RDW、NLR、D-二聚体联合检测对急性胰腺炎病情的预测价值

doi:10.3969/j.issn.1004-583X.2021.06.004

摘要/Abstract

摘要：

目的探讨红细胞分布宽度(RDW)、中性粒细胞与淋巴细胞比值(NLR)、D-二聚体联合检测对急性胰腺炎(AP)病情的预测价值。方法本研究纳入210例在消化内科确诊为AP的患者,126例为轻症组、42例为中度重症组、22例为重症组、20例为危重组,比较4组基本资料及相关参数,评估RDW、NLR、D-二聚体及联合检测对AP病情的预测价值。结果四组基本资料比较,由MAP组至CAP组,患者RDW、NLR、D-二聚体、WBC水平逐步升高,血钙、ALB水平逐步降低(P<0.05);RDW、D-二聚体是AP严重程度的独立危险因素,RDW+NLR+D-二聚体的灵敏度和特异度分别为60.8%、87.5%。结论 RDW、NLR、D-二聚体均可以作为评估AP严重程度的指标,其中RDW的预测价值更好,三者联合检测对AP严重程度预测的可靠性更高。

关键词: 胰腺炎, 红细胞, 异常, 中性粒细胞减少, D-二聚体

Abstract:

Objective To investigate the predictive value of combined detection of red blood cell distribution width(RDW), neutrophil-lymphocyte ratio(NLR) and D-dimer for acute pancreatitis(AP). Methods Totally 210 AP patients diagnosed by department of gastroenterology were divided into mild group (n=126), moderate severe group (n=42), severe group (n=22), and critical group (n=20). The basic data and related parameters in four groups were compared to evaluate the predictive value of RDW, NLR, D-dimer and combined detection for the condition of AP. Results Comparison with basic data in four groups,the ruslt showed that RDW, NLR, D-dimer and white blood cells(WBC) levels were gradually increased from MAP group to CAP group, while serum calcium and albumin(ALB) levels were gradually decreased(P<0.05). The independent risk factors for the severity of AP were RDW and D-dimer. RDW+NLR+D-dimer showed sensitivity and specificity 60.8% and 87.5%, respectively. Conclusion RDW, NLR and D-dimer could all assess the severity of AP, of which RDW has better predictive value, and the combined of the three is more reliable to predict the severity of AP.

Key words: pancreatitis, erythrocytes, abnormal, neutropenia, D-dimer

中图分类号:

R576.1

吴昊, 李静. RDW、NLR、D-二聚体联合检测对急性胰腺炎病情的预测价值[J]. 临床荟萃, 2021, 36(6): 504-508.

Wu Hao, Li Jing. Predictive value of combined detection of RDW, NLR and D-dimer for acute pancreatitis[J]. Clinical Focus, 2021, 36(6): 504-508.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.06.004

