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实验室相关指标在急性胰腺炎严重程度预测中的研究进展
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Abstract:
急性胰腺炎(acute pancreatitis, AP)是临床上一种常见的胰腺实质炎症。虽然大部分表现为自限性疾病，预后良好，但20%左右的AP患者会进展为重症急性胰腺炎(severe acute pancreatitis, SAP)，常出现局部或全身并发症，并继发全身多器官功能衰竭，死亡率高。因此，发病早期准确预测AP的严重程度，对优化诊疗措施和降低死亡率尤为重要。近年来，研究发现多种实验室指标能预测AP的严重程度，且操作简单，在入院早期即可快速获得。本文就实验室指标对AP严重程度预测价值的研究进展作一综述。
Acute pancreatitis (AP) is a common inflammatory condition of the pancreatic parenchyma in clinical practice. Although most cases are self-limiting with a good prognosis, around 20% of AP patients progress to severe acute pancreatitis (SAP), which often presents with local or systemic complications and can lead to multiple organ failure and high mortality rates. Therefore, accurately predicting the severity of AP in the early stages is crucial for optimizing diagnosis and treatment measures and reducing mortality rates. In recent years, various laboratory indicators have been found to be able to predict the severity of AP, and they are simple to measure and obtain quickly upon admission. This article provides an overview of the research progress on the predictive value of laboratory indicators for assessing the severity of AP.
| [1] | Petrov, M.S. and Yadav, D. (2019) Global Epidemiology and Holistic Prevention of Pancreatitis. Nature Reviews Gastroenterology & Hepatology, 16, 175-184. https://doi.org/10.1038/s41575-018-0087-5 |
| [2] | Banks, P.A., Bollen, T.L., Dervenis, C., et al. (2013) Classification of Acute Pancreatitis—2012: Revision of the Atlanta Classification and Definitions by International Consensus. Gut, 62, 102-111. https://doi.org/10.1136/gutjnl-2012-302779 |
| [3] | Boxhoorn, L., Voermans, R.P., Bouwense, S.A., et al. (2020) Acute Pancreatitis. The Lancet, 396, 726-734. https://doi.org/10.1016/S0140-6736(20)31310-6 |
| [4] | Silva-Vaz, P., Abrantes, A.M., Castelo-Branco, M., et al. (2020) Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice. International Journal of Molecular Sciences, 21, Article 338. https://doi.org/10.3390/ijms21010338 |
| [5] | Di, M.Y., Liu, H., Yang, Z.Y., et al. (2016) Prediction Models of Mortality in Acute Pancreatitis in Adults: A Systematic Review. Annals of Internal Medicine, 165, 482-490. https://doi.org/10.7326/M16-0650 |
| [6] | Sproston, N.R. and Ashworth, J.J. (2018) Role of C-Reactive Protein at Sites of Inflammation and Infection. Frontiers in Immunology, 9, Article 754. https://doi.org/10.3389/fimmu.2018.00754 |
| [7] | Lelubre, C., Anselin, S., Zouaoui, Boudjeltia, K., et al. (2013) Interpretation of C-Reactive Protein Concentrations in Critically Ill Patients. BioMed Research International, 2013, Article ID: 124021. https://doi.org/10.1155/2013/124021 |
| [8] | Mayer, A.D., et al. (1984) C Reactive Protein: An Aid to Assessment and Monitoring of Acute Pancreatitis. Journal of Clinical Pathology, 37, 207-211. https://doi.org/10.1136/jcp.37.2.207 |
| [9] | Vasudevan, S., Goswami, P., Sonika, U., et al. (2018) Comparison of Various Scoring Systems and Biochemical Markers in Predicting the Outcome in Acute Pancreatitis. Pancreas, 47, 65-71. https://doi.org/10.1097/MPA.0000000000000957 |
| [10] | Khanna, A.K., Meher, S., Prakash, S., et al. (2013) Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. Hepato-Biliary-Pancreatic Surgery, 2013, Article ID: 367581. https://doi.org/10.1155/2013/367581 |
