入院随机血糖及D-二聚体对急性胰腺炎并发持续性器官功能衰竭的预测价值

Predictive Value of Admission Random Blood Glucose and D-Dimer in Acute Pancreatitis Complicated with Persistent Organ Failure

摘要: 目的：本研究目的是探讨患者入院时随机血糖水平和D-二聚体水平及其他常见化验指标对急性胰腺炎患者发生持续性器官功能衰竭的预测作用。方法：本研究回顾性纳入分析了2013年01月01日至2019年09月30日期间发病时间小于24小时并进入本机构接受系统治疗的急性胰腺炎患者共184例。这些患者根据是否发生持续性器官功能衰竭分为持续性器官功能衰竭组和非持续性器官功能衰竭组。随后，分析患者的常见化验指标及临床资料，并评估可能与发生持续性器官功能衰竭相关的危险因素及其对持续性器官功能衰竭的预测价值。结果：在184位患者中，其中124位未出现持续性器官功能衰竭和60位出现器官功能衰竭。单因素分析显示入院随机血糖、身体质量指数、血浆白蛋白、血清肌酐、尿素氮、血清钙、D-二聚体、白细胞计、甘油三酯、凝血酶原时间与发生持续性器官功能衰竭有关。多因素分析显示入院随机血糖、D-二聚体、身体质量指数和血清钙是持续性器官功能衰竭的独立危险因素。进一步分析显示，分别建立预测模型来评估上述4个变量对急性胰腺炎患者发生持续性器官功能衰竭的预测价值，以受试者工作特征曲线下面积表现预测作用，入院随机血糖、D-二聚体、身体质量指数和血清钙的曲线下面积分别为0.780、0.771、0.670、0.249，得到的预测持续性器官功能衰竭的最佳临界值分别为12.35 mmol/L、1283.3 ng/mL、25.92、2.39 mmol/L。结论：入院随机血糖、D-二聚体、身体质量指数和血清钙对于急性胰腺炎患者并发持续性器官功能衰竭具有一定的预测价值。其中入院随机血糖预测价值最高，其最佳预测值为12.35 mmol/L，D-二聚体预测价值随后，最佳预测值为1283.5 ng/mL。这在临床上对于帮助早期识别潜在预后不良患者具有一定的临床实用价值。而急性胰腺炎患者血糖升高、D-二聚体升高与器官功能衰竭发生之间的机制等还需进一步探索。

Abstract: Objectives: The purpose of this study is to explore the predictive effect of random blood glucose level, D-dimer level and other common laboratory indexes on persistent organ failure in patients with acute pancreatitis. Method: From January 1, 2013 to September 30, 2019, a total of 184 patients with acute pancreatitis who had onset time less than 24 hours and received systematic treatment in our institution were included and analyzed retrospectively. According to the occurrence of persistent organ failure, these patients were divided into persistent organ failure group and non-persistent organ failure group. Then, the common laboratory indexes and clinical data of patients were analyzed, and the risk factors associated with persistent organ failure and its predictive value for persistent organ failure were evaluated. Result: Among 184 patients, 124 had no persistent organ failure and 60 had organ failure. Univariate analysis showed that admission random blood glucose, body mass index, plasma albumin, serum creatinine, urea nitrogen, serum calcium, D-dimer, leukocyte count, triglyceride, prothrombin time were associated with persistent organ failure. Multivariate analysis showed that admission random blood glucose, D-dimer, body mass index and serum calcium were independent risk factors for persistent organ failure. Further analysis showed that predictive models were established to evaluate the predictive value of the above four variables for persistent organ failure in patients with acute pancreatitis, and the area under the curve of subject working characteristic was used to predict the occurrence of persistent organ failure. The areas under the curves of random blood glucose, D-dimer, body mass index, and serum calcium were 0.780,0.771,0.670, and 0.249, respectively, and the optimal cutoff values for predicted persistent organ failure were 12.35 mmol/L, 1283.3 ng/mL, 25.92 mmol/L, 2.39 mmol/L, respectively. Conclusion: Admission random blood glucose, D-dimer, body mass index and serum calcium have certain predictive value for patients with acute pancreatitis complicated with persistent organ failure. The best predictive value of admission random blood glucose was 12.35 mmol/L, and the best predictive value of D-dimer was 1283.5 ng/ml. It has a certain clinical practical value for early identification of patients with potential poor prognosis. However, the mechanism between elevated blood glucose and D-dimer and organ failure in patients with acute pancreatitis needs to be further explored.