联合检测NLR、IL-6、CRP、PCT 对急性胰腺炎的诊断价值

Value of combined detection of NLR, IL-6, CRP and PCT in diagnosis of acute pancreatitis

摘要:

目的 探讨炎性指标中性粒细胞/ 淋巴细胞比值（NLR）、白细胞介素 6（IL-6）、C 反应蛋 白（CRP）及降钙素原（PCT）在急性胰腺炎（AP）中的表达及对该疾病严重性的诊断价值。方法 选 取河北省沧州市中心医院AP 患者99 例（重症AP 34 例、轻症AP 65 例）和体检健康者38 例，检测白细 胞计数（WBC）、中性粒细胞计数（NE）、淋巴细胞计数（LYM）、单核细胞计数（MON）、NLR 水平， 了解不同等级体重指数（BMI）分组中各指标的变化，AP 患者同时检测IL-6、CRP、PCT 及血淀粉酶 （AMY）水平，绘制ROC 曲线，预测炎性指标的临床应用价值。结果 急性胰腺炎中WBC、NLR、NE、 MON 均高于对照组，而LYM 低于对照组（P <0.05）。不同等级BMI 分组中的WBC、NLR、NE、LYM、 MON 差异无统计学意义（P >0.05）。重症急性胰腺炎组（SAP 组）中WBC、NLR、NE、LYM、MON、 PCT、CRP、IL-6、AMY 与轻症急性胰腺炎组（MAP 组）比较，差异有统计学意义（P <0.05）。淋巴细 胞与SAP 呈负相关（r =-0.240，P =0.017），其余均呈正相关。对于AP 严重程度诊断效能最大的是IL-6 （敏感性70.6%，特异性87.7%，AUC=0.859），其次是PCT（敏感性88.2%，特异性78.5%，AUC=0.848）。 结论 IL-6、NLR、CRP、PCT 的变化与AP 的病情严重程度有关，PCT 的敏感性最高，而NLR 的特异性最 强，IL-6 对预测AP 严重程度具有很大临床价值。

Abstract:

Objective To investigate the diagnostic value of neutrophil/lymphocyte ratio (NLR), and the expressions of interleukin 6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) in acute pancreatitis (AP). Methods In this study 99 cases of AP (34 cases of severe acute pancreatitis and 65 cases of mild acute pancreatitis) and 38 healthy controls in Cangzhou Central Hospital were selected. White blood cell count (WBC), neutrophil count (NE), lymphocyte count (LYM), monocyte count (MON), and NLR were measured to understand the changes of various indexes in different grades of body mass index (BMI); simultaneously, serum levels of IL-6, CRP, PCT and amylase (AMY) in the patients with AP were detected, the ROC curves were drawn to predict the clinical value of the inflammatory indexes. Results Compared to the normal control group, the levels of NLR, NE, WBC and MON were significantly higher, but LYM was lower in the AP group (P < 0.05). There was no significant difference in NLR, NE, WBC, LYM or MON among different BMI groups (P > 0.05). The indexes of NLR, NE, WBC, LYM, MON, PCT, CRP, IL-6 and AMY in the severe acute pancreatitis (SAP) group were statistically different from those in the mild acute pancreatitis group (P < 0.05). LYM was negatively correlated with SAP (r = -0.240, P = 0.017), and the rest were positively correlated with SAP. The diagnostic efficiency of IL-6 for AP was the highest (sensitivity 70.6%, specificity 87.7%, AUC = 0.859), followed by that of PCT (sensitivity 88.2%, specificity 78.5%, AUC = 0.848). Conclusions The changes in the levels of IL-6, NLR, CRP and PCT are related to the severity of AP; PCT has the highest sensitivity, NLR has the highest specificity, while IL-6 has the greatest clinical value in predicting the severity of AP.