| [11] | Miko, A., Vigh, E., Matrai, P., et al. (2019) Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-Analysis. Frontiers in Physiology, 10, Article 1002. https://doi.org/10.3389/fphys.2019.01002 |
| [12] | 付冰, 陈丽, 付丹. 血清SFlt-1、LDH及Hs-CRP联合检测对重型急性胰腺炎的早期诊断价值[J]. 标记免疫分析与临床, 2019, 26(2): 277-280. |
| [13] | Wu, H., Liao, B., Cao, T., et al. (2022) Diagnostic Value of RDW for the Prediction of Mortality in Adult Sepsis Patients: A Systematic Review and Meta-Analysis. Frontiers in Immunology, 13, Article 997853. https://doi.org/10.3389/fimmu.2022.997853 |
| [14] | Kust, D., Lucijanic, M., Urch, K., et al. (2017) Clinical and Prognostic Significance of Anisocytosis Measured as a Red Cell Distribution Width in Patients with Colorectal Cancer. QJM: An International Journal of Medicine, 110, 361-367. https://doi.org/10.1093/qjmed/hcw223 |
| [15] | Ku, N.S., Kim, H.W., Oh, H.J., et al. (2012) Red Blood Cell Distribution Width Is an Independent Predictor of Mortality in Patients with Gram-Negative Bacteremia. Shock, 38, 123-127. https://doi.org/10.1097/SHK.0b013e31825e2a85 |
| [16] | Zhang, T., Liu, H., Wang, D., et al. (2018) Predicting the Severity of Acute Pancreatitis with Red Cell Distribution Width at Early Admission Stage. Shock, 49, 551-555. https://doi.org/10.1097/SHK.0000000000000982 |
| [17] | Zhou, H., Mei, X., He, X., et al. (2019) Severity Stratification and Prognostic Prediction of Patients with Acute Pancreatitis at Early Phase: A Retrospective Study. Medicine (Baltimore), 98, E15275. https://doi.org/10.1097/MD.0000000000015275 |
| [18] | 汪镜静, 朱玲, 张敏, 等. 红细胞分布宽度对重症急性胰腺炎诊断价值的Meta分析[J]. 齐齐哈尔医学院学报, 2022, 43(15): 1424-1428. |
| [19] | Liang, Y., Zhao, X. and Meng, F. (2019) Procalcitonin, C-Reactive Protein, and Neutrophil Ratio Contribute to the Diagnosis and Prognosis of Severe Acute Pancreatitis. Iranian Journal of Public Health, 48, 2177-2186. https://doi.org/10.18502/ijph.v48i12.3548 |
| [20] | Gurda-Duda, A., Ku？nierz-Cabala, B., Nowak, W., et al. (2008) Assessment of the Prognostic Value of Certain Acute-Phase Proteins and Procalcitonin in the Prognosis of Acute Pancreatitis. Pancreas, 37, 449-453. https://doi.org/10.1097/MPA.0b013e3181706d67 |
| [21] | Purkayastha, S., Chow, A., Athanasiou, T., et al. (2006) Does Serum Procalcitonin Have a Role in Evaluating the Severity of Acute Pancreatitis? A Question Revisited. World Journal of Surgery, 30, 1713-1721. https://doi.org/10.1007/s00268-006-0167-5 |
| [22] | Mofidi, R., Suttie, S.A., Patil, P.V., et al. (2009) The Value of Procalcitonin at Predicting the Severity of Acute Pancreatitis and Development of Infected Pancreatic Necrosis: Systematic Review. Surgery, 146, 72-81. https://doi.org/10.1016/j.surg.2009.02.013 |
| [23] | Hagjer, S. and Kumar, N. (2018) Evaluation of the BISAP Scoring System in Prognostication of Acute Pancreatitis—A Prospective Observational Study. International Journal of Surgery, 54, 76-81. https://doi.org/10.1016/j.ijsu.2018.04.026 |
| [24] | Dinarello, C.A. (2011) Interleukin-1 in the Pathogenesis and Treatment of Inflammatory Diseases. Blood, 117, 3720-3732. https://doi.org/10.1182/blood-2010-07-273417 |
| [25] | 丁进, 胡艳艳, 程明, 等. 血清白细胞介素-1β在急性胰腺炎分型中的价值[J]. 中国医师进修杂志, 2009, 32(4): 32-33. |
