摘要
目的考察脑钠肽和c反应蛋白在急性重症胰腺炎中的预测价值。方法回顾性分析177例急性重症胰腺炎患者临床资料，考察入院时、入院后1d、3d的脑钠肽和C反应蛋白水平，并探讨最佳阈值的敏感性、特异性。结果出现持续性器官功能不全患者18例（10．2％）、死亡患者6例（3．4％）。入院0d，健康对照、未加重、持续性器官功能不全、死亡患者间脑钠肽和c反应蛋白水平存在差异，具有统计学意义（P〈0．01）。入院0d、1d和3d时的脑钠肽预测患者持续性器官功能不全的AuC分别为0．83（P〈0．01，95％CI：0．65～0．94），0．95（P〈0．01，95％CI：0．91—0．99），0．90（P〈0．01，95％CI：0．88—0．98）；最佳阈值为400、490和450ng／L，敏感性分别为0．92、0．98、0．92，特异性分别为0．90、0．97、0．98；预测患者死亡的AUC分别为0．73（P〈0．01，95％CI：0．55—0-82），0．85（P〈0．01，95％CI：0．75～0．91），0．80（P〈0．01，95％CI：0．69—0．88）；最佳阈值分别为420、490和460ng／L，敏感性分别为0．89、0．91、0．89，特异性分别为0．82、0．93、0．90。入院0d、1d和3d时的C反应蛋白预测患者持续性器官功能不全的AUC分别为0．66（P〈0．01，95％CI：0．65—0．94），0．65（P〈0．01，95％CI：0．51—0．79），0．73（P〈0．01，95％CI：0．58—0．87）。最佳阈值为220、340和320mg／L，敏感性分别为O．83、0．85、0．90，特异性分别为0．80、0．76、0．81；预测患者死亡的AUC分别为0．63（P〈0．01，95％CI：0．51～0．72），0．65（P〈0．01，95％CI：0．55～0．81），0．70（P〈0．01，95％CI：0．59～0．84）。最佳阈值分别为240、340和360mg／L，敏感性分别为0．75、0．74、O．83，特异性分别为0．84、0．88、0．84。结论入院后脑钠肽水平和C反应蛋白水平都能较好评估急性重症胰腺炎患者预后，其中脑钠肽水平对患者预后的判断更为准确，可以作为观察指标。
Objective To investigate the predictive value of brain natriuretic peptide and C reactive protein in acute severe panereatitis. Methods A retrospective analysis on the clinical data of 177 cases of severe acute panereatitis patients were carried out. Brain natriuretic peptide and C reaction protein levels on admission, 1 d and 3 d after admission were compared, and the sensitivity and specificity of the optimal threshold was explored. Results There were 18 cases （10.2%） of patients turned to persistent organ dysfunction and 6 cases （3.4%） of patients died. When admitted to the hospital, the brain natriuretie peptide and C reaction protein levels among healthy control, recovery patients, persistent organ dysfunction and death patients had significant different （P〈0.01）. The AUC of brain natriuretie peptide to predict persistent organ dysfunction at 0 d, 1 d and 3 d of the admission were 0.83 （P〈0.01, 95%CI： 0.65~0.94）, 0.95 （P〈0.01, 95%CI： 0.91-0.99） and 0.90 （P〈0.01, 95%Ch 0.88-0.98） respectively; the best thresholds were 400, 490 and 450 ng/L respectively, sensitivity was 0.92, 0.98, 0.92 and specificity was 0.82, 0.93, 0.90 respectively; the AUC of brain natriuretic peptide to predict mortality at 0 d, 1 d and 3 d of the admission were 0.73 （P〈0.01, 95%CI： 0.55- 0.82）, 0.85 （P〈0.01, 95%CI： 0.75-0.91）, 0.80 （P〈0.01, 95%Ch 0.69-0.88） respectively, the optimal thresholds were 420, 490 and 460 ng/L, respectively; the sensitivity were 0.89, 0.91, 0.89 and specificity were 0.82, 0.93, 0.90, respectively. The AUC of CRP to predict persistent organ dysfunction at 0 d, 1 d and 3 d of the admission were 0.66 （P〈 0.01, 95%CI： 0.65-0.94）,0.65 （P〈0.01,95%CI： 0.51-0.79）,0.73 （P〈0.01, 95%CI： 0.58-0.87）, respectively; the best thresholds were 220, 340 and 320 mg/L; the sensitivity were 0.83, 0.85, 0.90 and specificity were 0.80, 0.76, 0.81; the AUC to predicte mortality was 0.63 （P〈0.01, 95%CI： 0.51-0.72）, 0.65 （P〈0.01, 95%CI： 0.55-0.81）, 0.70 （P〈0.01, 95% CI： 0.59-0.84） respectively; the best thresholds were 240, 340, and 360 mg/L; the sensitivity were 0.75, 0.74, 0.83 and specificity were 0.84, 0.88, 0.84. Conclusion Brain natriuretic peptide and C reactive protein levels in patients at admission can better assess the prognosis of patients with severe acute panereatitis, and brain natriuretic peptide is more accurate for the prognosis, which shoud be used as onseruation index.
出处
《临床医学研究与实践》
2016年第20期1-3,共3页
Clinical Research and Practice
关键词
急性重症胰腺炎
脑钠肽
C反应蛋白
预后
acute severe acute pancreatitis
brain natriuretic peptide
C reactive protein
prognosis
