非胆源性急性胰腺炎严重程度早期预测因子及交互作用的影响

doi:10.3969/j.issn.1006-5725.2024.12.015

Abstract

Abstract:

Objective To explore the early prediction value of related test indicators for non-biliary acute pancreatitis and the influence of interaction of related test indicators on non-biliary acute pancreatitis. Methods A total of 280 patients with the first onset of non-biliary acute pancreatitis who were hospitalized in Jinshan Hospital of Fudan University from July 2019 to July 2023 were divided into mild group and severe group. The severe group included moderately severe and severe patients. Clinical data， tests and examination indicators of first-attack inpatients within 48 hours after admission were collected. Through logistics regression analysis， early detection indicators related to the severity of non-biliary acute pancreatitis were explored， and the influence of their interaction was studied. Results Single-factor analysis showed that albumin （ALB）， thyroxine （T4）， serum free triiodothyronine， albumin （ALB）， Thyroxine （T4） in both groups. FT3）， thyroid stimulating hormone （TSH）， serum triglyceride （TG）， calcium （Ca） and other indicators were statistically significant （P < 0.05）； Through multi-factor logistics regression analysis， it was found that the OR values of T4， FT3， TSH， CA and other detection indicators were all less than 1 （P < 0.05）； After controlling for gender， age， history of hypertension， history of diabetes and other factors， the interaction between TG and HbA1c was analyzed， the aOR was 1.500 when only HbA1c was increased （P > 0.05）， the aOR was 4.488 when only TG was increased （P < 0.05）， and the aOR was 5.084 when TG and HbA1c were increased simultaneously （P < 0.05）. Conclusion ALB， T4， FT3， TSH， CA were protective factors of non-biliary AP， and could be used as predictive indicators of the severity of non-biliary acute pancreatitis. Interaction of HbA1c with TG increases the risk of progression to severe non-biliary acute pancreatitis.

Key words: non-biliary, acute pancreatitis, severity degree, early prediction, interaction

CLC Number:

R576

Jing LI,Miao JIANG,Jingxian HU. Early predictors of severity and interaction of non⁃biliary acute pancreatitis[J]. The Journal of Practical Medicine, 2024, 40(12): 1701-1705.

Figures/Tables 5

Tab. 1

Tab. 2

Comparison of basic characteristics between mild group and severe group"

	轻度组（n = 214）	重度组（n = 66）	Z/t值	P值
WBC（×10⁹/L）	10.21 ± 4.72	13.44 ± 5.64	-6.6722	< 0.001
NEUT%	75.99 ± 9.33	86.84 ± 5.96	-8.974	< 0.001
HGB（g/L）	146.57 ± 13.85	149.83 ± 26.96	-2.100	0.039
TP（g/L）	65.98 ± 5.80	59.94 ± 8.92	2.779	0.007
ALB（g/L）	38.20 ± 4.18	34.17 ± 5.39	3.198	0.002
T3（nmol/L）	1.01 ± 0.29	0.80 ± 0.27	6.480	< 0.001
T4（nmol/L）	78.00 ± 18.12	61.59 ± 17.42	5.331	< 0.001
FT3（pmol/L）	3.04 ± 0.79	2.50 ± 1.13	5.559	< 0.001
NA（mmol/L）	138.17 ± 3.30	134.39 ± 6.29	4.311	< 0.001
CA（mmol/L）	2.24 ± 0.16	1.96 ± 0.22	5.855	< 0.001
P（mmol/L）	0.90 ± 0.28	0.86 ± 0.39	3.419	< 0.001
MG（mmol/L）	0.81 ± 0.10	0.74 ± 0.13	0.054	0.957
AT（%）	88.48 ± 18.42	71.00 ± 24.50	3.863	< 0.001
PLT［M（P₂₅，P₇₅），× 10⁹/L］	207.50（169.25，249.75）	188.50（155.25，299.25）	-1.298	0.194
CRP［M（P₂₅，P₇₅），mg/L］	63.45（13.49，113.20）	117.99（47.83，188.77）	-5.147	< 0.001
PCT［M（P₂₅，P₇₅），ng/mL］	0.13（0.05，0.65）	0.34（0.18，5.34）	-5.129	< 0.001
GLU［M（P₂₅，P₇₅），mmol/L］	8.50（7.20，14.10）	12.06（7.53，15.93）	-4.685	< 0.001
AST［M（P₂₅，P₇₅），U/L］	24.50（17.25，38.75）	26.50（15.00，48.25）	-1.073	0.283
ALB最低［M（P₂₅，P₇₅），g/L］	36.50（34.00，39.00）	31.50（26.00，35.00）	-6.118	< 0.001
LDH［M（P₂₅，P₇₅），U/L］	179.00（145.75，213.50）	224.00（172.00，429.75）	-5.828	< 0.001
UREA［M（P₂₅，P₇₅），mmol/L］	3.70（2.93，5.30）	3.85（3.30，8.93）	-0.276	0.782
FT4［M（P₂₅，P₇₅），pmol/L］	14.23（12.66，15.21）	14.03（11.19，14.81）	-2.166	0.030
TSH（mIU/L）	0.51 ± 0.37	0.47 ± 0.31	2.651	0.008
TG［M（P₂₅，P₇₅），mmol/L］	4.03（1.15，11.19）	8.29（3.45，19.12）	-5.157	< 0.001
CHOL［M（P₂₅，P₇₅），mmol/L］	5.89（4.76，8.44）	7.04（4.67，12.09）	-4.338	< 0.001
LDLC［M（P₂₅，P₇₅），mmol/L］	3.71（2.85，5.00）	3.13（2.12，5.11）	-1.086	0.277
HbA1c［M（P₂₅，P₇₅），%］	6.95（5.80，10.03）	8.20（5.43，10.38）	-1.846	0.065
K［M（P₂₅，P₇₅），mmol/L］	3.88（3.50，4.15）	4.00（3.83，4.50）	-0.520	0.603
PT［M（P₂₅，P₇₅），s］	12.00（11.60，12.48）	11.81（11.13，14.03）	-0.628	0.530

