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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (06) : 536 -540. doi: 10.3877/cma.j.issn.2095-2015.2024.06.010

论著

预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值
沈炎1, 张俊峰1,(), 唐春芳1   
  1. 1.214000 江苏省,无锡市锡山人民医院急诊科
  • 收稿日期:2024-07-16 出版日期:2024-12-01
  • 通信作者: 张俊峰
  • 基金资助:
    无锡市科协软科学研究课题(KX-22-C123)

Predictive value of prognostic nutritional index combined with PCT,CysC,and RBP levels for acute pancreatitis complicated with acute kidney injury

Yan Shen1, Junfeng Zhang1,(), Chunfang Tang1   

  1. 1.Department of Emergency,Wuxi Xishan People′s Hospital,Wuxi 214000,China
  • Received:2024-07-16 Published:2024-12-01
  • Corresponding author: Junfeng Zhang
引用本文:

沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.

Yan Shen, Junfeng Zhang, Chunfang Tang. Predictive value of prognostic nutritional index combined with PCT,CysC,and RBP levels for acute pancreatitis complicated with acute kidney injury[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 536-540.

目的

探讨预后营养指数(PNI)、血清降钙素原(PCT)、血清胱抑素C(CysC)和血清视黄醇结合蛋白(RBP)对急性胰腺炎(AP)合并急性肾损伤(AKI)患者的预测价值。

方法

选取2022 年6 月至2024 年6 月无锡市锡山人民医院收治的350 例AP 患者作为研究对象进行回顾性分析,根据是否并发AKI 将患者分为两组,即AP组和AP+AKI组。对比两组PNI、PCT、CysC 及RBP 水平的差异,通过Spearson 分析其与急性胰腺炎评价指标急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)、Ranson 和Balthazar CTSI 评分的相关性,通过ROC 曲线和多因素Logistic分析评估PNI、PCT、CysC 及RBP 水平对AP 合并AKI 的预测能力。

结果

AP组患者PNI 水平、APACHE Ⅱ评分、Ranson 评分和Balthazar CTSI 显著高于AP+AKI组,而血清PCT、CysC 和RBP水平显著低于AP+AKI组(P<0.05)。Spearson 相关性分析显示,PNI 与APACHE Ⅱ、Ranson 和Balthazar CTSI 评分呈负相关,PCT、CysC 和RBP 与APACHE Ⅱ、Ranson 和Balthazar CTSI 评分均呈正相关(P<0.05);ROC 曲线显示,PNI+PCT+CysC+RBP 联合曲线下面积为0.923,95%置信区间为0.861~0.984(P<0.05);多因素Logistic 分析显示PNI[OR=0.425,95% CI(0.193~0.755)]、PCT[OR=4.632,95% CI(2.131~5.085)]、CysC[OR=2.076,95% CI(1.635~2.978)]和RBP[OR=3.261,95% CI(2.478~4.639)]是AP 患者并发AKI 的独立危险因素。

结论

PNI、PCT、CysC 及RBP 水平可作为预测AP 患者并发AKI 的指标,有利于早期发现AP 容易并发AKI 的高危患者,优化治疗策略,改善患者预后,具有较高的临床推广意义。

Objective

To investigate the predictive value of prognostic nutritional index (PNI),serum procalcitonin (PCT),serum cystatin C (CysC),and serum retinol binding protein (RBP) for patients with acute pancreatitis (AP) complicated with acute kidney injury (AKI).

Methods

A retrospective analysis was conducted on 350 patients with AP admitted to Wuxi Xishan People's Hospital from June 2022 to June 2024. Patients were divided into two groups based on whether they had concurrent AKI: the AP group and the AP+AKI group. The differences in PNI,PCT,CysC,and RBP levels between the two groups were compared,and their correlations with AP evaluation indicators APACHEⅡ score,Ranson score,and Balthazar CTSI score were analyzed through Spearson analysis. The predictive abilities of PNI,PCT,CysC,and RBP levels for AP combined with AKI were evaluated through ROC curve and multivariate logistic analysis.

Results

The PNI level,APACHE Ⅱ score,Ranson score,and Balthazar CTSI of patients in the AP group were significantly higher than those in the AP+AKI group,while the serum PCT,CysC,and RBP levels were significantly lower than those in the AP+AKI group (P<0.05);Spearson correlation analysis showed that PNI was negatively correlated with APACHE Ⅱ score,Ranson score,and Balthazar CTSI score,while PCT,CysC,and RBP were positively correlated with APACHE Ⅱscore,Ranson score,and Balthazar CTSI score (P<0.05). The ROC curve showed that the area under the PNI+PCT+CysC+RBP joint curve was 0.923,with a 95% confidence interval of 0.861-0.984 (P<0.05).Multivariate logistic analysis showed that PNI [OR=0.425,95% CI (0.193-0.755)],PCT [OR=4.632,95%CI (2.131-5.085)],CysC [OR=2.076,95% CI (1.635-2.978)],and RBP [OR=3.261,95% CI (2.478-4.639)]were independent risk factors for AKI in AP patients.

Conclusion

PNI,PCT,CysC,and RBP levels can be used as indicators for predicting AKI in AP patients,which are conducive to early detection of high-risk patients with AP prone to AKI,optimization of treatment strategies,and improvement of patient prognosis,and have high clinical significance for promotion.

表1 两组一般资料比较
表2 两组实验室检查指标比较(± s
表3 两组患者病情评价指标的评分比较(± s
表4 PNI、PCT、CysC 和RBP 与病情评价指标的关系
图1 PNI、PCT、CysC 和RBP 单独及联合对急性胰腺炎患者并发急性肾损伤预测的ROC 曲线 注:PNI 预后营养指数、PCT 血清降钙素原、CysC 血清胱抑素C、RBP血清视黄醇结合蛋白。
表5 影响急性胰腺炎患者并发急性肾损伤的多因素Logistic 回归分析
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