RAR、CLR联合BISAP评分对中重度急性胰腺炎病情严重程度的预测价值

doi:10.3969/j.issn.1004-583X.2025.07.003

摘要/Abstract

摘要：

目的探讨红细胞分布宽度与血清白蛋白比值(red cell distribution width-albumin ratio,RAR)、C反应蛋白/淋巴细胞比率比值(C-reactive protein/lymphocyte ratio,CLR)联合急性胰腺炎严重程度床边指数(bedside index for severity in acute pancreatitis,BISAP)评分对急性胰腺炎(acute pancreatitis, AP)患者病情严重程度进行早期评估的预测价值。方法选取2022年4月-2024年10月济宁市第一人民医院收治的AP患者237例,根据修订的亚特兰大急性胰腺炎分级标准分为重度急性胰腺炎(severe acute pancreatitis,SAP)组(n=110)和非SAP组(n=127)。收集并比较两组的一般资料及相关实验室指标。结果 SAP组白细胞计数、C反应蛋白、CLR、血清淀粉酶、乳酸脱氢酶、降钙素原及BISAP评分均高于非SAP组,白蛋白、淋巴细胞比率、血清钙离子、RAR均低于非SAP组,差异均有统计学意义(P<0.05)。受试者工作特征曲线分析显示,RAR、CLR联合BISAP评分的曲线下面积高于BISAP评分、RAR、CLR及RAR联合CLR(P<0.005),其敏感度为86.4%,特异度为79.5%。结论 BISAP评分、RAR、CLR、RAR联合CLR及RAR、CLR联合BISAP评分均为评估AP病情严重程度的有效指标,相比之下,RAR、CLR联合BISAP评分的预测价值较好,更加准确,适用于对AP的综合评估,可广泛用于临床实践,值得推广。

关键词: 急性胰腺炎, 红细胞分布宽度, 白蛋白, C反应蛋白, 淋巴细胞比率, BISAP评分, 预测价值

Abstract:

Objective To investigate the predictive value of red cell distribution width-albumin ratio (RAR) combined with C-reactive protein/lymphocyte ratio (CLR) and bedside index for severity in acute pancreatitis (BISAP) score in the early assessment of the severity of acute pancreatitis (AP). Methods A total of 237 AP patients admitted to the First People's Hospital of Jining from April 2022 to October 2024 were selected. They were divided into the severe acute pancreatitis (SAP) group (n=110) and non-SAP group (n=127) according to the revised Atlanta classification criteria for AP. The general data and related laboratory indicators of the two groups were collected and compared. Results White blood cell count, C-reactive protein, CLR, serum amylase, lactate dehydrogenase, procalcitonin and BISAP scores in the SAP group were significantly higher, while albumin, lymphocyte ratio, serum calcium ion and RAR were significantly lower than those in the non-SAP group (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of RAR combined with CLR and BISAP score was significantly larger than the single indicator or RAR combined with CLR (P<0.005), with a sensitivity of 86.4% and a specificity of 79.5%. Conclusion BISAP score, RAR, CLR, RAR combined with CLR, and RAR combined with CLR and BISAP score are all valid indicators for assessing the severity of AP. In contrast, the predictive value of RAR combined with CLR and BISAP score is better and more accurate, which is applicable to the comprehensive assessment of AP, and can be promoted and widely used in clinical practice.

Key words: acute pancreatitis, erythrocyte distribution width, albumin, C-reactive protein, lymphocyte ratio, BISAP score, predictive value

中图分类号:

R576

张敬知, 张艳丽, 孟庆顺. RAR、CLR联合BISAP评分对中重度急性胰腺炎病情严重程度的预测价值[J]. 临床荟萃, 2025, 40(7): 595-601.

Zhang Jingzhi, Zhang Yanli, Meng Qingshun. Predictive value of red cell distribution width-albumin ratio combined with C-reactive protein/lymphocyte ratio and bedside index for severity in acute pancreatitis in the severity of moderate-to-severe acute pancreatitis[J]. Clinical Focus, 2025, 40(7): 595-601.

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参考文献 54

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项目	非SAP(n=127)	SAP组(n=110)	t/χ²值	P值
年龄(岁)	45.43±13.45	49.96±17.92	-2.173	0.031
性别[例(%)]
男女	98(77.2) 29(22.8)	75(68.2) 35(31.8)	2.413	0.120
病因[例(%)]
高脂血症	62(48.8)	47(42.7)
胆源性	19(15.0)	18(16.4)	0.887	0.642
其他	46(36.2)	45(40.9)
高血压史[例(%)]	31(24.4)	26(23.6)	0.019	0.890
糖尿病史[例(%)]	27(21.3)	24(21.8)	0.011	0.917
吸烟史[例(%)]	45(35.4)	30(27.3)	1.815	0.178
饮酒史[例(%)]	47(37.0)	35(31.8)	0.702	0.402
住院时间(d)	6.69±2.45	11.19±5.90	-7.455	0.000