Tab. 2

Fig.1

Fig.2

Fig. 3

References 19

1	ROXVALL L， BENGTSON A， SENNERBY L， et al. Activation of the complement cascade by trypsin［J］. Biol Chem Hoppe Seyler， 1991， 372（4）： 273-278. doi:10.1515/bchm3.1991.372.1.273 doi: 10.1515/bchm3.1991.372.1.273
2	MEDEROS M A， REBER H A， GIRGIS M D. Acute Pancreatitis： A Review［J］. JAMA， 2021， 325（4）： 382-390. doi:10.1001/jama.2020.20317 doi: 10.1001/jama.2020.20317
3	HU J X， ZHAO C F， WANG S L， et al. Acute pancreatitis： A review of diagnosis，severity prediction and prognosis assessment from imaging technology，scoring system and artificial intelligence［J］. 世界胃肠病学杂志：英文版， 2023， 29（37）： 5268-5291.
4	FORSMARK C H E， VEGE S S， WILCOX C M. Acute Pancreatitis［J］. N Engl J Med， 2017， 376（6）： 598-599. doi:10.1056/nejmc1616177 doi: 10.1056/nejmc1616177
5	BANKS P A， BOLLEN T L， DERVENIS C， et al. Classification of acute pancreatitis--2012： revision of the Atlanta classification and definitions by international consensus［J］. Gut， 2013， 62（1）： 102-111. doi:10.1136/gutjnl-2012-302779 doi: 10.1136/gutjnl-2012-302779
6	BUSIREDDY K K， ALOBAIDY M， RAMALHO M， et al. Pancreatitis-imaging approach［J］. World J Gastrointest Pathophysiol， 2014， 5（3）： 252-270. doi:10.4291/wjgp.v5.i3.252 doi: 10.4291/wjgp.v5.i3.252
7	THOENI R F. The revised Atlanta classification of acute pancreatitis： its importance for the radiologist and its effect on treatment［J］. Radiology， 2012， 262（3）： 751-764. doi:10.1148/radiol.11110947 doi: 10.1148/radiol.11110947
8	KISS L， FUR G， MATRAI P， et al. The effect of serum triglyceride concentration on the outcome of acute pancreatitis： systematic review and meta-analysis［J］. Sci Rep， 2018， 8（1）： 14096. doi:10.1038/s41598-018-32337-x doi: 10.1038/s41598-018-32337-x
9	VAN DEN BERG F F， DE BRUIJN， ANNA C，et al. Early laboratory biomarkers for severity in acute pancreatitis； A systematic review and meta-analysis［J］. Pancreatology， 2020， 20（7）： 1302-1311. doi:10.1016/j.pan.2020.09.007 doi: 10.1016/j.pan.2020.09.007
10	CHENG T， XIAO B J， LIU B F， et al. Efficiency of free thyroxine in predicting severity and mortality of patients with acute pancreatitis： A protocol for systematic review and meta-analysis［J］. Medicine （Baltimore）， 2021， 100（7）： e24809. doi:10.1097/md.0000000000024809 doi: 10.1097/md.0000000000024809
