预测急性胰腺炎严重程度及预后的研究进展
Research Progress on Predicting the Severity and Prognosis of Acute Pancreatitis
DOI: 10.12677/acm.2024.14112977, PDF,   
作者: 李政浩, 张钰华：吉首大学医学院，湖南 吉首；张克兰*：中南大学湘雅医学院附属常德医院普外科，湖南 常德
关键词: 急性胰腺炎；评分系统；实验室指标；严重程度；预后；Acute Pancreatitis； Scoring System； Laboratory Indicators； Severity； Prognosis
摘要: 急性胰腺炎是消化系统最常见的疾病之一，通常是由于胰腺自身的胰酶激活引起胰腺局部炎症反应的疾病，通常与各类病因相关，可以发生各种并发症，病情变化快，严重时可以危及患者的生命。当患者为重症急性胰腺炎(SAP)时，病情进展快，病程长，预后差，伴随高死亡率，因此尽早地对患者的病情及严重程度进行评估，给予早期的干预与治疗，有利于降低患者死亡率，改善预后。近年来已经出现各种评分系统以及临床上常用的实验室指标及影像学对急性胰腺炎的严重程度以及预后进行评估，对于患者后期的病情发展控制及改善预后有较大帮助。本文就近年来国内外评分系统以及临床上常用的实验室指标对预测急性胰腺炎严重程度及预后发展方面的研究进行综述。
Abstract: Acute pancreatitis is one of the most common diseases in the digestive system. It is usually a disease in which the activation of pancreatic enzymes in the pancreas itself causes a local inflammatory reaction in the pancreas, and it is usually related to various etiologies. Various complications can occur, the condition changes rapidly, and in severe cases, it can endanger the patient’s life. When a patient has severe acute pancreatitis (SAP), the disease progresses rapidly, the disease course is long, the prognosis is poor, and it is accompanied by a high mortality rate. Therefore, evaluating the patient’s condition and severity as early as possible and providing early intervention and treatment are conducive to reducing the patient’s mortality rate and improving the prognosis. In recent years, various scoring systems, commonly used clinical laboratory indicators, and imaging have emerged to evaluate the severity and prognosis of acute pancreatitis, which are of great help for the control of the patient’s later-stage disease development and the improvement of prognosis. This article reviews the research on domestic and foreign scoring systems and commonly used clinical laboratory indicators in recent years regarding the prediction of the severity and prognosis development of acute pancreatitis.
文章引用：李政浩, 张克兰, 张钰华. 预测急性胰腺炎严重程度及预后的研究进展[J]. 临床医学进展, 2024, 14(11): 1011-1020. https://doi.org/10.12677/acm.2024.14112977

参考文献

[1] Guo, X., Li, Y., Lin, H., Cheng, L., Huang, Z., Lin, Z., et al. (2022) A Nomogram for Clinical Estimation of Acute Biliary Pancreatitis Risk among Patients with Symptomatic Gallstones: A Retrospective Case-Control Study. Frontiers in Cellular and Infection Microbiology, 12, Article 935927. [Google Scholar] [CrossRef] [PubMed]
[2] Yan, J., Yilin, H., Di, W., Jie, W., Hanyue, W., Ya, L., et al. (2022) A Nomogram for Predicting the Risk of Mortality in Patients with Acute Pancreatitis and Gram-Negative Bacilli Infection. Frontiers in Cellular and Infection Microbiology, 12, Article 1032375. [Google Scholar] [CrossRef] [PubMed]
[3] Trikudanathan, G., Wolbrink, D.R.J., van Santvoort, H.C., Mallery, S., Freeman, M. and Besselink, M.G. (2019) Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach. Gastroenterology, 156, 1994-2007.E3. [Google Scholar] [CrossRef] [PubMed]
[4] Garg, P.K. and Singh, V.P. (2019) Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology, 156, 2008-2023. [Google Scholar] [CrossRef] [PubMed]
[5] Han, X., Hu, M., Ji, P. and Liu, Y. (2024) Construction and Alidation of a Severity Prediction Model for Acute Pancreatitis Based on CT Severity Index: A Retrospective Case-Control Study. PLOS ONE, 19, e0303684. [Google Scholar] [CrossRef] [PubMed]
[6] Banks, P.A. and Freeman, M.L. (2006) Practice Guidelines in Acute Pancreatitis. The American Journal of Gastroenterology, 101, 2379-2400. [Google Scholar] [CrossRef] [PubMed]
[7] Cho, J.H. (2015) Comparison of Scoring Systems in Predicting the Severity of Acute Pancreatitis. World Journal of Gastroenterology, 21, 2387-2394. [Google Scholar] [CrossRef] [PubMed]
