血浆致动脉粥样硬化指数联合急性胰腺炎床旁严重度指数对重症高甘油三酯血症性急性胰腺炎的早期预测价值

戢奇; 黄燨; 佘琛怡; 张松; 徐维田; 吴清明

doi:10.3969/j.issn.1001-5256.2023.06.021

血浆致动脉粥样硬化指数联合急性胰腺炎床旁严重度指数对重症高甘油三酯血症性急性胰腺炎的早期预测价值

DOI: 10.3969/j.issn.1001-5256.2023.06.021

戢奇¹,
黄燨¹,
佘琛怡¹,
张松²,
徐维田²,
吴清明^1, , ,

1.
武汉科技大学医学院，武汉 430065
2.
中部战区总医院消化内科，武汉 430070

基金项目:

国家自然科学基金 (82200708);

湖北省自然科学基金 (2021CFB001)

伦理学声明：本研究方案于2022年10月20日通过中部战区总医院伦理委员会审核批准，批号为[2022]035-01。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：戢奇负责课题设计，数据采集，统计分析，论文撰写与修改；黄燨、佘琛怡负责数据采集及分析；徐维田、张松负责研究指导和论文审阅；吴清明负责指导论文撰写及定稿。

详细信息

通信作者:
吴清明，wuhe9224@sina.com (ORCID: 0000-0002-8009-1867)

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出版历程
- 收稿日期: 2022-10-31
- 录用日期: 2022-12-05
- 出版日期: 2023-06-20

Value of atherogenic index of plasma combined with Bedside Index for Severity in Acute Pancreatitis in the early prediction of severe hypertriglyceridemic acute pancreatitis

1.
Medical College, Wuhan University of Science and Technology, Wuhan 430065, China
2.
Department of Gastroenterology, The General Hospital of Central Theater Command, Wuhan 430070, China

Research funding:

National Natural Science Foundation of China (82200708);

Natural Science Foundation of Hubei Province (2021CFB001)

More Information

Corresponding author: WU Qingming, wuhe9224@sina.com (ORCID: 0000-0002-8009-1867)