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I6/504

图/表 6

参考文献 19

[1]	Jin D, Tan J, Jiang J, et al. The early predictive value of routine laboratory tests on the severity of acute pancreatitis patients in pregnancy: A retrospective study[J]. Sci Rep, 2020, 10(1):10087. doi: 10.1038/s41598-020-66921-x pmid: 32572085
[2]	姜华, 高建鹏, 王辉, 等. 糖尿病与急性胰腺炎病死率的关系[J]. 中华消化杂志, 2018, 38(10):697-699.
[3]	Tee YS, Fang HY, Kuo IM, et al. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis[J]. Medicine, 2018, 97(7):9654.
[4]	中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编委会, 《中华消化杂志》编委会, 等. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 临床肝胆病杂志, 2019, 35(12):2706-2711.
[5]	Goyal H, Awad H, Hu ZD. Prognostic value of admission red blood cell distribution width in acute pancreatitis: A systematic review[J]. Ann Transl Med, 2017, 5(17):342. doi: 10.21037/atm URL
[6]	Miyamoto K, Inai K, Takeuchi D, et al. Relationships among red cell distribution width, anemia, and interleukin-6 in adult congenital heart disease[J]. Circ J, 2015, 79(5):1100-1106. doi: 10.1253/circj.CJ-14-1296 pmid: 25740502
[7]	Fava C, Cattazzo F, Hu ZD, et al. The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: useful or hype?[J]. Ann Transl Med, 2019, 7(20):581. doi: 10.21037/atm URL
[8]	Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients[J]. PLoS One, 2014, 9(8):105436.
[9]	Şenol K, Saylam B, Kocaay F, et al. Red cell distribution width as a predictor of mortality in acute pancreatitis[J]. Am J Emerg Med, 2013, 31(4):687-689. doi: 10.1016/j.ajem.2012.12.015 URL
[10]	Liu G, Tao J, Zhu Z, et al. The early prognostic value of inflammatory markers in patients with acute pancreatitis[J]. Clin Res Hepatol Gastroenterol, 2019, 43(3):330-337. doi: 10.1016/j.clinre.2018.11.002 URL
[11]	Lattanzi S, Brigo F, Trinka E, et al. Neutrophil-to-Lymphocyte Ratio in Acute Cerebral Hemorrhage: A System Review[J]. Transl Stroke Res, 2019, 10(2):137-145. doi: 10.1007/s12975-018-0649-4 pmid: 30090954
[12]	Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review[J]. Expert Rev Cardiovasc Ther, 2013, 11(1):55-59. doi: 10.1586/erc.12.159 URL
[13]	Li C, Wen TF, Yan LN, et al. Postoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio predicts the outcomes of hepatocellular carcinoma[J]. J Surg Res, 2015, 198(1):73-79. doi: 10.1016/j.jss.2015.05.003 URL
[14]	Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients[J]. Ann Surg Oncol, 2012, 19(1):217-224. doi: 10.1245/s10434-011-1814-0 URL
[15]	Suppiah A, Malde D, Arab T, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR[J]. J Gastrointest Surg, 2013, 17(4):675-681. doi: 10.1007/s11605-012-2121-1 URL
[16]	Wan J, Yang X, He W, et al. Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis[J]. BMC Gastroenterol, 2019, 19(1):67. doi: 10.1186/s12876-019-0989-x URL
[17]	Kearon C, Spencer FA, O’Keeffe D, et al. D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: A cohort study[J]. Ann Intern Med, 2015, 162(1):27-34. doi: 10.7326/M14-1275 pmid: 25560712
[18]	Ke L, Ni HB, Tong ZH, et al. D-dimer as a marker of severity in patients with severe acute pancreatitis[J]. J Hepatobiliary Pancreat Sci, 2012, 19(3):259-265. doi: 10.1007/s00534-011-0414-5 URL
[19]	Yang N, Hao J, Zhang D. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis[J]. J Int Med Res, 2017, 45(1):147-158. doi: 10.1177/0300060516677929 URL

组别	例数	性别(例)		年龄(岁)	病因[例(%)]
组别	例数	男	女	年龄(岁)	胆源性	高脂血症性	酒精性	其他
MAP	126	85	61	52.58±17.26	81(64.3)	14(11.1)	7(5.6)	24(19.0)
MSAP	42	24	18	53.45±19.80	23(54.8)	6(14.3)	4(9.5)	9(21.4)
SAP	22	4	8	63.58±19.28	14(63.6)	3(13.6)	3(13.6)	2(9.1)
CAP	20	6	4	45.80±12.64	13(65.0)	3(15.0)	2(10.0)	2(10.0)
统计值		χ²=0.600		F=2.009	χ²=7.112
P值		0.896		0.114	1.000

组别	例数	性别(例)		年龄(岁)	病因[例(%)]
组别	例数	男	女	年龄(岁)	胆源性	高脂血症性	酒精性	其他
MAP	126	85	61	52.58±17.26	81(64.3)	14(11.1)	7(5.6)	24(19.0)
MSAP	42	24	18	53.45±19.80	23(54.8)	6(14.3)	4(9.5)	9(21.4)
SAP	22	4	8	63.58±19.28	14(63.6)	3(13.6)	3(13.6)	2(9.1)
CAP	20	6	4	45.80±12.64	13(65.0)	3(15.0)	2(10.0)	2(10.0)
统计值		χ²=0.600		F=2.009	χ²=7.112
P值		0.896		0.114	1.000

