PLR、PDW联合BISAP评分对急性胰腺炎严重程度的预测价值

巩伟 李泽宇 邹益 王朋 王红

[摘要] 目的 探討不同程度急性胰腺炎（AP）患者血小板与淋巴细胞比值（PLR）、血小板分布宽度（PDW）水平变化及联合BISAP评分在诊断疾病严重程度中的价值。 方法 回顾性分析2018年1月至2019年12月期间在我院住院的急性胰腺炎患者，分为轻度胰腺炎（MAP）、中度胰腺炎（MSAP）、重度胰腺炎（SAP）三组，并收集24 h内检测的外周血血细胞计数及基本生命体征等临床资料，计算 PLR、PDW及BISAP评分，比较各组间的差异。采用受试者工作特征曲线（ROC曲线）对诊断效能进行评估。 结果 共有120例患者纳入本次研究，SAP组患者PLR、PDW及BISAP评分的水平均高于MSAP组、MAP组[PLR：（152.57±62.23） vs. （227.80±108.65） vs. （315.83±281.50）;PDW：（16.58±1.14）% vs. （17.19±0.81）% vs. （17.26±0.65）%;BISAP评分：（1.38±0.49）分 vs. （2.27±0.81）分  vs. （3.12±0.98）分]，差异均有统计学意义（P<0.05）。Pearson相关性分析显示，在疾病严重程度方面，PLR、PDW及BISAP评分与急性胰腺炎的严重程度均呈正相关，差异有统计学意义（P<0.05）。ROC曲线分析显示，PLR、PDW、BISAP评分及三者联合的曲线下面积分别为0.673、0.653、0.842和0.885。三者联合诊断的价值高于单一指标的诊断价值。PLR+PDW+BISAP评分的cut-off值为0.1181时灵敏度为0.971，特异度为0.663，95%CI 0.825～0.945。结论 PLR、PDW可反映疾病的严重程度，PLR、PDW、 BISAP评分联合使用对急性重症胰腺炎有重要的临床诊断价值。

[关键词] 急性胰腺炎;血小板/淋巴细胞比值;血小板分布宽度;BISAP评分

[中图分类号] R614.3          [文献标识码] B          [文章编号] 1673-9701（2021）30-0062-04

[Abstract] Objective To explore the value of platelet-to-lymphocyte ratio （PLR） and platelet distribution width （PDW） levels and the combined BISAP score in the diagnosis of disease severity in patients with different degrees of acute pancreatitis （AP）. Methods The acute pancreatitis patients hospitalized in our hospital from January 2018 to December 2019 were retrospectively analyzed. They were divided into mild acute pancreatitis group （MAP）， moderately severe acute pancreatitis group （MSAP）， and severe acute pancreatitis group （SAP）. The peripheral blood cell count detected within 24 hours and basic vital signs were collected. The PLR， PDW， and BISAP scores were calculated. The differences between the groups were compared. The receiver operating characteristic curve （ROC curve） was used to evaluate the diagnostic efficacy. Results A total of 120 patients were included in this study. The scores of PLR， PDW and BISAP in the SAP group were higher than those in the MSAP and MAP groups [PLR： （152.57±62.23） vs. （227.80±108.65） vs. （315.83±281.50）; PDW： （16.58±1.14）% vs. （17.19±0.81）% vs. （17.26±0.65）%]; BISAP score： （1.38±0.49）points vs. （2.27±0.81）points vs. （3.12±0.98）points]， and the differences were statistically significant （P<0.05）. Pearson correlation analysis showed that in terms of disease severity，PLR，PDW and BISAP scores were positively correlated with the severity of acute pancreatitis， and the difference was statistically significant（P<0.05）. ROC curve analysis showed that the area under the curve of PLR， PDW， BISAP score， and the combination of the above three were 0.673， 0.653， 0.842 and 0.885， respectively. The value of the combined diagnosis of the above three was higher than that of a single index. When the cut-off value of PLR+PDW+BISAP score was 0.1181， the sensitivity was 0.971， and the specificity was 0.663 95%CI 0.825-0.945. Conclusion PLR and PDW can reflect the severity of the disease. The combined use of PLR， PDW and BISAP scores has important clinical diagnostic value for severe acute pancreatitis.

[Key words] Acute pancreatitis; Platelet/lymphocyte ratio; Platelet distribution width; BISAP score

急性胰腺炎（Acute pancreatitis，AP）是消化系统的常见疾病之一，在全球范围内发病率逐年升高[1]。AP的临床特点是起病急、临床表现多样、并发症多、病情进展快、预后差等。因此早期识别重症胰腺炎对治疗具有重要意义。尽管目前临床上已存在许多对于AP的严重程度评分的系统，可以帮助评估病情，如Ranson评分、APACHE Ⅱ评分等，但存在一定的局限性，如有特定的时间限制、评分系统包含内容多、过程复杂，会给实际应用带来一些限制[2]。……