积和诊断特异度。结论 NLR在预测急性胰腺炎严重程度上具有一定的临床意义。

关键词: 急性胰腺炎, 中性粒细胞淋巴细胞比值, 严重程度, 预测

Abstract:

Objective To investigate the value of neutrophil-lymphocyte ratio (NLR) for predicting the severity of acute pancreatitis (AP) based on the Revised Atlanta Classification. Methods The clinical data of 118 patients with AP were retrospectively analyzed. Based on the Revised Atlanta Classification, the patients were assigned to 3 groups, i.e. the mild acute pancreatitis group, moderately severe acute pancreatitis group, and severe acute pancreatitis group. The dynamic changes in blood NLR levels in each group 1 and 7 d after admission and at discharge were observed, as well as differences across groups at each time points. The correlations between NLR and acute physiology, chronic health evaluation (APACHE) II score, length of ICU stay, and length of hospital stay were analyzed. The receiver operating characteristic curves (ROC curves) were plotted to compare the efficiency of NLR, BUN, APACHEII score, and NLR combined with BUN for predicting the severity of acute pancreatitis. Results The NLR in the severe acute pancreatitis group was the highest 1 and 7 d after admission, followed by the moderately acute pancreatitis group and the mild acute pancreatitis group (P=0.000). The correlations between NLR and APACHEII score,length of ICU stay, and length of hospital stay were positive (r=0.577,P=0.000;r=0.527,P=0.000;r=0.597,P=0.000, respectively). There was no statistical difference between the area under curve (AUC) of NLR and APACHEII score for predicting moderately-severe acute pancreatitis, but they were superior to BUN (0.876±0.032 vs 0.873±0.031, P=0.944; 0.876±0.032 vs 0.660±0.050, P=0.000). There were no statistical differences between NLR and APACHEII score, and NLR and BUN for predicting severe acute pancreatitis (0.794±0.053  vs  0.892±0.033, P=0.118; 0.794±0.053  vs  0.745±0.064, P=0.560). The combination of NLR and BUN could increase the area under curve and the diagnostic specificity. Conclusion NLR has certain clinical significance for predicting the severity of acute pancreatitis.

Key words: acute pancreatitis , neutrophil-lymphocyte ratio , severity , prediction