【摘要】 目的 探讨血清瓜氨酸组蛋白H3（CitH3）、调节激活正常T淋巴细胞表达和分泌的细胞因子（RANTES）对重症急性胰腺炎（SAP）合并腹腔感染患者预后不良的预测价值。方法 选取2021年7月至2023年7月河北北方学院附属第一医院收治的96例SAP合并腹腔感染患者为感染组，并根据预后情况将其分为生存组和死亡组。另选取同期河北北方学院附属第一医院收治的108例未合并腹腔感染的SAP患者为未感染组。比较感染组和未感染组及生存组和死亡组的临床资料。采用Pearson相关分析SAP合并腹腔感染患者血清CitH3、RANTES水平与APACHEⅡ评分的相关性。采用多因素Logistic回归分析SAP合并腹腔感染患者预后不良的危险因素。绘制受试者工作特征（ROC）曲线分析血清CitH3、RANTES对SAP合并腹腔感染患者预后不良的预测价值。结果 感染组患者APACHEⅡ评分及血清CitH3、RANTES水平高于未感染组，差异均有统计学意义（P<0.05）。随访结果显示，生存组有69例患者，死亡组有27例患者。死亡组患者血清CitH3、RANTES水平及APACHEⅡ评分高于生存组，差异均有统计学意义（P<0.05）。Pearson相关分析结果显示，SAP合并腹腔感染患者血清CitH3、RANTES水平与APACHEⅡ评分均呈正相关（r=0.461、0.442,P<0.05）。多因素Logistic回归分析结果显示，APACHEⅡ评分及血清CitH3、RANTES水平升高为SAP合并腹腔感染患者预后不良的危险因素（P<0.05）。ROC曲线分析结果显示，2项指标联合预测的AUC为0.959,大于CitH3、RANTES单独预测的AUC(Z_联合-CitH3=2.009,P=0.045;Z_{联合-RANTES}=2.213,P=0.027)。结论 在SAP合并腹腔感染患者中，血清CitH3、RANTES水平均升高，且2项指标联合检测对SAP合并腹腔感染患者预后不良具有较高的预测价值。更多还原

【Abstract】 Objective To investigate the predictive value of serum citroline histone H3（CitH3） and regulate and activate cytokines expressed and secreted by normal T lymphocytes（RANTES） in patients with severe acute pancreatitis（SAP） complicated with abdominal infection.Methods A total of 96 patients with SAP combined with abdominal infection admitted to the First Affiliated Hospital of Hebei North University from July 2021 to July 2023 were selected as the infection group and divided into survival group and death group according to the prognosis.In addition, 108 SAP patients without abdominal infection treated in the First Affiliated Hospital of Hebei North University during the same period were selected as the uninfected group.The clinical data of infected group and uninfected group, survival group and death group were compared.Pearson correlation was used to analyze the correlation between serum CitH3,RANTES and acute physiology and chronic health evaluation Ⅱ（ APACHEⅡ） score in SAP patients with abdominal infection.Multivariate Logistic regression was used to analyze the risk factors of poor prognosis in SAP patients with abdominal infection.Receiver operating characteristic（ROC） curve was used to analyze the predictive value of serum CitH3 and RANTES for poor prognosis in SAP patients with abdominal infection.Results The APACHEⅡ score and serum CitH3 and RANTES levels in infected group were higher than those in uninfected group, with statistical significance（P<0.05）.Follow-up results showed that 69 patients in the survival group and 27 patients in the death group.The levels of serum CitH3,RANTES and APACHEⅡ scores in death group were higher than those in survival group, with statistical significance（P<0.05）.Pearson correlation analysis showed that serum CitH3 and RANTES levels were positively correlated with APACHEⅡ scores in SAP patients with abdominal infection（r=0.461,0.442,P<0.05）.Multivariate Logistic regression analysis showed that the increase of APACHEⅡ score and serum CitH3 and RANTES levels were risk factors for poor prognosis in SAP patients with abdominal infection（P<0.05）.ROC curve analysis results showed that the area under the curve（AUC） predicted by the combination of the two indexes was 0.959,which was larger than the AUC predicted by CitH3 and RANTES alone(Z_{combined-CitH3}=2.009,P=0.045;Z_{combined-RANTES}=2.213,P=0.027).Conclusion Serum CitH3 and RANTES levels are elevated in SAP patients with abdominal infection, and the combined detection of these two indexes have a high predictive value for poor prognosis in SAP patients with abdominal infection.更多还原