【摘要】 目的探讨不同炎性因子对重症急性胰腺炎(SAP)的预测价值。方法本研究采用前瞻性观察性研究方法。选取于2014年6月—2016年10月收住兰州大学第二医院外科重症监护病房(SICU)的并发器官功能障碍的急性胰腺炎(AP)患者40例。入科48 h根据患者是否持续存在器官功能障碍,将患者分为中重症急性胰腺炎(MSAP)组27例和SAP组13例。比较两组患者入科时的肿瘤坏死因子α(TNF-α)、白介素1(IL-1)、白介素6(IL-6)、白介素8(IL-8)及白介素10(IL-10)水平,采用Spearman秩相关分析、Logistic回归分析筛选出能够预测SAP的炎性因子,绘制受试者工作特征(ROC)曲线并寻找其最佳截断点,比较其对SAP的预测价值。结果两组患者入住SICU时,TNF-α、IL-6水平比较,差异均有统计学意义(P<0.05);IL-1、IL-8、IL-10水平比较,差异均无统计学意义(P>0.05)。Spearman秩相关分析显示,SAP与TNF-α、IL-6呈正相关(rs值分别为0.539、0.557,P<0.05);与IL-1、IL-8、IL-10无相关性(rs值分别为0.303、0.284、-0.257,P>0.05)。Logistic回归分析结果显示,TNF-α、IL-6是SAP发生的影响因素[OR(95%CI)分别为1.143(1.011,1.293)、1.084(1.014,1.158),P<0.05]。TNF-α、IL-6预测SAP的ROC曲线下面积(AUC)分别为0.832(0.700,0.964)、0.843(0.684,1.000),均较好地预测了SAP的发生(P<0.05)。TNF-α、IL-6的截断点分别为141.7 pg/L、143.3pg/L时预测SAP的灵敏度和特异度较高。结论收住ICU的AP患者早期检测血浆中TNF-α与IL-6的水平,与其他炎性因子相比,可早期预测SAP的发生,为尽早采取措施保护器官功能提供了理论依据。更多还原

【Abstract】 Objective To investigate the predictive value of inflammatory cytokines in severe acute pancreatitis( SAP). Methods A prospective observational study was conducted in Lanzhou University Second Hospital. The participants were 40 cases of acute pancreatitis( AP) with organ dysfunction admitted in the Surgical Intensive Care Unit( SICU) of the hospital from June 2014 to October 2016. Of them,27 cases with organ dysfunction within 48 h after SICU admission were assigned to the moderate to severe acute pancreatitis( MSAP) group,and other 13 cases with organ dysfunction more than 48 h after SICU admission were assigned to the severe acute pancreatitis( SAP) group. We compared the concentrations of tumor necrosis factor-alpha( TNF-α),interleukin 1( IL-1),interleukin 6( IL-6),interleukin 8( IL-8) and interleukin 10( IL-10) measured on SICU admission between the groups. We selected the inflammatory cytokines associated with SAP from the above inflammatory cytokines by using analyses with Spearman’s rank correlation and Logistic regression models and compared the predictive value of them in SAP based on analyzing their ROC curves and cut-off values for the prediction of SAP. Results The levels of TNF-α and IL-6 measured on SICU admission differed significantly between the groups( P < 0. 05),while those of IL-1,IL-8 and IL-10 did not( P > 0. 05). Analysis with Spearman’s rank correlation found that,levels of TNF-α had a positive correlation with SAP( rs= 0. 539,P < 0. 05); levels of IL-6 were positively correlated with SAP( rs= 0. 557,P <0. 05); but no correlation was found between SAP and levels of IL-1,IL-8 and IL-10( rs= 0. 303,P > 0. 05; rs= 0. 284,P > 0. 05; rs=-0. 257,P > 0. 05,respectively). The analysis with Logistic regression models demonstrated that,levels of TNF-α and IL-6 were found to have predictive value for SAP [OR = 1. 143,95% CI( 1. 011,1. 293),P < 0. 05; OR= 1. 084,95% CI( 1. 014,1. 158), P < 0. 05, respectively ]. Both TNF-α and IL-6 had good performance in the prediction of SAP proved by the area under the ROC curve( AUC) [0. 832( 0. 700,0. 964),P < 0. 05; 0. 843( 0. 684,1. 000),P < 0. 05,respectively]. For predicting SAP,the optimal cut-off value of TNF-α and IL-6 was 141. 7 pg/L,143. 3 pg/L, respectively with maximized sensitivity and specificity. Conclusion The levels of plasma TNF-α and IL-6measured early in ICU patients with AP have values in the prediction of SAP,while those of other inflammatory cytokines do not,which provides a theoretical basis for taking measures to protect the patients’ organ function as soon as possible.更多还原