项目	非SAP(n=127)	SAP组(n=110)	t/χ²值	P值
年龄(岁)	45.43±13.45	49.96±17.92	-2.173	0.031
性别[例(%)]
男女	98(77.2) 29(22.8)	75(68.2) 35(31.8)	2.413	0.120
病因[例(%)]
高脂血症	62(48.8)	47(42.7)
胆源性	19(15.0)	18(16.4)	0.887	0.642
其他	46(36.2)	45(40.9)
高血压史[例(%)]	31(24.4)	26(23.6)	0.019	0.890
糖尿病史[例(%)]	27(21.3)	24(21.8)	0.011	0.917
吸烟史[例(%)]	45(35.4)	30(27.3)	1.815	0.178
饮酒史[例(%)]	47(37.0)	35(31.8)	0.702	0.402
住院时间(d)	6.69±2.45	11.19±5.90	-7.455	0.000

项目	非SAP组(n=127)	SAP组(n=110)	t/Z值	P值
WBC(×10⁹/L)	12.00±3.69	13.09±4.34	-2.11	0.036
HGB(g/L)	153.39±18.91	155.28±24.97	-0.65	0.518
PLT(×10⁹/L)	250.33±64.37	245.69±81.50	0.49	0.625
CRP(mg/L)	19.03(5.65,58.01)	50.12(18.53,98.32)	-4.48	0.000
LY%	12.90(9.50,18.00)	9.75(5.98,15.30)	-3.33	0.001
CLR	0.93(0.39,2.31)	5.11(1.21,12.76)	-6.43	0.000
RDW(%)	12.20(11.90,12.70)	12.35(11.90,12.90)	-1.40	0.160
ALB(g/L)	39.95±4.21	38.05±5.75	2.86	0.005
RAR	2.11(0.32,9.90)	0.32(0.29,0.38)	-6.81	0.000
AMY(IU/L)	265.50(115.40,519.00)	460.95(137.00,1118.00)	-2.87	0.004
Scr(μmol/L)	60.70(49.90,72.00)	58.65(48.65,72.38)	-0.17	0.866
BUN(mg/L)	4.29(3.32,5.30)	4.20(3.34,5.70)	-0.39	0.700
LDH(IU/L)	216.00(180.00,282.00)	259.00(207.68,345.25)	-3.76	0.000
Ca²⁺(mmol/L)	2.18±0.13	2.09±0.21	3.56	0.000
PCT(μg/L)	0.06(0.04,0.13)	0.13(0.07,0.58)	-4.47	0.000
BISAP评分(分)	1(0,1)	2(1,2)	-7.80	0.000

项目	非SAP组(n=127)	SAP组(n=110)	t/Z值	P值
WBC(×10⁹/L)	12.00±3.69	13.09±4.34	-2.11	0.036
HGB(g/L)	153.39±18.91	155.28±24.97	-0.65	0.518
PLT(×10⁹/L)	250.33±64.37	245.69±81.50	0.49	0.625
CRP(mg/L)	19.03(5.65,58.01)	50.12(18.53,98.32)	-4.48	0.000
LY%	12.90(9.50,18.00)	9.75(5.98,15.30)	-3.33	0.001
CLR	0.93(0.39,2.31)	5.11(1.21,12.76)	-6.43	0.000
RDW(%)	12.20(11.90,12.70)	12.35(11.90,12.90)	-1.40	0.160
ALB(g/L)	39.95±4.21	38.05±5.75	2.86	0.005
RAR	2.11(0.32,9.90)	0.32(0.29,0.38)	-6.81	0.000
AMY(IU/L)	265.50(115.40,519.00)	460.95(137.00,1118.00)	-2.87	0.004
Scr(μmol/L)	60.70(49.90,72.00)	58.65(48.65,72.38)	-0.17	0.866
BUN(mg/L)	4.29(3.32,5.30)	4.20(3.34,5.70)	-0.39	0.700
LDH(IU/L)	216.00(180.00,282.00)	259.00(207.68,345.25)	-3.76	0.000
Ca²⁺(mmol/L)	2.18±0.13	2.09±0.21	3.56	0.000
PCT(μg/L)	0.06(0.04,0.13)	0.13(0.07,0.58)	-4.47	0.000
BISAP评分(分)	1(0,1)	2(1,2)	-7.80	0.000

变量	回归系数	标准误	Waldχ²值	P值	OR值	95%CI
CRP	0.011	0.003	16.318	0.000	1.011	1.006~1.017
Ca²⁺	-2.867	0.834	11.811	0.001	0.057	0.011~0.292
PCT	0.231	0.103	5.038	0.025	1.260	1.030~1.542
AMY	0.000	0.000	5.143	0.023	1.000	1.000~1.001
LDH	0.002	0.001	5.526	0.019	1.002	1.000~1.004
BISAP评分	1.366	0.200	46.550	0.000	3.921	2.648~5.805
CLR	0.157	0.030	27.377	0.000	1.170	1.103~1.241
RAR	-0.979	0.239	16.829	0.000	0.376	0.235~0.600
ALB	-0.077	0.027	7.940	0.005	0.926	0.877~0.977
LY%	-0.041	0.018	5.325	0.021	0.960	0.927~0.094