| [26] | 叶朝阳, 马建中, 李后俊, 等. 急性胰腺炎患者外周血TLR4、IL-1β、NLR水平与疾病进展和预后的关系[J]. 天津医药, 2024, 52(6): 648-652. |
| [27] | 陈先强. 白细胞介素1β、6基因多态性与急性胰腺炎病情程度的相关性研究[D]: [硕士学位论文]. 福州: 福建医科大学, 2007. |
| [28] | Lee, P.J. and Papachristou, G.I. (2019) New Insights into Acute Pancreatitis. Nature Reviews Gastroenterology & Hepatology, 16, 479-496. https://doi.org/10.1038/s41575-019-0158-2 |
| [29] | Kolber, W., Dumnicka, P., Maraj, M., et al. (2018) Does the Automatic Measurement of Interleukin 6 Allow for Prediction of Complications during the First 48 H of Acute Pancreatitis? International Journal of Molecular Sciences, 19, Article 1820. https://doi.org/10.3390/ijms19061820 |
| [30] | Aoun, E., Chen, J., Reighard, D., et al. (2009) Diagnostic Accuracy of Interleukin-6 and Interleukin-8 in Predicting Severe Acute Pancreatitis: A Meta-Analysis. Pancreatology, 9, 777-785. https://doi.org/10.1159/000214191 |
| [31] | Dugernier, T.L., Laterre, P.F., Wittebole, X., et al. (2003) Compartmentalization of the Inflammatory Response during Acute Pancreatitis: Correlation with Local and Systemic Complications. American Journal of Respiratory and Critical Care Medicine, 168, 148-157. https://doi.org/10.1164/rccm.2204019 |
| [32] | Greer, P.J., Lee, P.J., Paragomi, P., et al. (2022) Severe Acute Pancreatitis Exhibits Distinct Cytokine Signatures and Trajectories in Humans: A Prospective Observational Study. American Journal of Physiology Gastrointestinal and Liver Physiology, 323, G428-G438. https://doi.org/10.1152/ajpgi.00100.2022 |
| [33] | 于方方. 血清Hs-CRP、IL-8、PCT水平检测对急性胰腺炎的诊断分析[J]. 西藏医药, 2021, 42(3): 22-23. |
| [34] | Zhang, J., Niu, J. and Yang, J. (2014) Interleukin-6, Interleukin-8 and Interleukin-10 in Estimating the Severity of Acute Pancreatitis: An Updated Meta-Analysis. Hepato-Gastroenterology, 61, 215-220. |
| [35] | Peng, T., Peng, X., Huang, M., et al. (2017) Serum Calcium as an Indicator of Persistent Organ Failure in Acute Pancreatitis. The American Journal of Emergency Medicine, 35, 978-982. https://doi.org/10.1016/j.ajem.2017.02.006 |
| [36] | Gerasimenko, J.V., Gerasimenko, O.V. and Petersen, O.H. (2014) The Role of Ca2+ in the Pathophysiology of Pancreatitis. The Journal of Physiology, 592, 269-280. https://doi.org/10.1113/jphysiol.2013.261784 |
| [37] | Peng, T., Peng, X., Huang, M., et al. (2017) Corrigendum to Serum Calcium as an Indicator of Persistent Organ Failure in Acute Pancreatitis. American Journal of Emergency Medicine, 35, 978-982. https://doi.org/10.1016/j.ajem.2017.06.056 |
| [38] | Gutierrez-Jimenez, A.A., Castro-Jimenez, E. and Lagunes-Cordoba, R. (2014) Total Serum Calcium and Corrected Calcium as Severity Predictors in Acute Pancreatitis. Revista de Gastroenterología de México, 79, 13-21. https://doi.org/10.1016/j.rgmxen.2014.05.003 |
| [39] | 宁静, 李清, 陈秀秉, 等. 血钙、C反应蛋白和血清铁蛋白对急性胰腺炎严重程度的预测价值[J]. 广西医科大学学报, 2022, 39(9): 1409-1413. |
| [40] | Yu, S., Wu, D., Jin, K., et al. (2019) Low Serum Ionized Calcium, Elevated High-Sensitivity C-Reactive Protein, Neutrophil-Lymphocyte Ratio, and Body Mass Index (BMI) Are Risk Factors for Severe Acute Pancreatitis in Patients with Hypertriglyceridemia Pancreatitis. Medical Science Monitor, 25, 6097-6103. https://doi.org/10.12659/MSM.915526 |
