2020 年第 5 期 第 15 卷

同型半胱氨酸水平与急性胰腺炎患者病情严重程度及预后的相关性研究

Relation among homocysteine, severity and prognosis of acute pancreatitis

作者：李会东;邢柏

英文作者：Li Huidong Xing Bo

单位：海南医学院第二附属医院东湖分院急诊科，海口570311

英文单位：Department of Emergency Donghu Branch of the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：急性胰腺炎；同型半胱氨酸；严重程度；预后

英文关键词：Acutepancreatitis;Homocysteine;Severity;Prognosis

• 摘要：

• 目的 探讨血清同型半胱氨酸（Hcy）水平与急性胰腺炎（AP）患者病情严重程度及预后的相关性。方法 回顾性分析2016年1月至2019年5月海南医学院附属第二医院急诊科收治的164例AP患者的临床资料，依据《急性胰腺炎诊治指南(2014)》分为轻症AP（MAP）组（60例）、中重症AP（MSAP）组（42例）和重症AP（SAP）组（62例）。同时根据28 d生存情况分为存活组（148例）和死亡组（16例）。收集并比较各组患者入院时的相关临床资料、血清Hcy水平以及急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分。采用Spearman相关性方法 分析评估血清Hcy水平与APACHE Ⅱ评分的相关性。采用多因素Logistic回归方法 分析影响AP患者预后的独立预测因素。通过受试者工作特征曲线评估血清Hcy水平和APACHE Ⅱ评分对AP患者预后的预测价值。结果 SAP组血清Hcy水平为（19±5）μmol/L，MSAP组为（12±3）μmol/L，MAP组为（10±4）μmol/L，两两比较差异均有统计学意义（均P＜0.01）。多因素Logistic回归分析结果 表明血清Hcy水平及APACHE Ⅱ评分为AP患者预后不良的独立危险因素（均P＜0.05）。AP患者血清Hcy水平与APACHE Ⅱ评分呈明显正相关（r＝0.779，P＜0.01）。血清Hcy水平及APACHE Ⅱ评分评估AP患者预后的曲线下面积分别为0.896（95%置信区间：0.838～0.937）和0.911（95%置信区间：0.856～0.950），二者之间差异无统计学意义（Z＝0.338，P＝0.735）。结论Hcy与AP患者病情严重程度密切相关，对AP患者预后具有较高的预测价值。

• Objective To investigate the relation among homocysteine（Hcy） level, severity of acute pancreatitis（AP） and prognosis. Methods Clinical data of 164 patients with AP admitted to the emergency department of the Second Affiliated Hospital of Hainan Medical University from January 2016 to May 2019 were retrospectively analyzed. According to the diagnostic criteria of Guidelines for Diagnosis and Treatment of Acute Pancreatitis in 2014, the patients were divided into mild AP(MAP group, n=60), moderate to severe AP(MSAP group, n=42) and severe AP(SAP group, n=62). According to 28 d survival condition, the patients were divided into survival group(n=148) and death group(n＝16). Relevant clinical factors, serum Hcy level and Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ) score were recorded on admission. Correlation between serum Hcy level and APACHE Ⅱ score was analyzed by Spearman test. Independent risk factors of the prognosis of AP were analyzed by multivariate Logistic regression. Predictive values of serum Hcy level and APACHE Ⅱ score for AP were analyzed by receiver operating characteristic curve. Results Serum Hcy level was （19±5）μmol/L in SAP group, （12±3）μmol/L in MSAP group and （10±4）μmol/L in MAP group, with statistically significant differences among them(P＜0.01). Multivariate logistic regression analysis showed that serum Hcy level and APACHE Ⅱ score were independent risk factors of poor prognosis of AP（both P＜0.05）. There was a positive correlation between serum Hcy level and APACHE Ⅱ score(r＝0.779, P＜0.01). There was no significant difference in area under curve(AUC) between serum Hcy level(AUC=0.896, 95% confidence interval: 0.838-0.937) and APACHE Ⅱ score(AUC=0.911, 95% confidence interval: 0.856-0.950) in predicting the prognosis of AP（Z＝0.338, P＝0.735）. ConclusionSerum Hcy level is closely related with the severity of AP and shows a high predictive value for prognosis.