摘要

摘要: 目的探讨血浆致动脉粥样硬化指数(AIP)与高甘油三酯血症性急性胰腺炎(HTG-AP)严重程度的相关性，评估AIP及联合急性胰腺炎床旁严重度指数(BISAP)对于重症HTG-AP(sHTG-AP)的早期预测价值。方法回顾性分析2017年1月—2021年12月中部战区总医院170例HTG-AP住院患者的临床资料，根据指南分为sHTG-AP组(n=28)和非sHTG-AP组(n=142)。所有患者均于入院24 h内完成外周血采集，比较两组患者性别、年龄、实验室检查结果、AIP、BISAP评分和MCTSI评分等。计数资料组间比较采用χ²检验或Fisher精确概率法。计量资料两组间比较采用Mann-Whitney U检验。采用Spearman秩相关检验分析各因素与HTG-AP严重程度的相关性，二元Logistic回归分析sHTG-AP的独立危险因素。绘制受试者工作特征曲线分析各指标预测效能。结果两组患者糖尿病病史、LYM、Alb、Ca²⁺、TG、HDL-C、AIP、BISAP评分、MCTSI评分、住院天数、住院费用之间均存在统计学差异(P值均＜0.05)。sHTG-AP组住院时间更长，住院费用更高，AIP值更大。AIP(OR=1.244，95%CI: 1.062~1.458，P＝0.007)、BISAP评分(OR=5.525，95%CI: 1.646~18.543，P=0.006)和MCTSI评分(OR=2.029，95%CI: 1.245~3.305，P=0.004)是sHTG-AP患者的危险因素。AIP、BISAP和MCTSI均与HTG-AP严重程度呈正相关(P值均＜0.001)，相关系数分别为0.291、0.631、0.649；AIP与BISAP评分、MCTSI评分正相关(P值均＜0.05)，相关系数分别为0.190、0.215。AIP预测sHTG-AP的最佳截断值为1.095，AIP、BISAP评分及AIP联合BISAP评分的曲线下面积分别为0.759、0.887、0.925，敏感度分别为0.821、0.857、0.786，特异度分别为0.627、0.817、0.937(P值均＜0.001)。结论 AIP是sHTG-AP的危险因素并与疾病严重程度相关，联合BISAP评分对于sHTG-AP具有较高的早期预测价值。
- 血浆致动脉粥样硬化指数 /
- 胰腺炎 /
- 高甘油三酯血症
Abstract: Objective To investigate the correlation between atherogenic index of plasma (AIP) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP) and the value of AIP combined with Bedside Index for Severity in Acute Pancreatitis (BISAP) score in the early prediction of severe HTG-AP (sHTG-AP). Methods A retrospective analysis was performed for the clinical data of 170 patients with HTG-AP who were hospitalized in The General Hospital of Central Theater Command from January 2017 to December 2021, and according to related guidelines, they were divided into the sHTG-AP group with 28 patients and non-sHTG-AP group with 142 patients. Peripheral blood samples were collected from all patients within 24 hours after admission, and the two groups were compared in terms of sex, age, laboratory test results, AIP, BISAP score, and modified CT severity index (MCTSI) score. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of continuous data between groups. The Spearman rank correlation test was used to investigate the correlation between each factor and the severity of HTG-AP, and the binary logistic regression analysis were used to investigate the independent risk factors for sHTG-AP. The receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy of each indicator. Results There were significant differences between the two groups in the medical history of diabetes, lymphocyte count, albumin, Ca²⁺, triglyceride, high-density lipoprotein cholesterol, AIP, BISAP score, MCTSI score, length of hospital stay, and hospital costs (all P < 0.05). The sHTG-AP group had a longer length of hospital stay, higher hospital costs, and a higher AIP value. AIP (odds ratio [OR]=1.244, 95% confidence interval [CI]: 1.062-1.458, P=0.007), BISAP score (OR=5.525, 95%CI: 1.646-18.543, P=0.006), and MCTSI score (OR=2.029, 95%CI: 1.245-3.305, P=0.004) were risk factors for sHTG-AP. AIP, BISAP score, and MCTSI score were positively correlated with the severity of HTG-AP (r=0.291, 0.631, and 0.649, all P < 0.001), and AIP was positively correlated with BISAP score and MCTSI score (r=0.190 and 0.215, both P < 0.05). AIP had an optimal cut-off value of 1.095 in predicting sHTG-AP, and AIP, BISAP score, and AIP combined with BISAP score had an area under the ROC curve of 0.759, 0.887, 0.925, respectively, a sensitivity of 0.821, 0.857, and 0.786, respectively, and a specificity of 0.627, 0.817, and 0.937, respectively (all P < 0.001). Conclusion AIP is a risk factor for sHTG-AP and is correlated with disease severity, and AIP combined with BISAP score has a relatively high value in the early prediction of sHTG-AP.
- Atherogenic Index of Plasma /
- Pancreatitis /
- Hypertriglyceridemia

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图 1 各指标预测sHTG-AP的ROC曲线

Figure 1. ROC curve of each index predicting sHTG-AP

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表 1 组间一般临床资料比较

Table 1. Comparison of the general clinical data between the two groups

指标	非sHTG-AP组 (n=142)	sHTG-AP组 (n=28)	统计值	P值
男性(例)	109	25	χ²=2.198	0.138
年龄(岁)	37(31~46)	43(35~49)	Z=-1.932	0.053
糖尿病(例)	47	16	χ²=5.797	0.016
脂肪肝(例)	99	19	χ²=0.038	0.845
NEUT(×10⁹)	10.16(7.79~11.79)	9.75(7.61~11.56)	Z=-0.170	0.865
LYM(×10⁹)	1.28(0.92~1.76)	0.97(0.72~1.36)	Z=-2.830	0.005
TBil(μmol/L)	17.05(12.35~24.13)	20.25(14.08~27.15)	Z=-0.660	0.509
Alb(g/L)	41(38~44)	39(34~41)	Z=-2.903	0.004
SCr(μmol/L)	53(39~64)	62(40~90)	Z=-1.813	0.070
Ca²⁺(mmol/L)	2.15(2.09~2.27)	2.10(1.86~2.18)	Z=-2.394	0.017
TC(mmol/L)	8.28(6.27~11.15)	9.05(5.58~12.88)	Z=-0.317	0.751
TG(mmol/L)	11.44(5.35~14.43)	13.79(9.73~19.20)	Z=-2.428	0.015
HDL-C(mmol/L)	1.07(0.75~1.34)	0.70(0.30~1.08)	Z=-3.464	0.001
AIP	1.03(0.70~1.21)	1.22(1.12~1.59)	Z=-4.321	＜0.001
BISAP	1(0~1)	2(2~2)	Z=-6.854	＜0.001
MCTSI	4(2~6)	6(6~8)	Z=-6.987	＜0.001
住院时长(d)	9(7~13)	13(9~23)	Z=-3.408	0.001
费用(元)	14 752(9 881~27 646)	44 608(2 732~66 878)	Z=-5.319	＜0.001

