【摘要】 目的观察急性胰腺炎(acute pancreatitis,AP)时血清新喋呤及其他巨噬细胞激活的标志物白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)的变化,探讨血清新喋呤与轻症急性胰腺炎(mild acute pancreatitis,MAP)和重症急性胰腺炎(severe acute pancreatitis,SAP)病情发展及预后的关系,评价新喋呤对SAP并发症多器官功能障碍综合征的预警价值。方法AP患者77例,根据疾病的严重程度分为SAP和MAP两组:SAP组32例,MAP组45例;对照组40例。所有患者于发病入院后次日清晨空腹静脉采血,分离血清,测定新喋呤、IL-6、TNF-α含量。结果SAP患者血清新喋呤显著高于正常对照组及MAP患者(P<0.01);与正常对照组比较,血清IL-6含量在SAP组及MAP组中均显著升高(P<0.01);MAP患者、SAP患者及正常对照组TNF-α水平比较无显著性差异;重症组中死亡与存活者之间血清新喋呤水平有非常显著的差异(P<0.01),与病情危急程度相关。新喋呤诊断多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的敏感性、特异性和准确性分别为88.9%、92.6%和92.2%。结论SAP患者血清新喋呤水平升高,说明SAP时细胞免疫系统激活程度较MAP时加重,新喋呤水平与疾病的严重程度成正相关;检测SAP患者血清新喋呤水平有助于协助诊断MODS的发生,判断病情轻重及预后,对早期采取措施、改善预后有重要意义。更多还原

【Abstract】 ObjectiveThe aim of this study was to investigate the levels of serum neopterin and other markers of leukocyte activation, such as interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in mild and severe acute pancreatitis(AP) and its relationship with AP and to evaluate the potential role of neopterin in SAP.MethodsSeventy-seven patients with acute pancreatitis were included in this study,and these patients were divided into mild group and severe group according to the severity of disease.Blood samples were obtained within 24 h after the onset of diseases.The values of serum neopterin,TNF-α and IL-6 were determined.ResultsWithin 24 h after the onset of acute pancreatitis, patients with severe disease showed significantly higher values of neopterin compared with patients with mild disease and controls(P<(0.01)).IL-6 levels were significantly higher in the severe than in the mild AP and normal controls;mild AP values were also significantly higher than in normal control.With regard to TNF-α values,no difference was seen in the two groups of patients in comparison with normal controls.In addition,the serum neopterin values of patients with fatal outcome were much higher than those of surviving patients(P<(0.01)).ConclusionThe results show that activation of cellular immunity system is implicated in the pathogenesis of severe AP and may be a main contributory factor to disease severity.更多还原