摘要目的:探讨血清白细胞介素-6（IL-6）、氯离子（Cl -）、D-二聚体和纤维蛋白降解产物（FDP）联合检测对急性胰腺炎（AP）严重程度的预测价值。 方法:从2020年12月至2022年3月在郑州大学第一附属医院急诊外科诊治的292例AP患者中筛选出符合纳入标准的132例患者，按分类标准将其分为重症急性胰腺炎（SAP）组（63例）和非SAP组（69例）。收集患者一般信息及相关实验室检查指标，包括血常规、血生化及相关影像学资料，并计算急性胰腺炎严重程度床旁指数（BISAP）评分。将有统计学意义的指标进行多因素Logistic回归分析，寻找影响AP患者病情严重程度的危险因素。绘制受试者工作特征曲线（ROC曲线），判断各指标对AP严重程度的临床预测价值。结果:共纳入132例AP患者。SAP组血清IL-6、D-二聚体、FDP水平及BISAP评分均明显高于非SAP组〔血清IL-6（ng/L）：62.73（21.54，187.47）比8.22（4.13，14.70），D-二聚体（mg/L）：5.36（2.94，8.25）比0.94（0.42，2.21），FDP（mg/L）：13.54（6.76，22.45）比3.20（2.50，6.10），BISAP评分：2.00（1.00，3.00）比1.00（0，2.00），均 P<0.05〕，而血清Cl -水平则明显低于非SAP组（mmol/L：97.90±4.86比101.73±4.32， P<0.05）。多因素Logistic回归分析显示，IL-6〔优势比（ OR）＝1.02，95%可信区间（95% CI）为1.01~1.04〕、D-二聚体（ OR＝1.21，95% CI为1.05~1.40）水平升高及Cl -（ OR＝0.88，95% CI为0.79~0.98）水平降低是AP患者发生SAP的危险因素（均 P<0.05）。ROC曲线分析显示，IL-6、Cl -、D-二聚体、FDP联合检测预测AP患者病情严重程度的ROC曲线下面积（AUC）较大（为0.89），敏感度（82.50%）及特异度（85.50%）较高。 结论:相比单一指标检测，血清IL-6、Cl -、D-二聚体、FDP联合检测对AP病情的判断更为准确。

abstractsObjective:To explore the predictive value of combined detection of serum interleukin-6 (IL-6), chloride (Cl -), D-dimer and fibrin degradation products (FDP) for severity of acute pancreatitis (AP). Methods:From December 2020 to March 2022, 132 AP patients who met the criteria for inclusion were screened for retrospective analysis from 292 AP patients admitted in emergency surgery at the First Affiliated Hospital of Zhengzhou University and they were divided into severe acute pancreatitis (SAP) group and non-SAP group, with 63 in SAP group and 69 in non-SAP group, according to classification criteria. The data including lab results, abdominal doppler ultrasound and chest and abdominal CT, etc. The bedside index for severity in acute pancreatitis (BISAP) score was calculated. Multivariate Logistic regression analysis was carried out to find the risk factors for the severity of AP patients. The receiver operator characteristic curve (ROC) was drawn to judge the clinical predictive value of each factor.Results:A total of 132 AP patients were enrolled. The serum IL-6, D-dimer, FDP levels and the BISAP score in SAP group were significantly higher than those in non-SAP group [serum IL-6 (ng/L): 62.73 (21.54, 187.47) vs. 8.22 (4.13, 14.70), D-dimer (mg/L): 5.36 (2.94, 8.25) vs. 0.94 (0.42, 2.21), FDP (mg/L): 13.54 (6.76, 22.45) vs. 3.20 (2.50, 6.10), BISAP score: 2.00 (1.00, 3.00) vs. 1.00 (0, 2.00), all P < 0.05], while the serum Cl - level was significantly lower than that of non-SAP group (mmol/L: 97.90±4.86 vs. 101.73±4.32, P < 0.05). Multivariate Logistic regression analysis showed that increased levels of IL-6 [odds ratio ( OR) = 1.02, 95% confidence interval (95% CI) was 1.01-1.04], D-dimer ( OR = 1.21, 95% CI was 1.05-1.40) and decreased Cl - level ( OR = 0.88, 95% CI was 0.79-0.98) were risk factors for SAP (all P < 0.05). The ROC curve analysis showed that the area under the ROC curve (AUC) of IL-6, Cl -, D-dimer and FDP combined to predict the severity of AP patients was larger (0.89), and the sensitivity (82.50%) and specificity (85.50%) were higher. Conclusion:Compared with single index, the combined detection of serum IL-6, Cl -, D-dimer and FDP is more precise in determining the condition of AP.