重症急性胰腺炎后期感染性胰腺坏死危险因素的临床研究

Risk factors of the development of infected pancreatic necrosis in the late course of severe acute pancreatitis

摘要:

目的  探讨重症急性胰腺炎（SAP）后期发生感染性胰腺坏死的危险因素。方法  回顾性分析该院2011年1月-2015年5月收治的205例SAP患者的临床资料。根据患者后期是否发生感染性胰腺坏死，分为感染组和非感染组，比较两组患者的临床资料，评估其发生后期感染性胰腺坏死的危险因素，选取有统计学意义的指标构建ROC曲线，评价其敏感度和特异度。结果  205例SAP患者中有76例发生感染性胰腺坏死，其发生率为37.1%。感染组C反应蛋白（CRP）、降钙素原（PCT）及APACHE II评分高于非感染组，差异有统计学意义（P <0.05）。ROC曲线分析显示，CRP、PCT及APACHE II评分对应曲线下面积分别为0.861、0.809和0.804，对应诊断准确度最高的临界值分别为235.5 mg/L、7.5 ng/ml和15.5分，敏感度分别为81.7%、81.1%和89.0%，特异度分别为77.9%、70.6%和68.4%。结论  CRP、PCT及APACHE II评分的升高对SAP发生后期感染性胰腺坏死有较大的早期预判价值。

Abstract:

Objective To investigate risk factors of the development of infected pancreatic necrosis in the late course of severe acute pancreatitis (SAP). Methods The clinical data of 205 patients with SAP treated in our hospital from January 2011 to May 2015 were retrospectively analyzed. According to the presence of infected pancreatic necrosis, the patients were divided into two groups: infection group and non-infection group. The risk factors of the disease were evaluated. The receiver operating characteristic (ROC) curves for the significant parameters were generated to assess their sensitivities and specificities for diagnosis of the infected pancreatic necrosis. Results 76 cases of the 205 patients with SAP were appeared infectious pancreatic necrosis, and the incidence was 37.1 %. The C-reactive protein (CRP), procalcitonin (PCT) and APACHE II score in the infected group were significantly higher than the non-infected group (P ＜ 0.05). The ROC curve analysis showed that area under the ROC curve of CRP, PCT and APACHE II were 0.861, 0.809 and 0.804, their correspondent cut-off value 235.5 mg/L, 7.5 ng/ml and 15.5, sensitivity 81.7 %、81.1 % and 89.0 %, specificity 77.9%, 70.6% and 68.4 %, respectively. Conclusion The elevated abnormally of CRP, PCT and APACHE II have major detective value for the development of infected pancreatic necrosis in the late course of SAP.