| [41] | Geersing, G.J., Zuithoff, N.P., Kearon, C., et al. (2014) Exclusion of Deep Vein Thrombosis Using the Wells Rule in Clinically Important Subgroups: Individual Patient Data Meta-Analysis. The British Medical Journal, 348, G1340. https://doi.org/10.1136/bmj.g1340 |
| [42] | Lisman, T. and Porte, R. (2010) Activation and Regulation of Hemostasis in Acute Liver Failure and Acute Pancreatitis. Seminars in Thrombosis and Hemostasis, 36, 437-443. https://doi.org/10.1055/s-0030-1254052 |
| [43] | Anna, K., Vasilios, P., Konstantinos, M., et al. (2007) Coagulation, Platelets, and Acute Pancreatitis. Pancreas, 34, 15-20. https://doi.org/10.1097/01.mpa.0000240617.66215.d2 |
| [44] | Zhang, G.Q., Wang, G., Li, L., et al. (2019) Plasma D-Dimer Level Is an Early Predictor of Severity of Acute Pancreatitis Based on 2012 Atlanta Classification. Medical Science Monitor, 25, 9019-9027. https://doi.org/10.12659/MSM.918311 |
| [45] | Wan, J., Yang, X., He, W., et al. (2019) Serum D-Dimer Levels at Admission for Prediction of Outcomes in Acute Pancreatitis. BMC Gastroenterology, 19, Article No. 67. https://doi.org/10.1186/s12876-019-0989-x |
| [46] | Linkins, L.A., Takach and Lapner, S. (2017) Review of D-Dimer Testing: Good, Bad, and Ugly. International Journal of Laboratory Hematology, 39, 98-103. https://doi.org/10.1111/ijlh.12665 |
| [47] | Azevedo, L.C.P., Kim, M.H., Ahn, J.Y., et al. (2015) The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLOS ONE, 10, E0132109. https://doi.org/10.1371/journal.pone.0132109 |
| [48] | Xu, H., Hu, L., Wei, X., et al. (2019) The Predictive Value of Preoperative High-Sensitive C-Reactive Protein/Albumin Ratio in Systemic Inflammatory Response Syndrome after Percutaneous Nephrolithotomy. Journal of Endourology, 33, 1-8. https://doi.org/10.1089/end.2018.0632 |
| [49] | Zhou, T., Zhao, Y., Zhao, S., et al. (2019) Comparison of the Prognostic Value of Systemic Inflammation Response Markers in Small Cell Lung Cancer Patients. Journal of Cancer, 10, 1685-1692. https://doi.org/10.7150/jca.29319 |
| [50] | Haider, Kazmi, S.J., Zafar, M.T., Zia, B.F., et al. (2022) Role of Serum C-Reactive Protein (CRP)/Albumin Ratio in Predicting The Severity of Acute Pancreatitis: A Retrospective Cohort. Annals of Medicine and Surgery, 82, Article 104715. https://doi.org/10.1016/j.amsu.2022.104715 |
| [51] | Karabuga, B., Gemcioglu, E., Konca, Karabuga, E., et al. (2022) Comparison of the Predictive Values of CRP, CRP/Albumin, RDW, Neutrophil/Lymphocyte, and Platelet/Lymphocyte Levels in Determining the Severity of Acute Pancreatitis in Patients with Acute Pancreatitis According to the BISAP Score. Bratislavské lekárske listy, 123, 129-135. https://doi.org/10.4149/BLL_2022_020 |
| [52] | Behera, M.K., Mishra, D., Sahu, M.K., et al. (2023) C-Reactive Protein/Albumin and Ferritin as Predictive Markers for Severity and Mortality in Patients with Acute Pancreatitis. Przeglad Gastroenterologiczny, 18, 168-174. https://doi.org/10.5114/pg.2022.115609 |
| [53] | 覃敏珍, 姚敦卫, 唐国都. 血清C反应蛋白/白蛋白比值对重症急性胰腺炎的预测价值[J]. 广西医学, 2019, 41(20): 2576-2579. |
| [54] | Cupp, M.A., Cariolou, M., Tzoulaki, I., et al. (2020) Neutrophil to Lymphocyte Ratio and Cancer Prognosis: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies. BMC Medicine, 18, Article 360. |
| [55] | Azab, B., Jaglall, N., Atallah, J, P., et al. (2011) Neutrophil-Lymphocyte Ratio as a Predictor of Adverse Outcomes of Acute Pancreatitis. Pancreatology, 11, 445-452. https://doi.org/10.1159/000331494 |