11	KUMAR B G V， PRASAD K， SINGH D， et al. Hypertriglyceridemia induced acute pancreatitis： 4 years' experience from a tertiary care institute and quick literature review［J］. J Family Med Prim Care， 2022， 11（6）： 3360-3367. doi:10.4103/jfmpc.jfmpc_1426_21 doi: 10.4103/jfmpc.jfmpc_1426_21
12	CHOI Y H， HAN K D， CHO I R， et al. Underweight Is Associated with a Higher Risk of Acute Pancreatitis in Type 2 Diabetes： A Nationwide Cohort Study［J］. J Clin Med， 2022， 11（19）：5641. doi:10.3390/jcm11195641 doi: 10.3390/jcm11195641
13	WALLER A， LONG B， KOYFMAN A， et al. Acute Pancreatitis： Updates for Emergency Clinicians［J］. J Emerg Med， 2018， 55（6）： 769-779. doi:10.1016/j.jemermed.2018.08.009 doi: 10.1016/j.jemermed.2018.08.009
14	张冰，孙秋，杜丽明，等. 前瞻性队列研究—甘油三酯葡萄糖指数与急性胰腺炎发病风险［J］. 实用医学杂志， 2023， 39（23）： 3116-3119. doi:10.3969/j.issn.1006-5725.2023.23.016 doi: 10.3969/j.issn.1006-5725.2023.23.016
15	HUANG Y， ZHU Y， PENG Y， et al. Triglycerides to high-density lipoprotein cholesterol （TG/HDL-C） ratio is an independent predictor of the severity of hyperlipidaemic acute pancreatitis［J］. J Hepatobiliary Pancreat Sci， 2023， 30（6）： 784-791. doi:10.1002/jhbp.1281 doi: 10.1002/jhbp.1281
16	KIM Y J， KIM D B， CHUNG W C， et al. Analysis of factors influencing survival in patients with severe acute pancreatitis［J］. Scand J Gastroenterol， 2017， 52（8）： 904-908. doi:10.1080/00365521.2017.1310291 doi: 10.1080/00365521.2017.1310291
17	SHEN H N， CHANG Y H， CHEN H F， et al. Increased risk of severe acute pancreatitis in patients with diabetes［J］. Diabet Med， 2012， 29（11）： 1419-1424. doi:10.1111/j.1464-5491.2012.03680.x doi: 10.1111/j.1464-5491.2012.03680.x
18	MA L P， LIU X， CUI B C， et al. Diabetic Ketoacidosis With Acute Pancreatitis in Patients With Type 2 Diabetes in the Emergency Department： A Retrospective Study［J］. Front Med （Lausanne）， 2022， 9：813083. doi:10.3389/fmed.2022.813083 doi: 10.3389/fmed.2022.813083
19	CHEN E X， TU YA S Q， SHE Z F， et al. The clinical characteristic of alcohol-hyperlipidemia etiologically complex type of acute pancreatitis［J］. Eur Rev Med Pharmacol Sci， 2022， 26（19）： 7212-7218.

	轻度组（n = 214）	重度组（n = 66）	χ²/Z值	P值
年龄［M（P₂₅，P₇₅），岁］	45.00（38.00，59.25）	41.00（34.00，53.00）	-1.985	0.047
性别			0.079	0.778
男	153（71.50）	46（69.70）
女	61（28.50）	20（30.30）
饮酒史			0.058	0.810
无	189（78.42）	59（89.39）
有	25（21.58）	7（10.61）
糖尿病史			0.446	0.504
无	155（72.43）	45（68.18）
有	59（27.57）	21（31.82）
高血压史			0.071	0.790
无	140（65.42）	42（63.64）
有	74（34.58）	24（36.36）

