急性胰腺炎严重程度与预后的评估策略

马敏; 刘鑫; 韦懿芳; 李培武

doi:10.12449/JCH260634

急性胰腺炎严重程度与预后的评估策略

DOI: 10.12449/JCH260634

马敏¹,
刘鑫¹,
韦懿芳¹,
李培武^2, , ,

1.
兰州大学第二临床医学院，兰州 730030
2.
兰州大学第二医院急诊科，兰州 730030

基金项目:

国家自然科学基金 (82260135)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：马敏负责文献检索，拟定写作思路，撰写论文；刘鑫、韦懿芳参与文献检索，资料整理；刘鑫负责修改论文；李培武指导撰写文章并最后定稿。

详细信息

通信作者:
李培武， lipeiw@lzu.edu.cn （ORCID： 0000-0003-3127-930X）

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出版历程
- 收稿日期: 2025-10-16
- 录用日期: 2025-11-28
- 出版日期: 2026-06-25

Assessment of the severity and prognosis of acute pancreatitis

Min MA¹,
Xin LIU¹,
Yifang WEI¹,
Peiwu LI^{2
, ,
,}

1.
The Second Clinical Medical College of Lanzhou University，Lanzhou 730030，China
2.
Department of Emergency Medicine，The Second Hospital of Lanzhou University，Lanzhou 730030，China

Research funding:

National Natural Science Foundation of China (82260135)

More Information

Corresponding author: LI Peiwu， lipeiw@lzu.edu.cn （ORCID： 0000-0003-3127-930X）

摘要

摘要: 急性胰腺炎起病急骤，虽多数病例呈自限性，但存在快速恶化的风险，严重威胁患者生命。目前，传统评估工具如临床评分系统和血清标志物，已广泛用于病情严重程度及预后的判断。为提升评估准确性，临床上常采用联合检测策略，整合不同评分与生物标志物，但仍存在特异性不足、早期敏感性有限及缺乏统一截断值等局限。为此，当前研究正致力于探索具有更高特异性和敏感性的新型标志物，并优化其联合应用策略。本文综述了传统评估工具与联合检测的应用现状，并概述了新型标志物的研究进展。
- 胰腺炎 /
- 评估工具 /
- 标志物 /
- 预后
Abstract: Acute pancreatitis （AP） often has an acute onset， and although most cases are self-limiting， there is still a risk of rapid deterioration， posing a serious threat to the lives of patients. Currently， traditional assessment tools such as clinical scoring systems and serum biomarkers are widely used to determine disease severity and prognosis. To enhance the accuracy of assessment， combined detection strategies integrating different scores and biomarkers are often used in clinical practice； however， there are still certain limitations such as insufficient specificity， limited early sensitivity， and a lack of consistent cut-off values. Therefore， current studies are actively exploring novel biomarkers with superior specificity and sensitivity and continuously optimizing their combined application strategies. This article summarizes the current application status of traditional assessment tools and reviews the research advances in novel biomarkers.
- Pancreatitis /
- Assessment Tools /
- Biomarkers /
- Prognosis

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表 1 AP传统评估工具

Table 1. AP traditional assessment tool

标志物类别	优势	局限性
血清学标志物^［6-8］
CRP	应用广泛，是评估炎症严重程度的常用指标	（1）滞后性：通常在发病后48～72 h才达到峰值，不利于早期预测（2）非特异性：任何严重炎症、感染或创伤都可升高
PCT	动态监测有助于早期预警，对继发胰腺感染或脓毒症的预测价值优于CRP	非胰腺特异性：全身性细菌感染均可引起升高
临床评分量表^［9-11］
BISAP	（1）简单快速：仅需5项指标（2）预测价值良好：对病死率和器官衰竭有较好的早期预测能力	特异性待提高
APACHEⅡ	全面、动态评估	（1）参数繁多：计算复杂（2）非特异性：并非AP专用评分，任何重症患者均可使用
Ranson评分	临床研究数据丰富，成本低	计算繁琐：无法在入院时立即提供准确预测
影像学检查^［12-13］
腹部超声	快速、便捷、无辐射，是检测胆源性AP的最佳初筛工具	受限明显：肠道气体干扰严重，常无法清晰显示胰腺本身
计算机体层成像增强检查	评估严重程度的“金标准”，能准确评估胰腺坏死范围及并发症	（1）有辐射（2）需注射碘对比剂：肾功能不全或过敏者禁忌（3）早期敏感性不足
磁共振成像	无辐射、软组织分辨率高	（1）检查时间长，危重患者不易配合（2）成本高，设备普及性不如CT
注：AP，急性胰腺炎；CRP，C反应蛋白；PCT，降钙素原；BISAP，急性胰腺炎严重程度床边指数；APACHEⅡ，急性生理与慢性健康评分Ⅱ；Ranson评分，兰森评分。

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表 2 新型标志物

Table 2. New biomarker

类别	特点与用途	临床适用性
生物标志物
PLD2	直接参与AP的核心病理生理过程，其水平变化能直接反映疾病活动度	目前主要处于基础研究与早期临床转化阶段，未来可能用于辅助诊断、病情严重程度的精准判断以及作为新型治疗靶点的研发
评分系统
BHN评分	适用于急诊或入院初期（24～48 h内）对患者进行快速危险分级，识别潜在的重症患者	已进入临床验证与应用研究阶段，部分研究证实其效能与 BISAP等传统评分相当，甚至更优
影像学
dVPCT	量化评估胰腺、肝脏等器官的微循环变化	前沿探索，用于揭示病理生理机制
AI	自动分割胰腺、辅助决策和优化评估流程	快速发展中，未来有望融入临床工作
注：PLD2，磷脂酶D2；BHN评分，血尿素氮-心率-中性粒细胞淋巴细胞比值评分；dVPCT，动态容积灌注CT；AI，人工智能；AP，急性胰腺炎；BISAP，急性胰腺炎严重程度床边指数。

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表 3 其他潜在生物标志物分类及特点

Table 3. Other potential biomarker categories and characteristics

生物标志物	核心机制	作为新型生物标志物的潜力	主要限制与挑战
FXR^［36-37］	胆汁酸代谢关键受体，其激动剂可减轻胰腺腺泡细胞坏死	作为潜在治疗靶点；血清胆汁酸水平变化可能与病情相关	胆汁酸代谢动态复杂，特异性改变与 AP严重程度的普适性待证实
ORAI1^［38-39］	介导钙内流，参与AP早期病理性“钙超载”	微RNA-26a等可调控其表达，影响钙信号，是潜在的治疗靶点	缺乏大型临床队列验证其作为独立生物标志物的特异性与敏感性
NET^［40］	中性粒细胞释放的DNA网状结构，过度形成会加剧组织损伤、炎症	血液中NET成分可能反映AP严重程度与预后	检测标准化方案缺失，定量困难
P-selectin^［41］	促进白细胞募集、黏附，加剧炎症反应及微循环障碍	可能参与AP多种重要病理、生理过程	非特异性指标，在AP诊断中特异性不足
注：FXR，法尼醇X受体；ORAI1，钙释放激活钙通道蛋白1；NET，中性粒细胞胞外诱捕网；P-selectin，P-选择素；AP，急性胰腺炎。

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