| [56] | Liu, G., Tao, J., Zhu, Z., et al. (2019) The Early Prognostic Value of Inflammatory Markers in Patients with Acute Pancreatitis. Clinics and Research in Hepatology and Gastroenterology, 43, 330-337. https://doi.org/10.1016/j.clinre.2018.11.002 |
| [57] | Kong, W., He, Y., Bao, H., et al. (2020) Diagnostic Value of Neutrophil-Lymphocyte Ratio for Predicting the Severity of Acute Pancreatitis: A Meta-Analysis. Disease Markers, 2020, Article 9731854. |
| [58] | Liu, L., Shao, Z., Yu, H., et al. (2020) Is the Platelet to Lymphocyte Ratio a Promising Biomarker to Distinguish Acute Appendicitis? Evidence from a Systematic Review with Meta-Analysis. PLOS ONE, 15, E0233470. https://doi.org/10.1371/journal.pone.0233470 |
| [59] | Fang, T., Wang, Y., Yin, X., et al. (2020) Diagnostic Sensitivity of NLR and PLR in Early Diagnosis of Gastric Cancer. Journal of Immunology Research, 2020, Article 9146042. |
| [60] | Wang, D., Bai, N., Hu, X., et al. (2019) Preoperative Inflammatory Markers of NLR and PLR as Indicators of Poor Prognosis in Resectable HCC. Peer J, 7, E7132. |
| [61] | 刘云, 孙静芳, 丁爽. 血常规相关指标在急性胰腺炎分期和病情评估中的作用分析[J]. 检验医学与临床, 2021, 18(8): 1025-1028. |
| [62] | Cho, S.K., Jung, S., Lee, K.J., et al. (2018) Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Can Predict the Severity of Gallstone Pancreatitis. BMC Gastroenterology, 18, Article No. 18. https://doi.org/10.1186/s12876-018-0748-4 |
| [63] | Fung, J., Chen, B., Ye, B., et al. (2013) RDW to Platelet Ratio: A Novel Noninvasive Index for Predicting Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis B. PLOS ONE, 8, E68780. https://doi.org/10.1371/journal.pone.0068780 |
| [64] | 邓兴锋, 罗灿桦, 林美红, 等. 红细胞分布宽度与血小板之比评估急性胰腺炎严重程度的价值[J]. 广州医科大学学报, 2020, 48(2): 26-30. |
| [65] | 任慧, 邢曙光, 马珺珂, 等. 红细胞分布宽度与血小板计数比值在急性胰腺炎中的临床研究[J]. 中国医学创新, 2021, 18(21): 89-93. |
| [66] | Cetinkaya, E., Senol, K., Saylam, B., et al. (2014) Red Cell Distribution Width to Platelet Ratio: New and Promising Prognostic Marker in Acute Pancreatitis. World Journal of Gastroenterology, 20, 14450-14454. https://doi.org/10.3748/wjg.v20.i39.14450 |
| [67] | Gravito-Soares, M., Gravito-Soares, E., Gomes, D., et al. (2018) Red Cell Distribution Width and Red Cell Distribution Width to Total Serum Calcium Ratio as Major Predictors of Severity and Mortality in Acute Pancreatitis. BMC Gastroenterology, 18, Article 108. https://doi.org/10.1186/s12876-018-0834-7 |
| [68] | Tianyong, H., Tao, C., Ye, L., et al. (2022) The Ratio of Red Blood Cell Distribution Width to Serum Calcium Predicts Severity of Patients with Acute Pancreatitis. American Journal of Emergency Medicine, 53, 190-195. https://doi.org/10.1016/j.ajem.2022.01.024 |
| [69] | 王先令, 朱丽叶, 陶坤林, 等. 红细胞分布宽度/血清钙离子对急性胰腺炎严重程度的早期诊断价值[J]. 实用医学杂志, 2020, 36(5): 650-654. |
| [70] | 王俊, 胡莲, 刘诗, 等. NLPR、HsCRP/PA、PCT联合检测对重症急性胰腺炎的预测价值[J]. 西部医学, 2024, 36(3): 427-432. |
| [71] | 罗辉黄, 高明, 尹纯林, 等. 早期IL-12p70、CAR、PCT联合检测对急性胰腺炎病情严重程度的预测价值[J]. 医学信息, 2024, 37(1): 115-119. |
| [72] | Zhong, Y., Yu, Z., Wang, L., et al. (2021) Combined Detection of Procalcitonin, Heparin-Binding Protein, and Interleukin-6 Is a Promising Assay to Diagnose and Predict Acute Pancreatitis. Journal of Clinical Laboratory Analysis, 35, E23869. https://doi.org/10.1002/jcla.23869 |