[8] Papachristou, G.I., Muddana, V., Yadav, D., O'Connell, M., Sanders, M.K., Slivka, A., et al. (2010) Comparison of BISAP, Ranson’s, APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis. American Journal of Gastroenterology, 105, 435-441. [Google Scholar] [CrossRef] [PubMed]
[9] Wu, B.U., Johannes, R.S., Sun, X., Tabak, Y., Conwell, D.L. and Banks, P.A. (2008) The Early Prediction of Mortality in Acute Pancreatitis: A Large Population-Based Study. Gut, 57, 1698-1703. [Google Scholar] [CrossRef] [PubMed]
[10] Singh, V.K., Wu, B.U., Bollen, T.L., Repas, K., Maurer, R., Johannes, R.S., et al. (2009) A Prospective Evaluation of the Bedside Index for Severity in Acute Pancreatitis Score in Assessing Mortality and Intermediate Markers of Severity in Acute Pancreatitis. The American Journal of Gastroenterology, 104, 966-971. [Google Scholar] [CrossRef] [PubMed]
[11] Tahir, H., Rahman, S., Habib, Z., Khan, Y. and Shehzad, S. (2021) Comparison of the Accuracy of Modified CT Severity Index Score and Neutrophil-to-Lymphocyte Ratio in Assessing the Severity of Acute Pancreatitis. Cureus, 13, e17020. [Google Scholar] [CrossRef] [PubMed]
[12] Liao, Q., He, W.H., Li, T.M., et al. (2022) [Evaluation of Severity and Prognosis of Acute Pancreatitis by CT Severity Index and Modified CT Severity Index]. Chinese Medical Journal, 102, 2011-2017.
[13] Ezzat, G.M., Nageb, S.M., Haredi, M.A. and El-Masry, M.A. (2023) Mitochondrial DNA Copy Number, a Damage-Associated Molecular Pattern Molecule, Can Predict Pancreatic Necrosis and Is Correlated with the Severity of Acute Pancreatitis. Digestive Diseases and Sciences, 68, 4175-4185. [Google Scholar] [CrossRef] [PubMed]
[14] Xu, Y., Ye, C. and Tan, B. (2023) Evaluation of Inflammatory Infiltration in the Retroperitoneal Space of Acute Pancreatitis Using Computer Tomography and Its Correlation with Clinical Severity. Contrast Media & Molecular Imaging, 2023, Article ID: 7492293. [Google Scholar] [CrossRef] [PubMed]
[15] Pathak, A. and Agrawal, A. (2019) Evolution of C-Reactive Protein. Frontiers in Immunology, 10, Article 943. [Google Scholar] [CrossRef] [PubMed]
[16] Stirling, A.D., Moran, N.R., Kelly, M.E., Ridgway, P.F. and Conlon, K.C. (2017) The Predictive Value of C-Reactive Protein (CRP) in Acute Pancreatitis—Is Interval Change in CRP an Additional Indicator of Severity? HPB, 19, 874-880. [Google Scholar] [CrossRef] [PubMed]
[17] Zhong, R., Xu, J., Luo, X., Shi, X., Peng, Y., Xu, H., et al. (2022) Development and Evaluation of a Nomogram to Predict the Eventual Severity of the First Episode of Acute Pancreatitis. Pancreas, 51, 540-548. [Google Scholar] [CrossRef] [PubMed]
[18] Wan, J., Yang, X., He, W., Zhu, Y., Zhu, Y., Zeng, H., et al. (2019) Serum D-Dimer Levels at Admission for Prediction of Outcomes in Acute Pancreatitis. BMC Gastroenterology, 19, Article No. 67. [Google Scholar] [CrossRef] [PubMed]
[19] Dumnicka, P., Kuśnierz-Cabala, B., Sporek, M., Mazur-Laskowska, M., Gil, K., Kuźniewski, M., et al. (2017) Serum Concentrations of Angiopoietin-2 and Soluble fms-Like Tyrosine Kinase 1 (sFLT-1) Are Associated with Coagulopathy among Patients with Acute Pancreatitis. International Journal of Molecular Sciences, 18, Article 753. [Google Scholar] [CrossRef] [PubMed]
[20] Zhou, B., Qiu, Z., Niu, K., Wang, Y. and Jie, F. (2022) Construction of a Nomogram Model for Predicting Pleural Effusion Secondary to Severe Acute Pancreatitis. Emergency Medicine International, 2022, Article ID: 4199209. [Google Scholar] [CrossRef] [PubMed]
[21] Arroyo, V., García-Martinez, R. and Salvatella, X. (2014) Human Serum Albumin, Systemic Inflammation, and Cirrhosis. Journal of Hepatology, 61, 396-407. [Google Scholar] [CrossRef] [PubMed]
