毛细血管渗漏指数在急性重症胰腺炎合并急性肺损伤病人病情预测及预后评估中的价值

杜杰; 徐志鹏; 郑传明; 张太哲; 王振杰

doi:10.13898/j.cnki.issn.1000-2200.2023.07.008

毛细血管渗漏指数在急性重症胰腺炎合并急性肺损伤病人病情预测及预后评估中的价值

Value of capillary leakage index in predicting the condition and evaluating the prognosis of patients with severe acute pancreatitis complicated with acute lung injury

摘要

摘要:
目的探讨毛细血管渗漏指数(CLI)在急性重症胰腺炎(SAP)合并急性肺损伤(ALI)病人病情预测及预后评估中的价值。
方法选取78例SAP病人作为研究对象，根据是否合并急性肺损伤分为非ALI组40例和ALI组38例，根据病人入院28 d存活情况分为存活组45例和死亡组33例。分析SAP病人的临床基线资料；采用Pearson相关分析评价CLI与急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、改良CT严重程度指数(MCTSI)及乳酸的相关性；使用ROC曲线分析CLI对SAP合并ALI发生和28 d死亡风险的预测；采用Kaplan-Meier生存曲线分析不同CLI水平危险分层下的累积生存率。
结果ALI组病人C反应蛋白(CRP)、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于非ALI组(P < 0.05~P < 0.01)；ALI组病人血清白蛋白(ALB)水平明显低于非ALI组(P < 0.01)。存活组与死亡组性别差异无统计学意义(P>0.05)；死亡组病人年龄、CRP、CLI、乳酸水平、MCTSI及APACHEⅡ评分均高于存活组(P < 0.05~P < 0.01)；死亡组病人ALB水平明显低于存活组(P < 0.01)。SAP病人入院时CLI与APACHEⅡ评分、MCTSI及乳酸均呈明显正相关关系(P < 0.01)。CLI对预测SAP合并ALI和28 d死亡的ROC曲线下面积分别为0.802(95%CI：0.705~0.899)和0.758(95%CI：0.651~0.865)；最佳截断值分别为0.517和0.394，对应的CLI为9.335和9.770，敏感度分别为84.20%和72.70%，特异度分别为67.50%和67.70%。基于9.552为最新最佳截断值进行Kaplan-Meier生存曲线分析，结果显示，CLI>9.552组的28 d累积生存率明显低于CLI≤9.552组(P < 0.01)。
结论CLI可以早期预测SAP合并ALI的发生，并且在评估病人预后方面发挥重要价值，特别对于CLI>9.552的SAP病人其短期死亡风险更高，需要临床医生予以重点关注。

Abstract:
ObjectiveTo explore the value of capillary leakage index (CLI) in predicting the condition and evaluating the prognosis of patients with severe acute pancreatitis (SAP) complicated with acute lung injury (ALI).
MethodsA total of 78 SAP patients were selected as the study subjects, and divided into non-ALI group (n=40) and ALI group (n=38) based on whether acute lung injury occured.According to the 28-day survival status of the patients, they were divided into survival group (n=45) and death group (n=33).The clinical baseline data of SAP patients were analyzed; the correlation between CLI and acute physiology and chronic health evaluation scoring system (APACHEⅡ), modified CT severity index (MCTSI), and lactate was evaluated using Pearson correlation analysis; the prediction of CLI on the occurrence of ALI and risk of 28-day mortality was analyzed by ROC curve; the cumulative survival rate under different risk stratification levels of CLI was analyzed with Kaplan-Meier survival curve.
ResultsThe C-reactive protein (CRP), CLI, lactate level, MCTSI, and APACHEⅡ scores of patients in the ALI group were higher than those in the non-ALI group (P < 0.05 to P < 0.01);the serum albumin (ALB) level of patients in the ALI group was significantly lower than that in the non-ALI group (P < 0.01).There was no statistically significant difference in gender between the survival group and the death group (P>0.05);the age, CRP, CLI, lactate level, MCTSI, and APACHEⅡ scores of patients in the death group were higher than those in the survival group (P < 0.05 to P < 0.01);the ALB level of patients in the death group was significantly lower than that in the survival group (P < 0.01).There was a significant positive correlation between CLI and APACHEⅡ score, MCTSI, and lactate level of SAP patients at admission (P < 0.01).The area under the ROC curve of CLI for predicting SAP complicated with ALI and 28-day mortality was 0.802 (95%CI: 0.705-0.899) and 0.758 (95%CI: 0.651-0.865), respectively; the optimal cutoff values were 0.517 and 0.394, with corresponding CLI values of 9.335 and 9.770, sensitivity of 84.20% and 72.70%, and specificity of 67.50% and 67.70%, respectively.Based on the latest optimal cutoff value of 9.552, Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in the CLI>9.552 group was significantly lower than that in the CLI≤9.552 group (P < 0.01).
ConclusionsCLI can predict the occurrence of SAP complicated with ALI in the early stage and plays an important role in evaluating the prognosis of patient, especially for SAP patients with CLI>9.552, who have a higher risk of short-term mortality, which needs special attention from clinical doctors.

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