α-黑色素细胞刺激素、胰蛋白酶原激活肽、白介素-6与急性胰腺炎病情严重度及预后相关性研究

发布时间：2018-06-24 05:14

  本文选题：急性胰腺炎 + α-黑色素细胞刺激素　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的急性胰腺炎(Acute pancreatitis,AP)目前是临床上一种常见的急腹症,并逐年呈上升趋势。虽然近年来AP的治疗逐渐规范化,但病死率及复发率仍居高不下。及时评估病情、寻找一种能及时反映患者病情的临床指标不仅有利于早期的临床干预,同时对患者病情进展及治疗方案调整有着重要意义。目前临床上已有许多评分及指标应用于AP的病情评估,但其所涉及的指标过多,测量步骤繁琐、花费时间长或准确性及灵敏度低。因此,本文旨在通过对外周血α-黑色素细胞刺激素(alpha melanocyte stimulation hormone,α-MSH)、胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)、白介素-6(interleukin 6,IL-6)的动态检测研究其在评估AP病情严重度及预后方面的价值,并为临床更早、更准确的掌握病情,评估预后提供依据。方法选择我院2015年6月至2016年3月期间收治的97例发病在24h以内的急性胰腺炎(AP)患者作为研究对象,其中轻症组56例、重症组41例。所有患者入院后第1、3、5、7天抽取外周静脉血,采用酶联吸附法定量测定血清α-MSH、TAP、IL-6水平。重症组患者入院时给予一次急性生理及慢性健康状况评分(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯性器官衰竭评估评分(Sequential organ failur assessment,SOFA)及Ranson评分。然后进行数据的收集,对轻症组与重症组数据进行统计学分析;再对重症组中发生多器官功能障碍综合征(MODS)及未发生多器官功能障碍综合征(非MODS)进行统计学比较及ROC回归曲线分析。结果通过研究发现,与轻症组相比,重症组血清α-MSH水平较低(P0.05),血清IL-6及前3天血清TAP水平明显高于轻症组(P0.05)。在病情预后评估方面,α-MSH敏感度80.3%、特异度72.0%、曲线下面积0.848;SOFA评分敏感度80.2%、特异度72.4%、曲线下面积0.819;Ranson评分敏感度76.7%、特异度72.1%、曲线下面积0.818;APACHE-Ⅱ评分敏感度80.1%、特异度70.3%、曲线下面积0.789;TAP敏感度62.8%、特异度70.1%、曲线下面积0.675;IL-6敏感度75.3%,特异度60.1%、曲线下面积0.693;α-MSH、TAP及IL-6联合敏感度87.0%、特异度75.0%、曲线下面积0.906。结论外周血α-MSH、TAP、IL-6水平在急性胰腺炎病情严重度评估上具有一定的临床价值,可以用于评估AP病情严重程度。在评估患者预后方面,α-MSH敏感性、特异性及准确度均高于TAP及IL-6,另外,三者共同检测具有更高的敏感性、特异性及准确度。
[Abstract]:Objective at present, acute pancreatitis (AP) is a common acute abdomen, and it is increasing year by year. Although the treatment of AP is gradually standardized in recent years, the mortality and recurrence rate are still high. Timely evaluation of the patient's condition and finding a clinical index that can reflect the patient's condition in time are not only beneficial to the early clinical intervention, but also of great significance to the progress of the patient's condition and the adjustment of the treatment plan. At present, many clinical scores and indicators have been applied to the assessment of AP's condition, but they involve too many indicators, the measurement steps are tedious, and it takes a long time or low accuracy and sensitivity. Therefore, the purpose of this study was to evaluate the clinical significance of 伪 -melanocyte stimulating hormone (alpha melanocyte stimulation hormone, 伪 -MSH), trypsinogen activated peptide (trypsinogen activation peptidetad tap) and interleukin-6 (interleukin 6 IL-6) in evaluating the severity and prognosis of AP. A more accurate grasp of the disease, evaluation of prognosis to provide the basis. Methods from June 2015 to March 2016, 97 cases of acute pancreatitis (AP) with onset within 24 hours were selected as study subjects, including 56 cases of mild disease group and 41 cases of severe group. Peripheral venous blood was collected from all patients on the 1st day of admission, and the serum level of 伪 -MSHtapine IL-6 was measured by enzyme-linked adsorption assay (Elisa). The patients in the severe group were given once acute physiological and chronic health status score (Acute physiology and chronic health evaluation 鈪，

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