Page 45 - 2022-12-中国全科医学

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proved to have a certain significance in predicting the severity of pancreatitis，however，at present，there are few relevant
studies on the diagnostic and predictive value of NLR and PLR for liver injury in biliary acute pancreatitis（BAP）. Objective
To explore the correlation between NLR and PLR in the severity of BAP and the concurrent acute liver injury（ALI）. Methods
A total of 142 patients with BAP admitted to Emergency Department of the Second Affiliated Hospital of Nanchang University
from March 2019 to March 2021 were selected and divided into mild（MAP）/moderately（MSAP） group（n=98） and severe
（SAP） group（n=44） according to Atlanta classification. According to whether the liver function is damaged or not，they
were divided into ALI group（n=92） and non-ALI group（n=50）. The ALI group was further divided into hepatocyte type
liver injury subgroup（n=1），bile duct type liver injury subgroup（n=16） and mixed type liver injury subgroup（n=75）.
The general condition and clinical data of patients were collected，and the predictive value of NLR and PLR on the severity of
BAP and concurrent ALI was explored by the ROC curve and binary Logistic regression analysis. Results The NLR and PLR
in MAP/MSAP group were lower than those in SAP group（P<0.05）. The NLR and PLR in ALI group were higher than those in
non-ALI group（P<0.05）. There was no significant difference in NLR and PLR between bile duct type liver injury subgroup and
mixed type liver injury subgroup （P>0.05）. The area under the ROC curve of NLR，PLR and their joint prediction of SAP was
0.809，0.667，0.809，respectively. The area under the ROC curve of NLR，PLR and their joint prediction of ALI in BAP was
0.774，0.767，0.806，respectively. The area under the ROC curve of NLR，PLR and their joint prediction of the occurrence of
cholangiocytic liver injury in BAP was 0.813，0.742，0.861，respectively. The area under ROC curve of NLR，PLR and their
joint prediction of mixed liver injury in BAP was 0.763，0.770 and 0.794 respectively. The results of binary Logistic regression
analysis showed that elevated NLR was a risk factor for SAP〔OR=1.184，95%CI（1.102，1.271），P<0.001〕. Elevated NLR
and PLR were the risk factors for ALI in BAP〔OR=1.140，95%CI（1.050，1.238），P=0.002；OR=1.007，95%CI（1.001，
1.013），P=0.023〕；elevated NLR was a risk factor for bile duct cell liver injury in BAP〔OR=1.184，95%CI（1.054，1.331），
P=0.004〕. Elevated NLR and PLR were risk factors for mixed liver injury in BAP〔OR=1.120，95%CI（1.120，1.221），
P=0.011；OR=1.007，95%CI（1.001，1.013），P=0.034〕. Conclusion Elevated NLR is a risk factor for SAP，elevated
NLR and PLR are the risk factors for ALI in BAP. The predictive value of NLR on the severity of BAP and concurrent ALI is better
than PLR，and the combined detection effect is better.
【Key words】 Pancreatitis；Biliary acute pancreatitis；Neutrophil to lymphocyte ratio；Platelet to lymphocyte ratio；
Acute liver injury

急性胰腺炎（AP）时胰腺局部损伤，通过激活细 临床评估 BAP 严重程度及预测 ALI 提供简便的方法。
胞因子级联导致全身炎性反应，其临床表现不尽相同， 1 对象与方法
从无症状到全身炎症反应综合征（SIRS）、多器官功 1.1 研究对象 选取 2019 年 3 月至 2021 年 3 月就诊
能衰竭甚至死亡。胆源性急性胰腺炎（BAP）是常见 于南昌大学第二附属医院急诊科的 142 例 BAP 患者。
的 AP 病因之一，其中急性肝损伤（ALI）是 BAP 常见 纳入标准：（1）AP 的诊断符合 2012 年修订的亚特兰
的并发症之一 ［1］ 。BAP 肝损伤的机制较复杂，从引发 大定义 ［7］ ，AP 的诊断符合以下 3 项标准中的至少 2 项：
ALI 的源头疾病来讲，除胰腺炎疾病本身对肝脏造成的 ①急性、持续中上腹疼痛；②血清淀粉酶或脂肪酶 > 参
影响，胆管疾病亦可引发肝损伤。目前普遍认为 BAP 考值上限的 3 倍；③ AP 的典型影像学改变。（2）经
并发 ALI 或胆源性胰腺炎肝损伤等类似名称均包括了 影像学（B 超、CT、MRI/MRCP）检查确定 AP 的病因
AP 和胆管疾病引起的肝损伤 ［1-3］ 。BAP 肝损伤的发病 为胆源性。（3）病例有完整记录，无中途出院或不遵
机制为炎性反应、感染、胰酶损伤、胆汁淤积、氧化应 医嘱出院情况。（4）入院 24 h 内（使用药物治疗前采
激等 ［1-3］ 。因此，及时准确评估 BAP 严重程度、尽早 集血液进行检测）完成所需实验室指标采集。排除标准：
预测 ALI 并积极治疗，避免胰腺炎重症化显得尤其重要。 （1）存在慢性肝功能不全、肾功能不全、冠心病病史，
目前诊断 ALI 的基础手段为肝功能实验室检测，但其 或进行过肝移植、合并肝硬化、合并肝恶性肿瘤；（2）
价格相对昂贵且检测时间较长。炎性反应在引起胰腺炎 就诊 7 d 内有相关可疑导致肝损伤行为：如服用肝脏毒
重症化及并发 ALI 中具有重要作用 ［1，4］ 。中性粒细胞 性药物、大量饮酒等；（3）存在重大影响免疫力的疾
与淋巴细胞比值（NLR）、血小板计数与淋巴细胞比值 病：如艾滋病、恶性肿瘤等。患者均已签署知情同意
（PLR）作为炎性反应标志物，已被证实在预测肝损伤、 书，并经南昌大学第二附属医院伦理委员会审批（研临
胆管疾病严重程度中具有重要意义 ［5-6］ 。本研究拟探讨 审 2021 第 87 号）。
［7］
NLR、PLR 与 BAP 严重程度及 ALI 的相关性，以期为 1.2 分类 按照 2012 年修订的亚特兰大分类和定义 ：