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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2023, Vol. 13 ›› Issue (04) : 224 -228. doi: 10.3877/cma.j.issn.2095-2015.2023.04.007

论著

未成熟粒细胞计数、C反应蛋白、中性粒细胞/淋巴细胞、降钙素原结合MCTSI评分在急性胆源性胰腺炎中的诊断价值
王庆†(), 夏婷婷   
  1. 233500　安徽省，亳州市第二中医院（蒙城县中医院）急诊科
    215000　苏州大学附属第一医院消化内科
  • 收稿日期:2023-04-03 出版日期:2023-08-01
  • 通信作者: 王庆

Diagnostic value of immature granulocyte count, C-reactive protein, NLR, PCT combined with MCTSI score in acute biliary pancreatitis

Qing Wang†(), Tingting Xia   

  1. Department of Emergency, Bozhou Second Hospital of Traditional Chinese Medicine(Mengchen County Hospital of Traditional Chinese Medicine), Bozhou 233500, China
    Department of Gastroenterology, First Affiliated Hospital of Soochow University, Suzhou 215000, China
  • Received:2023-04-03 Published:2023-08-01
  • Corresponding author: Qing Wang
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王庆, 夏婷婷. 未成熟粒细胞计数、C反应蛋白、中性粒细胞/淋巴细胞、降钙素原结合MCTSI评分在急性胆源性胰腺炎中的诊断价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 224-228.

Qing Wang, Tingting Xia. Diagnostic value of immature granulocyte count, C-reactive protein, NLR, PCT combined with MCTSI score in acute biliary pancreatitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(04): 224-228.

目的

分析未成熟粒细胞计数(IG)、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比率(NLR)、降钙素原(PCT)及改良CT严重指数评分(MCTSI)在急性胆源性胰腺炎(ABP)病情及并发症预测中的应用价值。

方法

纳入2020年3月至2022年10月亳州市第二中医院收治的107例ABP患者，检测其治疗前血清CRP、PCT及血浆IG、NLR水平，并比较不同病情、不同并发症发生情况者检测结果差异及MCTSI评分差异。使用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析上述指标评估患者病情、预测并发症风险的效能。

结果

107例胆源性ABP患者中，轻中度69例、重度38例；21例发生全身并发症、57例发生局部并发症，并发症发生率为72.90%(78/107)。轻中度组IG、CRP、NLR、PCT及MCTSI评分均低于重度组，差异有统计学意义(P<0.05)。未发生组IG、CRP、NLR、PCT及MCTSI评分均低于发生组，差异有统计学意义(P<0.05)。MCTSI评分及IG+CRP+NLR+PCT(综合评估)患者病情的准确率分别为71.96%、78.50%(P<0.05)，综合评估患者病情的灵敏度、特异性略高于MCTSI评分。MCTSI评分及综合评估预测患者并发症发生的准确率分别为79.44%、85.05%(P<0.05)，综合评估预测患者并发症的灵敏度、特异性略高于MCTSI评分。

结论

ABP患者病情进展及并发症的发生均伴随着MCTSI评分，以及IG、CRP、NLR、PCT水平的上升，血液指标变化评估患者病情、预测并发症的效能略高于MCTSI评分。

关键词: 急性胆源性胰腺炎, 未成熟粒细胞计数, C反应蛋白, 中性粒细胞/淋巴细胞, 降钙素原, 改良CT严重指数评分
Objective

To analyze the application value of immature granulocyte count(IG), C-reactive protein(CRP), neutrophil-lymphocyte ratio(NLR), procalcitonin(PCT)and modified CT severity index score(MCTSI)in predicting the condition and complications of acute biliary pancreatitis(ABP).

Methods

A total of 107 patients with ABP admitted to Bozhou Second Hospital of Traditional Chinese Medicine from March 2020 to October 2022 were enrolled, and their serum CRP, PCT, plasma IG and NLR levels were detected before treatment.The differences of detection results and MCTSI scores were compared between patients with different conditions and different complications.Receiver operating characteristic curve(ROC)and area under curve(AUC)were used to analyze the effectiveness of the above indicators in evaluating patients′ condition and predicting the risk of complications.