[22] Li, S., Liu, Z. and Wu, H. (2019) The Product Value of Serum Albumin and Prothrombin Time Activity Could Be a Useful Biomarker for Severity Prediction in AP: An Ordinal Retrospective Study. Pancreatology, 19, 230-236. [Google Scholar] [CrossRef] [PubMed]
[23] Dong, X., Pan, S., Zhang, D., Hong, W., Chen, T., Zhang, B., et al. (2022) Hyperlipemia Pancreatitis Onset Time Affects the Association between Elevated Serum Triglyceride Levels and Disease Severity. Lipids in Health and Disease, 21, Article No. 49. [Google Scholar] [CrossRef] [PubMed]
[24] Chhabra, P. (2016) Hypocalcemic Tetany: A Simple Bedside Marker of Poor Outcome in Acute Pancreatitis. Annals of Gastroenterology, 29, 214-220. [Google Scholar] [CrossRef] [PubMed]
[25] Xue, E., Shi, Q., Guo, S., Zhang, X., Liu, C., Qian, B., et al. (2022) Preexisting Diabetes, Serum Calcium and D-Dimer Levels as Predictable Risk Factors for Pancreatic Necrosis of Patients with Acute Pancreatitis: A Retrospective Study. Expert Review of Gastroenterology & Hepatology, 16, 913-921. [Google Scholar] [CrossRef] [PubMed]
[26] Hsu, P.P. and Sabatini, D.M. (2008) Cancer Cell Metabolism: Warburg and Beyond. Cell, 134, 703-707. [Google Scholar] [CrossRef] [PubMed]
[27] Malik, P., Patel, U., Mehta, D., Patel, N., Kelkar, R., Akrmah, M., et al. (2020) Biomarkers and Outcomes of COVID-19 Hospitalisations: Systematic Review and Meta-analysis. BMJ Evidence-Based Medicine, 26, 107-108. [Google Scholar] [CrossRef] [PubMed]
[28] Asim Riaz, H.M., Islam, Z., Rasheed, L., Sarfraz, Z., Sarfraz, A., Robles-Velasco, K., et al. (2022) The Evaluation of Inflammatory Biomarkers in Predicting Progression of Acute Pancreatitis to Pancreatic Necrosis: A Diagnostic Test Accuracy Review. Healthcare, 11, Article 27. [Google Scholar] [CrossRef] [PubMed]
[29] Khanna, A.K., Meher, S., Prakash, S., Tiwary, S.K., Singh, U., Srivastava, A., 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. HPB Surgery, 2013, Article ID: 367581. [Google Scholar] [CrossRef] [PubMed]
[30] Rao, S.A. and Kunte, A.R. (2017) Interleukin-6: An Early Predictive Marker for Severity of Acute Pancreatitis. Indian Journal of Critical Care Medicine, 21, 424-428. [Google Scholar] [CrossRef] [PubMed]
[31] Heath, D.I., Cruickshank, A., Gudgeon, M., Jehanli, A., Shenkin, A. and Imrie, C.W. (1993) Role of Interleukin-6 in Mediating the Acute Phase Protein Response and Potential as an Early Means of Severity Assessment in Acute Pancreatitis. Gut, 34, 41-45. [Google Scholar] [CrossRef] [PubMed]
[32] Komara, N.L., Paragomi, P., Greer, P.J., Wilson, A.S., Breze, C., Papachristou, G.I., et al. (2020) Severe Acute Pancreatitis: Capillary Permeability Model Linking Systemic Inflammation to Multiorgan Failure. American Journal of Physiology-Gastrointestinal and Liver Physiology, 319, G573-G583. [Google Scholar] [CrossRef] [PubMed]
[33] Zhang, X.P., Wang, L. and Zhou, Y.F. (2007) The Pathogenic Mechanism of Severe Acute Pancreatitis Complicated with Renal Injury: A Review of Current Knowledge. Digestive Diseases and Sciences, 53, 297-306. [Google Scholar] [CrossRef] [PubMed]
[34] Papachristou, G.I., Muddana, V., Yadav, D. and Whitcomb, D.C. (2010) Increased Serum Creatinine Is Associated with Pancreatic Necrosis in Acute Pancreatitis. American Journal of Gastroenterology, 105, 1451-1452. [Google Scholar] [CrossRef] [PubMed]
[35] Tenner, S., Baillie, J., DeWitt, J. and Vege, S.S. (2013) American College of Gastroenterology Guideline: Management of Acute Pancreatitis. American Journal of Gastroenterology, 108, 1400-1415. [Google Scholar] [CrossRef] [PubMed]