[1]	Zihui FU,Ming JIANG,Qun FU,Xiaokun ZHANG,Rong YANG,Yang JIAO,Changxi. SHI. Application of dynamic monitoring index pulse pressure variability based on cardiopulmonary interaction in early prevention of prostate resection syndrome [J]. The Journal of Practical Medicine, 2025, 41(6): 806-812.
[2]	Le WU,Runlu GENG,Jingjiang ZHOU,Li LI,Lei XU,Jie KANG,Bin LU,Ying YE,Hongning YANG,Weichao. DING. Efficacy of HP in series with CRRT integrated combined blood purification under extracorporeal citrate anticoagulation in the treatment of severe HTG⁃AP [J]. The Journal of Practical Medicine, 2025, 41(4): 561-568.
[3]	Lulu CHEN,Meng LUO,Kaiqi SU,Jing GAO,Xiaodong. FENG. Research progress of the endoplasmic reticulum⁃mitochondrial interactions in post⁃stroke cognitive impairment [J]. The Journal of Practical Medicine, 2024, 40(7): 1023-1028.
[4]	Qingmin YANG,Hongxia DING,Xiaoxiao. YE. The interactive effect of vitamin D and triglyceride/high⁃density lipoprotein cholesterol on achieving glycemic control in hospitalized type 2 diabetes patients [J]. The Journal of Practical Medicine, 2024, 40(21): 3054-3060.
[5]	Qizhu FENG,Manman LU,Jie SUN,Jiaquan ZHANG,Sheng DING,Jian ZHANG,Qi. WANG. Novel markers of systemic inflammation in prediction of the early severity of acute pancreatitis [J]. The Journal of Practical Medicine, 2024, 40(14): 1963-1968.
[6]	A′fang SU,Guangjian LI,Yunshui ZHANG,Xiujuan ZHAO,Shouling WU,Xiaozhong. JIANG. A study on the association between exposure of uric acid accumulation and risks of acute pancreatitis [J]. The Journal of Practical Medicine, 2024, 40(14): 2009-2014.
[7]	Ruxue SUN,Mengli ZHU,Jingjing LIU,Fei. CHEN. Role and mechanism of RhoF-mediated Th17 polarization in development of acute pancreatitis [J]. The Journal of Practical Medicine, 2024, 40(10): 1351-1356.
[8]	Bing ZHANG,Qiu SUN,Liming DU,Shuohua. CHEN. Correlation between triglyceride glucose index and risk of acute pancreatitis： A prospective cohort study [J]. The Journal of Practical Medicine, 2023, 39(23): 3116-3119.
[9]	XU Zhirong, MAI Juanjuan, WANG Li, LIU Guolian, BAI Yaru, MA Jiahui, YAO Wenlian.. Effect of home visit nursing based on interaction model of client health behavior on rehabilitation of com⁃ munity stroke patients [J]. The Journal of Practical Medicine, 2022, 38(20): 2614-2619.
[10]	WU Qian, GAO Yumin, LI Wuyuntana, PANG Hui, ZHAO Yanping, YU Pei⁃ yao, WANG Zhidi, CHEN Le, ZHAO Lingyan.. Study on the interaction of leptin receptor and adiponectin receptor gene polymorphisms with type 2 diabe⁃ tes in Mongolian population [J]. The Journal of Practical Medicine, 2022, 38(1): 57-61.
[11]	WAN Xingyu, MAO Ping, FAN Zhongbao, LIU Qingfeng.. The efficacy of intravenous application of selective non ⁃ steroidal anti ⁃inflammatory drugs for preventing post ⁃ERCP pancreatitis after endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy [J]. The Journal of Practical Medicine, 2021, 37(24): 3158-3162.
[12]	PAN Longfei, PEI Honghong, HONG Xin, WANG Liming, ZHANG Zhengliang, BAI Zhenghai.. Diagnosis and treatment of hypertriglyceridemic acute pancreatitis [J]. The Journal of Practical Medicine, 2021, 37(20): 2569-2574.
[13]	LI Hongying, MENG Mingming. . Effect of feeding at different times on postoperative curative effect，gastrointestinal function recovery and humoral immune indexes in patients with acute pancreatitis [J]. The Journal of Practical Medicine, 2021, 37(18): 2395-2400.

Early predictors of severity and interaction of non⁃biliary acute pancreatitis

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 19

Related Articles 13

Recommended Articles

Metrics

Comments