Results

Among 107 patients with ABP, 69 cases were mild to moderate and 38 cases were severe.Systemic complications occurred in 21 cases, and local complications occurred in 57 cases, with a complication rate of 72.90%(78/107). The IG, CRP, NLR, PCT and MCTSI score in the mild and moderate group were lower than those in the severe group, with a statistically significant difference(P<0.05). The IG, CRP, NLR, PCT and MCTSI score in the non-occurrence group were lower than those in the occurrence group, with a statistically significant difference(P<0.05). The accuracy of MCTSI score and IG+ CRP+ NLR+ PCT in evaluating patients′ condition were 71.96% and 78.50% respectively(P<0.05), and the sensitivity and specificity of IG+ CRP+ NLR+ PCT in evaluating patients′ condition were slightly higher than those of MCTSI score.The accuracy of MCTSI score and IG+ CRP+ NLR+ PCT in predicting the occurrence of complications were 79.44% and 85.05% respectively(P<0.05), and the sensitivity and specificity of IG+ CRP+ NLR+ PCT in predicting the occurrence of complications were slightly higher than those of MCTSI score.

Conclusion

The progress of patients with ABP and the occurrence of complications are accompanied by the increase of MCTSI score, as well as the increase of IG, CRP, NLR and PCT, and the efficacy of blood index changes in evaluating patients′ condition and predicting patients′ complications is slightly higher than that of MCTSI score.

Key words: Acute biliary pancreatitis, Immature granulocyte count, C-reactive protein, Neutrophil-lymphocyte ratio, Procalcitonin, Modified CT severity index score
表1 不同病情患者血液指标及MCTSI评分比较(±s)
组别 例数 IG(%) CRP(mg/L) NLR PCT(ng/mL) MCTSI(分)
轻中度组 69 1.80±0.19 118.35±19.74 7.83±0.71 19.16±3.52 2.76±0.38
重度组 38 2.47±0.22 165.71±24.33 11.46±1.13 28.73±4.19 3.25±0.44
t值   16.494 10.920 20.393 12.567 6.031
P值   <0.001 <0.001 <0.001 <0.001 <0.001
表2 不同并发症发生情况患者血液指标及MCTSI评分比较(±s)
组别 例数 IG(%) CRP(mg/L) NLR PCT(ng/mL) MCTSI(分)
未发生组 29 1.85±0.17 126.04±18.45 8.19±0.68 20.22±3.31 4.55±0.29
发生组 78 2.11±0.25 138.56±25.26 9.46±1.25 23.43±4.46 6.08±0.51
t值   5.166 2.435 5.183 3.527 15.237
P值   <0.001 0.017 <0.001 0.001 <0.001
图1 MCTSI及血液指标评估患者病情的ROC曲线
表3 各项指标评估患者病情的效能分析
指标 截断值 AUC P值 灵敏度(%) 特异性(%)
IG 1.95% 0.236 0.252 31.37 52.69
CRP 127.53 mg/L 0.441 0.103 34.85 51.39
NLR 9.05 0.315 0.208 36.94 58.82
PCT 22.16 ng/mL 0.408 0.129 33.41 60.52
MCTSI 5分 0.720 0.033 68.17 80.33
IG+CRP+NLR+PCT － 0.785 0.007 74.92 82.55
图2 MCTSI及血液指标预测患者并发症的ROC曲线
表4 各项指标预测患者并发症的效能分析
指标 截断值 AUC P值 灵敏度(%) 特异性(%)
IG 1.99% 0.225 0.269 30.55 51.34
CRP 129.31 mg/L 0.467 0.115 34.87 52.56
NLR 8.94 0.348 0.197 36.95 59.07
PCT 21.62 ng/mL 0.419 0.138 35.48 62.65
MCTSI 3分 0.794 0.002 72.55 81.84
IG+CRP+NLR+PCT － 0.850 <0.001 80.19 85.36
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