急性胰腺炎患者sICAM-1、TNF-α和D-二聚体水平与病情严重程度的关系  

Relationship of plasma levels of sICAM-1,TNF-α and D-dimer with disease severity in patients with acute pancreatitis

作　　者：李春燕[1] 雍桂珍[1] 冯迎春[1] 贺国斌[1] 向军英[1] 明文[1] 

机构地区：[1]川北医学院附属医院消化内科,四川省南充市637000

出　　处：《世界华人消化杂志》2010年第32期3480-3484,共5页World Chinese Journal of Digestology

基　　金：四川省教育厅课题基金资助项目;No.2004A082~~

摘　　要：目的:探讨急性胰腺炎(AP)患者血浆sICAM-1、TNF-α、D-二聚体水平以及与疾病严重程度的关系.方法:收集轻型胰腺炎组(MAP)22例及重症胰腺炎组(SAP)34例,全身炎症反应综合征(SIRS)组36例与非SIRS组20例,正常对照24例.应用ELISA检测患者血浆中sICAM-1、TNF-α和D-二聚体水平,结果用方差分析,Pearson相关分析和ROC曲线分析.结果:SAP组血浆中sICAM-1、D-二聚体浓度明显高于MAP组(740.18μg/L±649.54μg/L vs481.18μg/L±306.50μg/L;0.90mg/L±0.20mg/L vs0.69mg/L±0.19mg/L,均P<0.05).TNF-α浓度高于对照组,MAP组与SAP组比较无显著性差异.SIRS组患者血浆中sICAM-1、TNF-α、D-二聚体浓度明显高于非SIRS组(741.17μg/L±592.95μg/L vs479.65μg/L±451.21μg/L;17.82μg/L±13.84μg/L vs12.09μg/L±3.99μg/L;0.90mg/L±0.17mg/L vs0.69mg/L±0.23mg/L,均P<0.05).MAP、SAP的sICAM-1与D-二聚体相关分别为(r=0.738,r=0.452;均P<0.01).TNF-α与D-二聚体无相关(r=0.110;P=0.420),ROC曲线显示D-二聚体诊断SAP曲线下面积更大.结论:sICAM-1和D-二聚体在SAP升高更明显.sICAM-1、D-二聚体明显升高提示SAP诊断,在SAP患者D-二聚体升高提示治疗应防治血栓形成.AIM：To investigate the relationship of plasma levels of soluble intercellular adhesion molecule-1（sICAM-1）,tumor necrosis factor-alpha（TNF-α）and D-dimer with disease severity in patients with acute pancreatitis（AP）.METHODS：Thirty-four patients with severe acute pancreatitis（SAP）,22 patients with mild acute pancreatitis（MAP）,36 patients with systemic inflammatory response syndrome（SIRS）,20 patients with non-SIRS diseases,and 24 healthy volunteers were evaluated in this study.Plasma concentrations of sICAM-1,TNF-α and D-dimer were measured by ELISA.The data obtained were subjected to one-way ANOVA,Pearson correlation and ROC curve analyses.RESULTS：There were significant differences in plasma sICAM-1 and D-dimer levels between SAP and MAP patients（740.18 μg/L ± 649.54 μg/L vs 481.18 μg/L ± 306.50 μg/L;0.90 mg/L ± 0.20 mg/L vs 0.69 mg/L ± 0.19 mg/L,both P 0.05）.Significant difference was also noted in plasma TNF-α level between AP patients and healthy controls though there was no significant difference in plasma TNF-α level between SAP and MAP patients.Compared with the non-SIRS group,the plasma concentrations of sICAM-1,TNF-α and D-dimer were significantly higher in the SIRS group（741.17 μg/L ± 592.95 μg/L vs 479.65 μg/L ± 451.21 μg/L;17.82 μg/L ± 13.84 μg/L vs 12.09 μg/L ± 3.99 μg/L;0.90 mg/L ± 0.17 mg/L vs 0.69 mg/L ± 0.23 mg/L,all P 0.05）.Plasma sICAM-1 level was related to D-dimer level in both MAP（r = 0.738,P 0.01）and SAP patients（r = 0.452,P 0.01）.Plasma TNF-α level was not correlated with D-dimer level（r = 0.110,P = 0.420）.D-dimer had larger area under the ROC curve in diagnosing SAP.CONCLUSION：Plasma sICAM-1 and D-dimer concentrations increase greatly in SAP patients.Highly elevated plasma sICAM-1 or D-dimer levels may help identify SAP.

关 键 词：胰腺炎 可溶性细胞间黏附分子 肿瘤坏死因子-α D-二聚体 全身炎症反应综合征 

分 类 号：R576[医药卫生—消化系统]