[36] Li, B., Wu, W., Liu, A., Feng, L., Li, B., Mei, Y., et al. (2023) Establishment and Validation of a Nomogram Prediction Model for the Severe Acute Pancreatitis. Journal of Inflammation Research, 16, 2831-2843. [Google Scholar] [CrossRef] [PubMed]
[37] Qi, X., Yang, F., Huang, H., Du, Y., Chen, Y., Wang, M., et al. (2017) A Reduced Lymphocyte Ratio as an Early Marker for Predicting Acute Pancreatitis. Scientific Reports, 7, Article No. 44087. [Google Scholar] [CrossRef] [PubMed]
[38] Zhou, J., Chen, W., Liu, Y., Qu, C., Jiang, W., Yin, J., et al. (2021) Trajectories of Lymphocyte Counts in the Early Phase of Acute Pancreatitis Are Associated with Infected Pancreatic Necrosis. Clinical and Translational Gastroenterology, 12, e00405. [Google Scholar] [CrossRef] [PubMed]
[39] Mei, L., Gan, Q., Hu, J., Li, Y., Tian, R. and Shi, C. (2024) Assessment of Early Factors for Identification or Prediction Severe Acute Pancreatitis in Pregnancy. World Journal of Clinical Cases, 12, 5502-5512. [Google Scholar] [CrossRef] [PubMed]
[40] Xu, M., Xu, J., Gao, X., Mo, S., Xing, J., Liu, J., et al. (2024) Clinical Study of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Hypertriglyceridemia-Induced Acute Pancreatitis and Acute Biliary Pancreatitis with Persistent Organ Failure. World Journal of Gastrointestinal Surgery, 16, 1647-1659. [Google Scholar] [CrossRef] [PubMed]
[41] Sarkar, S., Kannan, S., Khanna, P. and Singh, A.K. (2021) Role of Platelet‐to‐lymphocyte Count Ratio (PLR), as a Prognostic Indicator in COVID‐19: A Systematic Review and Meta‐Analysis. Journal of Medical Virology, 94, 211-221. [Google Scholar] [CrossRef] [PubMed]
[42] Jeon, T.J. and Park, J.Y. (2017) Clinical Significance of the Neutrophil-Lymphocyte Ratio as an Early Predictive Marker for Adverse Outcomes in Patients with Acute Pancreatitis. World Journal of Gastroenterology, 23, 3883-3889. [Google Scholar] [CrossRef] [PubMed]
[43] Halaseh, S.A., Kostalas, M., Kopec, C., Toubasi, A.A. and Salem, R. (2022) Neutrophil-to-lymphocyte Ratio as an Early Predictor of Complication and Mortality Outcomes in Individuals with Acute Pancreatitis at a UK District General Hospital: A Retrospective Analysis. Cureus, 14, e29782. [Google Scholar] [CrossRef] [PubMed]
[44] Djordjevic, D., Rondovic, G., Surbatovic, M., Stanojevic, I., Udovicic, I., Andjelic, T., et al. (2018) Neutrophil-to-lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia? Mediators of Inflammation, 2018, Article ID: 3758068. [Google Scholar] [CrossRef] [PubMed]
[45] Naess, A., Nilssen, S.S., Mo, R., Eide, G.E. and Sjursen, H. (2016) Role of Neutrophil to Lymphocyte and Monocyte to Lymphocyte Ratios in the Diagnosis of Bacterial Infection in Patients with Fever. Infection, 45, 299-307. [Google Scholar] [CrossRef] [PubMed]
[46] Xiang, J., Zhou, L., Li, X., Bao, W., Chen, T., Xi, X., et al. (2017) Preoperative Monocyte-to-Lymphocyte Ratio in Peripheral Blood Predicts Stages, Metastasis, and Histological Grades in Patients with Ovarian Cancer. Translational Oncology, 10, 33-39. [Google Scholar] [CrossRef] [PubMed]
[47] Goyal, H., Awad, H. and Hu, Z. (2017) Prognostic Value of Admission Red Blood Cell Distribution Width in Acute Pancreatitis: A Systematic Review. Annals of Translational Medicine, 5, 342-342. [Google Scholar] [CrossRef] [PubMed]
[48] Gravito-Soares, M., Gravito-Soares, E., Gomes, D., Almeida, N. and Tomé, L. (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 No. 108. [Google Scholar] [CrossRef] [PubMed]
[49] Ghaffari, S. (2008) Oxidative Stress in the Regulation of Normal and Neoplastic Hematopoiesis. Antioxidants & Redox Signaling, 10, 1923-1940. [Google Scholar] [CrossRef] [PubMed]

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