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Received:August 29, 2025 Published Online:May 22, 2026
Received:August 29, 2025 Published Online:May 22, 2026
中文摘要: 目的 探讨重症急性胰腺炎（SAP）患者血清丙二醛（MDA）、内毒素、外周血平均血小板体积（MPV）/血小板计数（PLT）比值与早期肾损伤发生的关系，为SAP患者肾损伤的预测提供参考。方法 选取2021年2月至2024年3月佳木斯市中心医院收治的90例SAP患者为研究对象，根据早期肾损伤发生情况将患者分为肾损伤组与非肾损伤组，比较两组血清 MDA、内毒素和外周血 MPV/PLT 比值，采用多因素 logistic 回归分析 SAP 患者早期肾损伤的危险因素。绘制受试者工作特征（ROC）曲线分析 3 种指标对患者早期肾损伤的预测效能。结果 90例患者中有37例（41.11%）发生早期肾损伤（肾损伤组），其余53例（58.89%）患者未发生肾损伤（非肾损伤组）。肾损伤组急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、CRP、MDA、内毒素水平、MPV/PLT 比值均显著高于非肾损伤组（P＜0.05），尿量、血钙水平显著低于非肾损伤组（P＜0.05）。多因素logistic回归分析显示，高水平的 MDA（OR =7.870，95%CI：1.669~37.108）、内毒素（OR =1.260，95%CI：4.814~34.034）、MPV/PLT比值（OR =4.424，95%CI：1.408~13.897）为SAP患者早期肾损伤的独立危险因素（P＜0.05）；ROC曲线分析结果显示，内毒素预测早期急性肾损伤的 ROC 曲线下面积（AUC）为 0.884，敏感度、特异度分别为78.38%、90.57%；MDA预测的AUC为0.874，敏感度、特异度分别为91.89%、69.81%；MPV/PLT比值预测的AUC为0.875，敏感度、特异度分别为78.38%、92.45%。结论 MDA、内毒素及MPV/PLT比值与SAP患者早期肾损伤发生存在密切关联，三者对SAP患者早期肾损伤发生具有较高的预测效能。
Abstract:Objective To investigate the relationship between serum malondialdehyde（MDA），endotoxin，peripheral blood mean platelet volume（MPV）to platelet count（PLT）ratio and early acute kidney injury in patients with severe acute pancreatitis（SAP），and to provide a reference for predicting kidney injury in patients with SAP. Methods A total of 90 patients with SAP admitted to Jiamusi Central Hospital from February 2021 to March 2024 were enrolled.According to the occurrence of early acute kidney injury，patients were divided into a kidney injury group and a non-kidney injury group. Serum MDA，endotoxin，and peripheral blood MPV/PLT ratio were compared between the two groups. Multivariate logistic regression was used to analyze independent risk factors for early acute kidney injury in SAP patients. Receiver operating characteristic（ROC）curves were constructed to evaluate the predictive efficacy of the three indicators. Results Of the 90 patients，37（41.11%）developed early acute kidney injury（kidney injury group），and the remaining 53（58.89%）did not（non-kidney injury group）. Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）score，CRP，MDA，endotoxin，and MPV/PLT ratio were significantly higher，while urine volume and serum calcium（Ca2 +）were significantly lower in the kidney injury group compared to in the non-kidney injury group（P＜0.05）. Multivariate logistic regression analysis showed that high levels of MDA（OR =7.870，95%CI：1.669-37.108），endotoxin（OR =1.260，95%CI：4.814-34.034），and MPV/PLT ratio（OR =4.424，95%CI：1.408-13.897）were independent risk factors for early acute kidney injury in SAP patients（P＜0.05）. ROC curve analysis showed that the area under the ROC curve（AUC）of endotoxin was 0.884，with a sensitivity of 78.38% and a specificity of 90.57%；the AUC of MDA was 0.874，with a sensitivity of 91.89% and a specificity of 69.81%；the AUC of MPV/PLT ratio was 0.875，with a sensitivity of 78.38% and a specificity of 92.45%. Conclusion MDA，endotoxin，and MPV/PLT ratio are closely related to the occurrence of early kidney injury in patients with SAP. These three all have high predictive efficacy for early kidney injury in patients with SAP.
keywords: Severe acute pancreatitis Kidney injury,early Malondialdehyde Endotoxin Mean platelet volume Platelet count
文章编号： 中图分类号：R657.5+1 文献标志码：A
基金项目:黑龙江省卫生健康委科研课题（2020-363）
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