【摘要】 目的 探究多种血清学指标预测老年重症急性胰腺炎（severe acute pancreatitis,SAP）合并急性肾损伤（acute kidney injury,AKI）的临床价值，以期为分子标志物的遴选提供参考依据。方法 回顾性纳入2020年1月—2023年12月哈尔滨医科大学附属第一医院住院治疗的SAP患者336例，根据住院期间是否发生AKI，分为SAP-AKI组80例（23.81%）和非SAP-AKI组256例（76.19%）。通过电子病历系统收集所有SAP患者的临床资料，采用多因素Logistic回归法筛选AKI的危险因素，绘制受试者工作特征曲线（receiver operating characteristic curve,ROC）对各血清学指标预测AKI的效能进行分析，结果以计算曲线下面积（area under the curve,AUC）表示。结果与非SAP-AKI组比较，SAP-AKI组年龄、糖尿病比例、改良CT严重指数（modified computerized tomography severity index,MCTSI）评分、红细胞分布宽度、降钙素原、白细胞介素（interleukin,IL）-33、IL-6、乳酸、中性粒细胞淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）、三酰甘油-葡萄糖（triglyceride glucose,TyG）指数升高，白蛋白降低，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄（OR=1.401,95%CI:1.098～2.997）、MCTSI评分（OR=2.090,95%CI:1.351～3.112）、IL-33(OR=1.809,95%CI:1.223～3.397)、NLR(OR=1.872,95%CI:1.334～3.796)、TyG指数（OR=1.520,95%CI:1.069～2.912）是SAP患者住院期间发生AKI的独立危险因素。ROC曲线显示，IL-33、NLR、TyG指数单独预测预测SAP患者住院期间发生AKI的AUC为0.665～0.763，三者联合应用时AUC为0.885(95%CI:0.844～0.925)，敏感度为77.50%，特异度为90.60%，预测效能优于单一指标。结论 IL-33、NLR、TyG指数对SAP患者继发AKI均具有一定的提示作用，三者联合应用有望辅助临床进行AKI筛查，为临床决策提供参考。更多还原

【Abstract】 Objective To investigate the clinical value of multiple serological indicators in predicting acute kidney injury(AKI) in elderly patients with severe acute pancreatitis(SAP), aiming to provide a reference for selecting molecular biomarkers. Methods A retrospective cohort study was conducted on 336 SAP patients hospitalized at the First Affiliated Hospital of Harbin Medical University from January 2020 to December 2023. Patients were divided into the SAP-AKI group(n=80, 23.81%) and the non-SAP-AKI group(n=256, 76.19%) based on the occurrence of AKI during hospitalization. Clinical data were collected from electronic medical records. Multivariate logistic regression was used to identify risk factors for AKI, and the predictive performance of serological indicators was analyzed using receiver operating characteristic(ROC) curve, with results expressed as the area under the ROC curve(AUC). Results Compared with the non-SAP-AKI group, the SAP-AKI group exhibited significantly older age, higher prevalence of diabetes, increased modified computerized tomography severity index(MCTSI) score, red cell distribution width, procalcitonin, interleukin(IL)-33, IL-6, lactate, neutrophil-to-lymphocyte ratio(NLR), and triglyceride glucose(TyG) index, and lower albumin levels, with all differences being statistically significant(P<0.05). Multivariate logistic regression analysis revealed that age(OR=1.401, 95%CI: 1.098-2.997), MCTSI score(OR=2.090, 95%CI: 1.351-3.112), IL-33(OR=1.809, 95%CI: 1.223-3.397), NLR(OR=1.872, 95%CI: 1.334-3.796), TyG index(OR=1.520, 95%CI: 1.069-2.912) were independent risk factors for AKI during hospitalization in SAP patients. The ROC curve showed that the AUC of IL-33, NLR, and TyG index alone for predicting AKI during hospitalization in SAP patients ranged from 0.665 to 0.763, while the combined detection yielded an AUC of 0.885(95%CI: 0.844-0.925), with a sensitivity of 77.50% and a specificity of 90.60%, demonstrating superior predictive performance compared with indicators detected alone. Conclusion IL-33, NLR, and TyG index each demonstrate predictive value for secondary AKI in SAP patients. Their combined application holds promise for assisting clinical AKI screening and informing clinical decision-making.更多还原