Zhang Yu, Ye Xiao-Ling, Wan Xin-Yue
Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China; Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China.
Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China; Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
J Formos Med Assoc. 2024 Sep 17. doi: 10.1016/j.jfma.2024.09.011.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains a major concern for clinicians. Hence early identification of PEP is meaningful to minimize medical risks.
This study aims to explore the value of dynamic leukocyte changes for early prediction of PEP.
Patients from January 2017 to December 2018 (training set) and January 2019 to December 2022 (test set) were retrospectively reviewed. The dynamic changes of leukocyte, neutrophil, and lymphocyte were examined to evaluate the diagnostic value of PEP.
A total of 498 patients (36 PEP cases) in training set and 948 patients (71 PEP cases) in test set were analyzed. Four predictors were finally identified in training set containing margin and ratio of 3h-post ERCP leukocyte count (Po Leu) to pre-ERCP leukocyte count (Pr Leu), 3h post-ERCP neutrophil-to-lymphocyte ratio (NLR) and pre-ERCP fibrinogen levels. ROC analysis revealed the optimal thresholds were 2.3 (x10/L), 1.6, 4.8 and 3.1 (g/L), respectively. The sensitivity and specificity of Po Leu - Pr Leu and Po Leu/Pr Leu were 71.0%, 82.7%, 66.1% and 86.3% to diagnosis PEP in patients with hyperamylasemia.
For early identification of PEP, the elevation of amylase and lipase still exhibits the highest sensitivity, while the dynamic changes of leukocyte would be helpful for the different diagnosis of hyperamylasemia.
内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）仍是临床医生主要关注的问题。因此，早期识别PEP对于将医疗风险降至最低具有重要意义。
本研究旨在探讨动态白细胞变化对PEP早期预测的价值。
回顾性分析2017年1月至2018年12月（训练集）和2019年1月至2022年12月（测试集）的患者。检测白细胞、中性粒细胞和淋巴细胞的动态变化，以评估PEP的诊断价值。
训练集共分析498例患者（36例PEP病例），测试集共分析948例患者（71例PEP病例）。最终在训练集中确定了四个预测指标，包括ERCP术后3小时白细胞计数（Po Leu）与ERCP术前白细胞计数（Pr Leu）的差值和比值、ERCP术后3小时中性粒细胞与淋巴细胞比值（NLR）以及ERCP术前纤维蛋白原水平。ROC分析显示，最佳阈值分别为2.3（×10/L）、1.6、4.8和3.1（g/L）。Po Leu - Pr Leu和Po Leu/Pr Leu对高淀粉酶血症患者诊断PEP的敏感性和特异性分别为71.0%、82.7%、66.1%和86.3%。
对于PEP的早期识别，淀粉酶和脂肪酶升高仍具有最高的敏感性，而白细胞的动态变化有助于对高淀粉酶血症进行鉴别诊断。