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表 2 二元Logistic回归分析sHTG-AP的危险因素

Table 2. Binary logistic regression analysis of risk factors for sHTG-AP

指标	B值	OR	95%CI	P值
糖尿病	0.287	1.333	0.311~5.707	0.699
LYM	-0.972	0.378	0.090~1.598	0.186
Alb	-0.102	0.903	0.781~1.045	0.172
Ca²⁺	1.521	4.577	0.198~105.820	0.342
AIP	0.219	1.244	1.062~1.458	0.007
BISAP	1.709	5.525	1.646~18.543	0.006
MCTSI	0.707	2.029	1.245~3.305	0.004

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表 3 各指标对sHTG-AP的预测效能

Table 3. Predictive efficacy of each index for sHTG-AP

变量	截断值	AUC	95%CI	P值	敏感度	特异度
TG	7.040	0.645	0.543~0.748	0.015	0.929	0.331
HDL-C	0.510	0.707	0.587~0.828	＜0.001	0.429	0.944
AIP	1.095	0.759	0.668~0.850	＜0.001	0.821	0.627
BISAP评分	1.500	0.887	0.832~0.942	＜0.001	0.857	0.817
AIP联合BISAP	2.500	0.925	0.876~0.974	＜0.001	0.786	0.937

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参考文献(17)

