不同炎性因子对重症急性胰腺炎的预测价值研究

发布时间：2018-04-24 02:02

本文选题：重症急性胰腺炎 + 炎性因子　；参考：《中国全科医学》2017年25期

【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(P0.05);IL-1、IL-8、IL-10水平比较,差异均无统计学意义(P0.05)。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,P0.05);与IL-1、IL-8、IL-10无相关性(rs值分别为0.303、0.284、-0.257,P0.05)。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),P0.05]。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(P0.05)。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。
[Abstract]:Objective to investigate the predictive value of different inflammatory factors in severe acute pancreatitis (SAP). Methods A prospective observational study was used in this study. From June 2014 to October 2016, 40 patients with acute pancreatitis complicated with organ dysfunction in surgical intensive care unit (SICU) of second Hospital of Lanzhou University were selected. According to the persistent organ dysfunction, patients were divided into moderate and severe acute pancreatitis group (n = 27) and SAP group (n = 13). The levels of TNF- 伪, IL-1, IL-6, IL-8 and IL-10 were compared between the two groups. The inflammatory factors which could predict SAP were screened by Spearman rank correlation analysis and logistic regression analysis. The operating characteristics of the subjects were drawn and the optimal truncation point was found, and the predictive value of the curve to SAP was compared. Results the levels of TNF- 伪 IL-6 were significantly different between the two groups when they were admitted to SICU, and the levels of IL-8 and IL-8 were significantly different between the two groups. There was no significant difference in P0.05U. Spearman rank correlation analysis between SAP and TNF- 伪 IL-6. The positive correlation between SAP and TNF- 伪 IL-6 was 0.539 / 0. 557 (P0.05) and there was no correlation with IL-1IL-8 / IL-10. The results of logistic regression analysis showed that TNF- 伪 IL-6 was the influential factor of SAP [OR995 CI]. TNF- 伪 IL-6 was a predictor of ROC in SAP (P < 0.05, P < 0. 05, P < 0. 05), but not correlated with IL-8 / IL-10 (P = 0. 3030.284- 0. 257P0.05. logistic regression analysis showed that TNF- 伪 IL-6 was an influential factor in the occurrence of SAP. [ORN95CIR = 1. 1431.011 / 1.29384 / 1.014141.158p] .TNF- 伪 was used to predict the ROC of SAP. The area under the curve was 0.832 ~ 0.700 ~ 0.964g / L, respectively. The sensitivity and specificity of SAP prediction were higher when the cut-off point of SAP was 141.7 PG / L ~ (143.3) PG / L, respectively, and the area under the curve was 0.832 ~ 0.700 ~ 0.964p ~ (-1) ~ (-1) ~ (-1) ~ 0.684 ~ (-1) ~ (-1) ~ (-1), respectively. The results showed that the sensitivity and specificity of prediction of SAP were higher when the cut-off point of SAP was 141.7 PG / L ~ (-1), respectively. Conclusion the early detection of plasma levels of TNF- 伪 and IL-6 in AP patients with ICU can predict the occurrence of SAP early compared with other inflammatory factors and provide a theoretical basis for early protection of organ function.
【作者单位】：兰州大学第二医院重症医学一科;
【基金】：甘肃省兰州市城关区科技计划项目(2015-3-7)
【分类号】：R576

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