腹内压、C反应蛋白、降钙素原检测对妊娠晚期急性胰腺炎的预测价值

目的 探讨检测腹内压(IAP)、C反应蛋白(CRP)、降钙素原(PCT)在妊娠晚期急性胰腺炎中的临床价值。方法 选取2008年9月-2018年9月于南华大学附属第一医院妇产科和肝胆外科住院的妊娠晚期(28周以上)急性胰腺炎孕妇80例,其中轻症及中重症急性胰腺炎45例(对照组),重症急性胰腺炎35例(观察组)。收集两组孕妇临床资料,包括IAP、CRP、PCT、胎儿窘迫、新生儿Apgar评分等。计量资料两组间比较采用 t 检验;计数资料两组间比较采用χ 2 检验。Pearson相关法检验CRP、PCT、IAP与胰腺炎严重程度,以及与胎儿不良结局(胎儿窘迫、出生时1 min Apgar评分)的相关性。根据受试者工作特征曲线(ROC曲线)计算各项指标诊断准确度最高的临界值,以及该值所对应的敏感度和特异度,评价各项指标对妊娠晚期急性胰腺炎的预判价值。结果观察组CRP[(185.92±23.59) mg/L vs (120.92±20.02) mg/L]、PCT[(12.93±3.16) ng/ml vs (5.67±1.65) ng/ml]、IAP[(12.67±1.40) mm Hg vs (5.77±1.10) mm Hg]均显著高于对照组( t 值分别为13.318、12.298、23.858, P值均<0.001)。对照组胎儿窘迫发生率显著低于观察组(6/45 vs 15/35,χ 2=8.864,P =0.003),新生儿1 min Apgar评分显著高于观察组[(8.22±0.67)分 vs (5.97±0.78)分, t=-13.817,P <0.001]。相关性分析结果显示,IAP与CRP、PCT水平及妊娠晚期胰腺炎Ranson评分均呈正相关( r值分别为0.814、0.712、0.788,P 值均<0.001),与新生儿1 min Apgar评分呈负相关( r=-0.820,P <0.001)。CRP、PCT及IAP对应的ROC曲线下面积分别为0.838、0.853和0.903,计算所对应诊断准确度最高的临界值分别为158.32 mg/L、10.23 ng/L和10.09 mm Hg,敏感度分别为77.1%、71.4%和82.9%,特异度分别为93.3%、97.8%和95.6%。结论 检测IAP、CRP及PCT对于妊娠期重症急性胰腺炎有较大的早期预判价值,有利于评估妊娠晚期胰腺炎的严重程度及终止妊娠时机。

Clinical value of the measurement of intra-abdominal pressure,C-reactive protein,and procalcitonin in patients with acute pancreatitis in late pregnancy

Objective To investigate the clinical value of the measurement of intra-abdominal pressure (IAP), C-reactive protein (CRP), and procalcitonin (PCT) in patients with acute pancreatitis in late pregnancy. Methods A total of 80 patients with acute pancreatitis in late pregnancy (≥28 gestational weeks) who were hospitalized in Department of Obstetrics and Gynecology and Department of Hepatobiliary Surgery in The First Affiliated Hospital of Nanhua University from September 2008 to September 2018 were enrolled, and among these patients, 45 with mild or moderately severe acute pancreatitis were enrolled as control group, and 35 with severe acute pancreatitis were enrolled as observation group. Related clinical data were collected, including IAP, CRP, PCT, fetal distress, and neonatal Apgar score. The t -test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of CRP, PCT, and IAP with the severity of pancreatitis and poor fetal outcomes (fetal distress and neonatal Apgar score at 1 minute after birth). The receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off values of these indices for accurate diagnosis and corresponding sensitivity and specificity, in order to evaluate their value in predicting acute pancreatitis in late pregnancy. Results Compared with the control group, the observation group had significantly higher levels of CRP (185.92±23.59 mg/L vs 120.92±20.02 mg/L, t=13.318, P <0.001), PCT (12.93±3.16 ng/ml vs 5.67±1.65 ng/ml, t=12.298, P <0.001), and IAP (12.67±1.40 mm Hg vs 5.77±1.10 mm Hg, t=23.858, P <0.001). Compared with the observation group, the control group had a significantly lower incidence rate of fetal distress (6/45 vs 15/35,χ 2=8.864, P =0.003) and a significantly higher neonatal 1-minute Apgar score (8.22±0.67 vs 5.97±0.78, t=-13.817, P <0.001). The correlation analysis showed that IAP was positively correlated with CRP, PCT, and Ranson score for pancreatitis in late pregnancy ( r= 0.814, 0.712, and 0.788, all P <0.001) and was negatively correlated with neonatal 1-minute Apgar score (r=-0.820, P <0.001). CRP had an area under the ROC curve (AUC) of 0.838 at the optimal cut-off value of 158.32 mg/L, with a sensitivity of 77.1% and a specificity of 93.3%;PCT had an AUC of 0.853 at the optimal cut-off value of 10.23 ng/L, with a sensitivity of 71.4% and a specificity of 97.8%;IAP had an AUC of 0.903 at the optimal cut-off value of 10.09 mm Hg, with a sensitivity of 82.9% and a specificity of 95.6%. Conclusion The measurement of IAP, CRP, and PCT has a good value in the early prediction of severe acute pancreatitis in pregnancy and can help to determine the severity of pancreatitis in late pregnancy and decide the timing of termination of pregnancy.