[1]	PU W, LUO G, CHEN T, et al. A 5-year retrospective cohort study: Epidemiology, etiology, severity, and outcomes of acute pancreatitis[J]. Pancreas, 2020, 49(9): 1161-1167. DOI: 10.1097/MPA.0000000000001637.
[2]	WU H, MA K, LIAO B, et al. Comparative analysis of early clinical features and complications of different types of acute pancreatitis[J]. Oxid Med Cell Longev, 2022, 2022: 3771610. DOI: 10.1155/2022/3771610.
[3]	LIU SZ, YAO JR, MO SJ, et al. Research progress of nutritional support in severe acute pancreatitis[J/OL]. Chin J Hepat Surg(Electronic Edition), 2021, 10(5): 533-535. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.022. 刘世洲, 姚佳柔, 莫绍剑, 等. 重症急性胰腺炎营养支持研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(5): 533-535. DOI: 10.3877/cma.j.issn.2095-3232.2021.05.022.
[4]	DOBIÁSOVÁ M, FROHLICH J. The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL))[J]. Clin Biochem, 2001, 34(7): 583-588. DOI: 10.1016/s0009-9120(01)00263-6.
[5]	CHO SK, KIM JW, HUH JH, et al. Atherogenic index of plasma is a potential biomarker for severe acute pancreatitis: a prospective observational study[J]. J Clin Med, 2020, 9(9): 2982. DOI: 10.3390/jcm9092982.
[6]	WANG Q, WANG G, QIU Z, et al. Elevated serum triglycerides in the prognostic assessment of acute pancreatitis: a systematic review and meta-analysis of observational studies[J]. J Clin Gastroenterol, 2017, 51(7): 586-593. DOI: 10.1097/MCG.0000000000000846.
[7]	SU W, GUO F. Triglyceride-controlling during acute phase of hypertriglyceridemia induced pancreatitis[J]. Chin J Dig Surg, 2023, 22(1): 89-93. DOI: 10.3760/cma.j.cn115610-20221220-00755. 苏伟, 郭丰. 高甘油三酯血症性胰腺炎急性期的血脂控制[J]. 中华消化外科杂志, 2023, 22(1): 89-93. DOI: 10.3760/cma.j.cn115610-20221220-00755.
[8]	HANSEN S, MADSEN CM, VARBO A, et al. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population[J]. Clin Chem, 2019, 65(2): 321-332. DOI: 10.1373/clinchem.2018.294926.
[9]	DONG X, PAN S, ZHANG D, et al. Hyperlipemia pancreatitis onset time affects the association between elevated serum triglyceride levels and disease severity[J]. Lipids Health Dis, 2022, 21(1): 49. DOI: 10.1186/s12944-022-01656-4.
[10]	ZHANG Y, GUO F, LI S, et al. Decreased high density lipoprotein cholesterol is an independent predictor for persistent organ failure, pancreatic necrosis and mortality in acute pancreatitis[J]. Sci Rep, 2017, 7(1): 8064. DOI: 10.1038/s41598-017-06618-w.
[11]	LI YJ, LI J. The value of red blood cell distribution width to platelet ratio and C-reactive protein to albumin ratio combined with BISAP scores in the assessment of acute pancreatitis[J]. Chin J Emerg Med, 2022, 31(9): 1200-1205. DOI: 10.3760/cma.j.issn.1671-0282.2022.09.008. 李艳杰, 李静. 红细胞分布宽度/血小板计数、C反应蛋白/白蛋白联合BISAP评分对急性胰腺炎病情评估的价值[J]. 中华急诊医学杂志, 2022, 31(9): 1200-1205. DOI: 10.3760/cma.j.issn.1671-0282.2022.09.008.
[12]	DONG BY, MAO YQ, LI ZY, et al. The value of the atherogenic index of plasma in non-obese people with non-alcoholic fatty liver disease: a secondary analysis based on a cross-sectional study[J]. Lipids Health Dis, 2020, 19(1): 148. DOI: 10.1186/s12944-020-01319-2.
[13]	LI YW, KAO TW, CHANG PK, et al. Atherogenic index of plasma as predictors for metabolic syndrome, hypertension and diabetes mellitus in Taiwan citizens: a 9-year longitudinal study[J]. Sci Rep, 2021, 11(1): 9900. DOI: 10.1038/s41598-021-89307-z.
[14]	WON KB, HEO R, PARK HB, et al. Atherogenic index of plasma and the risk of rapid progression of coronary atherosclerosis beyond traditional risk factors[J]. Atherosclerosis, 2021, 324: 46-51. DOI: 10.1016/j.atherosclerosis.2021.03.009.
[15]	LI X, GUO X, JI H, et al. Relationships between metabolic comorbidities and occurrence, severity, and outcomes in patients with acute pancreatitis: a narrative review[J]. Biomed Res Int, 2019, 2019: 2645926. DOI: 10.1155/2019/2645926.
[16]	HUANG HM, YANG HY, QIN YY, et al. Relationship between visceral fat related index and the severity of acute pancreatitis[J]. J Clin Hepatol, 2022, 38(10): 2313-2319. DOI: 10.3969/j.issn.1001-5256.2022.10.021. 黄河铭, 杨慧莹, 覃颖颖, 等. 内脏脂肪相关指数与急性胰腺炎严重程度的关系[J]. 临床肝胆病杂志, 2022, 38(10): 2313-2319. DOI: 10.3969/j.issn.1001-5256.2022.10.021.
[17]	SONG XJ, GAO WB, ZHU JH. The prognostic value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio combined with BISAP score for severe hypertriglyceridemia pancreatitis[J]. Chin J Emerg Med, 2022, 31(9): 1193-1199. DOI: 10.3760/cma.j.issn.1671-0282.2022.09.007. 宋小静, 高伟波, 朱继红. 中性粒/淋巴细胞比率、血小板/淋巴细胞比率联合BISAP评分对于重症高三酰甘油血症性胰腺炎早期预测分析[J]. 中华急诊医学杂志, 2022, 31(9): 1193-1199. DOI: 10.3760/cma.j.issn.1671-0282.2022.09.007.