血清和肽素与APACHEⅢ在重症急性胰腺炎患者病情及预后评估中的应用

目的 探讨血清和肽素联合急性生理学与慢性健康状况评分系统Ⅲ(APACHEⅢ)在重症急性胰腺炎(SAP)患者病情及预后评估中的应用。 方法 选取某医院2017年6月—2018年6月收治的SAP患者64例作为研究对象,并在入院时进行APACHEⅢ评分,同时测定血清和肽素水平,分析APACHEⅢ评分和血清和肽素水平与SAP患者病情及预后的关系。 结果 随着APACHEⅢ评分的增高,SAP患者的血清和肽素水平也呈上升趋势,且各计分段血清和肽素水平比较,差异有统计学意义(P<0.05);存活患者的APACHEⅢ评分和血清和肽素水平明显低于死亡患者(P<0.05);APACHEⅢ评分的最佳临界值为60分;血清和肽素水平最佳临界值为3.48 ng/mL。APACHEⅢ评分和血清和肽素水平与SAP患者预后的ROC曲线下面积分别为0.926、0.878(P>0.05);两者联合预测时ROC曲线下面积为0.956,其准确度大于其中任何一项单独预测(P<0.05)。 结论 血清和肽素水平和APACHEⅢ评分均可用于判断SAP患者的病情程度及预后,且两者联合测定时可明显提高对SAP患者预后的准确度。

Value of serum copeptin combined with APACHEIII in assessment of condition and prognosis of patients with severe acute pancreatitis

Objective To evaluate the value of serum copeptin combined with acute physiology and chronic health status scoring system III (APACHEIII) in the assessment of the severity and prognosis of patients with severe acute pancreatitis (SAP). Methods Sixty-six patients with SAP admitted to the hospital were enrolled in the studyfrom June to May 2018.The APACHE III score was performed at the admission. The serum copeptin levels were measured. The APACHE III score and serum copeptin levels were analyzed for the relationship between the condition and prognosis of the patients. Results With the increase of APACHE III score, the serum copeptin levels of SAP patients also showed an upward trend, and the difference of the serum copeptin levels among each segment was statistically significant (P<0.05). The APACHEIII score and serum copeptin levelsof the surviving patients were significantly lower than those of the died patients (P<0.05). The optimal cut-off value of the APACHEIII score was 60 points; the optimal cut-off value of serum copeptin levels was 3.48 ng/mL. The areas under the ROC curve of APACHE III score and the serum copeptin level and the prognosis of SAP patients were 0.926 and 0.878, respectively (P>0.05). The area under the ROC curve of the combination of APACHE III score and the serum copeptin level and the prognosis of SAP patientswas 0.956, and the accuracy was greater than any of the individual predictions (P<0.05). Conclusion The serum copeptin levels and APACHE III scores can be used to determine the severity and prognosis of SAPpatients, and the combined determination of the two can significantly improve the accuracy of the prognosis of SAP patients.