摘要
目的建立基于甘油三酯-葡萄糖指数(triglyceride glucose index,TyG)和降钙素原(procalcitonin,PCT)的急性胰腺炎(acute pancreatitis,AP)并发急性肾损伤(acute kidney injury,AKI)早期预警模型,并评价其诊断价值。方法本研究为单中心前瞻性研究,选取2022年1月至12月在北京大学人民医院急诊科诊治的AP患者为研究对象。以诊断AP后14 d为观察终点,根据患者是否发生AKI分为AKI组和对照组。比较两组患者一般特征、实验室指标、并发症情况及临床评分等,通过Logistic分析建立风险预测模型。绘制受试者工作特征曲线并计算曲线下面积(area under the curve,AUC),计算该模型的诊断敏感度、特异度,与Ranson评分、APACHEⅡ及BISAP评分的诊断价值进行比较。结果研究共纳入258例患者,其中AKI组79例,对照组179例。两组患者基础血肌酐及血尿素氮水平差异无统计学意义。但AKI组与对照组相比,患者男性居多,年龄更大,既往患高血压病的比例更高,炎症指标中性粒细胞/淋巴细胞比值、PCT及TyG明显升高,Ranson评分、APACHEⅡ评分及BISAP评分均较高,且后期更多的合并ARDS及浆膜腔积液。多因素Logistic回归分析发现,年龄(OR=1.071,95%CI:1.020~1.125,P=0.006)、TyG升高(OR=2.632,95%CI:1.423~4.866,P=0.002)以及PCT水平升高(OR=1.275,95%CI:1.067~1.524,P=0.008)为AP患者并发AKI的危险因素。根据上述危险因素,建立预测AP患者并发AKI风险评估模型:Logistic(AKI/AP)=-16.697+0.069×年龄+0.968×TyG+0.243×PCT。该模型预测AP发生AKI的敏感度为79.75%,特异度为96.65%,AUC=0.856(95%CI:0.790~0.922)。预测能力优于Ranson评分、BISAP评分及APACHEⅡ评分(AUC:0.856 vs.0.691 vs.0.745 vs.0.705,P=0.041)。结论基于TyG、PCT建立的预测模型具有早期预测AP并发AKI的价值。
Objective To establish an early prediction model based on triglyceride glucose index(TyG)and procalcitonin(PCT)for patients of acute pancreatitis(AP)complicated with acute kidney injury(AKI),and evaluate the diagnostic value of prediction model.Methods This study was a single center prospective study.AP patients were recruited from the Emergency Department at Peking University People’s Hospital from January to December 2022.The observation endpoint was 14 days after the diagnosis of acute pancreatitis,patients were divided into AKI and control(no AKI)groups according to the observation endpoint.The general characteristics,clinical laboratory examinations,complications,and clinical scores were compared.The risk for AKI development was determined using logistic analyses to establish a risk prediction model.The receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated.The diagnostic sensitivity and specificity of the model were calculated,and the diagnostic value of the model was compared with that of Ranson score,APACHEⅡscore and BISAP score.Results A total of 258 patients were selected for this study,including 79 in the AKI group and 179 in the control group.There was no significant difference in serum creatinine and blood urea nitrogen levels between the two groups.Compared with the control group,the AKI group had a higher proportion of males,older age,and had a higher proportion of hypertension.The ratio of neutrophil/lymphocyte ratio,PCT,and TyG were significantly increased.The Ranson score,APACHEⅡscore,and BISAP score were higher,and more patients had ARDS and serous fluid accumulation in the later period.Multivariate logistic regression showed that age(OR=1.071,95%CI:1.020-1.125,P=0.006),increased TyG index(OR=2.632,95%CI:1.423-4.866,P=0.002),and elevated PCT(OR=1.275,95%CI:1.067-1.524,P=0.008)were risk factors for AKI in AP patients.According to the risk factors,forecast the AP patients complicated with AKI risk assessment model is established:Logistic(AKI/AP)=-16.697+0.069×age+0.968×TyG+0.243×PCT.The sensitivity and specificity of the model for predicting AKI in AP were 79.75%and 96.65%,respectively,and the AUC was 0.856(95%CI:0.790-0.922).The predictive ability was better than that of Ranson score,BISAP score and APACHEⅡscore(AUC:0.856 vs.0.691 vs.0.745 vs.0.705,P=0.041).Conclusion The prediction model based on age,TyG and PCT was valuable for the prediction of AP concurrent AKI in early stage.
作者
迟骋
马勇
宋小静
王春雨
朱继红
Chi Cheng;Ma Yong;Song Xiaojing;Wang Chunyu;Zhu Jihong(Department of Emergency Medicine,Peking University People's Hospital,Beijing 100044,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2024年第9期1242-1248,共7页
Chinese Journal of Emergency Medicine
作者简介
通信作者:朱继红,Email:zhujihong64@sina.com。