组别		例数		Glu(mmol/L)^a		BUN(mmol/L)^a		Cr(μmol/L)^a		AMS(U/L)^a
MAP		126		7.65(6.10,10.83)		5.20(4.00,6.80)		64.70(52.45,78.80)		346.50(81.25,861.00)
MSAP		42		8.90(7.20,11.90)^*		5.00(3.80,6.20)^*		66.30(56.00,83.40)^*		558.00(166.00,1300.00)^*
SAP		22		8.90(7.60,13.30)		5.90(3.55,7.05)		74.50(52.45,96.10)		480.00(275.00,1300.00)
CAP		20		11.05(8.23,16.13)		7.05(4.83,8.95)		84.30(51.28,171.75)		395.50(217.25,635.25)
H值				9.338		5.177		4.043		6.863
P值				0.055		0.159		0.257		0.076
组别	例数		NLR^a		MPV(fl)^a		ALT(U/L)^a		AST(U/L)^a		D-D(mg/L)^a
MAP	126		6.43(3.53,11.07)		9.90(8.88,10.60)		23.00(15.00,57.00)		20.50(16.00,57.00)		0.46(0.34,0.77)
MSAP	42		8.82(5.93,20.46)^*		10.01(9.10,11.00)^*		26.00(16.00,119.00)^*		30.00(20.00,70.00)^*		0.64(0.42,1.29)^*
SAP	22		15.18(6.30,25.33)		9.50(8.40,10.60)		16.00(13.00,47.50)		22.00(17.00,51.50)		0.75(0.58,1.95)
CAP	20		16.97(8.92,26.17)		10.25(9.23,11.53)		20.00(12.75,41.00)		37.50(18.25,51.00)		0.81(0.63,2.73)
H值			22.860		3.844		4.739		5.350		14.065
P值			0.000		0.274		0.192		0.148		0.003
组别		例数		RDW(fl)^b		血钙(mmol/L)^b		WBC(×10⁹)^b		ALB(g/L)^b
MAP		126		40.81±2.53		2.26±0.17		11.10±3.68		39.38±3.72
MSAP		42		42.82±1.86^*		2.23±0.20^*		11.89±3.69^*		37.81±5.14^*
SAP		22		44.65±3.82		2.06±0.25		13.61±4.41		37.09±3.36
CAP		20		46.43±4.30		1.82±0.60		14.49±6.56		33.92±8.20
F值				29.732		18.169		4.852		8.058
P值				0.000		0.000		0.003		0.000

组别		例数		Glu(mmol/L)^a		BUN(mmol/L)^a		Cr(μmol/L)^a		AMS(U/L)^a
MAP		126		7.65(6.10,10.83)		5.20(4.00,6.80)		64.70(52.45,78.80)		346.50(81.25,861.00)
MSAP		42		8.90(7.20,11.90)^*		5.00(3.80,6.20)^*		66.30(56.00,83.40)^*		558.00(166.00,1300.00)^*
SAP		22		8.90(7.60,13.30)		5.90(3.55,7.05)		74.50(52.45,96.10)		480.00(275.00,1300.00)
CAP		20		11.05(8.23,16.13)		7.05(4.83,8.95)		84.30(51.28,171.75)		395.50(217.25,635.25)
H值				9.338		5.177		4.043		6.863
P值				0.055		0.159		0.257		0.076
组别	例数		NLR^a		MPV(fl)^a		ALT(U/L)^a		AST(U/L)^a		D-D(mg/L)^a
MAP	126		6.43(3.53,11.07)		9.90(8.88,10.60)		23.00(15.00,57.00)		20.50(16.00,57.00)		0.46(0.34,0.77)
MSAP	42		8.82(5.93,20.46)^*		10.01(9.10,11.00)^*		26.00(16.00,119.00)^*		30.00(20.00,70.00)^*		0.64(0.42,1.29)^*
SAP	22		15.18(6.30,25.33)		9.50(8.40,10.60)		16.00(13.00,47.50)		22.00(17.00,51.50)		0.75(0.58,1.95)
CAP	20		16.97(8.92,26.17)		10.25(9.23,11.53)		20.00(12.75,41.00)		37.50(18.25,51.00)		0.81(0.63,2.73)
H值			22.860		3.844		4.739		5.350		14.065
P值			0.000		0.274		0.192		0.148		0.003
组别		例数		RDW(fl)^b		血钙(mmol/L)^b		WBC(×10⁹)^b		ALB(g/L)^b
MAP		126		40.81±2.53		2.26±0.17		11.10±3.68		39.38±3.72
MSAP		42		42.82±1.86^*		2.23±0.20^*		11.89±3.69^*		37.81±5.14^*
SAP		22		44.65±3.82		2.06±0.25		13.61±4.41		37.09±3.36
CAP		20		46.43±4.30		1.82±0.60		14.49±6.56		33.92±8.20
F值				29.732		18.169		4.852		8.058
P值				0.000		0.000		0.003		0.000

项目	回归系数	标准误	OR值	P值	95%CI
项目	回归系数	标准误	OR值	P值	下限	上限
RDW	0.786	0.284	7.640	0.006	0.229	1.343
NLR	0.054	0.035	2.360	0.124	-0.015	0.122
D-二聚体	0.756	0.322	5.523	0.019	0.125	1.386
Cr	0.003	0.003	1.043	0.307	-0.003	0.010
血钙	-2.362	0.767	9.484	0.002	-3.865	-0.859
WBC	0.202	0.046	19.093	0.000	0.111	0.293
ALB	-0.037	0.036	1.066	0.302	-0.107	0.033