可溶性B7-H2在早期急性胰腺炎严重程度判定中的应用及其临床意义  

Application of soluble B7-H2 detection in early evaluation and its clinical significance on severity of patients with acute pancreatitis

作　　者：黄坚[1] 张光波[2] 何广胜[3] 沈佳庆[1] 孔小明[1] 沈月平[4] 

机构地区：[1]苏州大学附属第一医院急诊内科,江苏苏州215006 [2]苏州大学附属第一医院临床免疫学实验室,江苏苏州215006 [3]江苏省人民医院血液科,南京210029 [4]苏州大学医学部公共卫生学院,江苏苏州215006

出　　处：《中国实用内科杂志》2015年第3期236-238,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金资助(81300357)

摘　　要：目的分析可溶性B7-H2(s B7-H2)表达差异,探讨s B7-H2在早期急性胰腺炎(AP)严重程度鉴别诊断中的临床价值。方法以2012年1月至2013年12月苏州大学附属第一医院住院的75例AP患者为研究对象,其中轻度急性胰腺炎(MAP)30例、中度急性胰腺炎(MSAP)20例以及重度急性胰腺炎(SAP)25例。同时收集健康体检者20名作为对照组。采用双抗体夹心ELISA法检测腹痛开始24 h的AP患者血浆s B7-H2值,分析其与胰腺炎严重程度关联性的敏感度和特异度,并分析s B7-H2与临床常用检测指标相关性。结果腹痛24 h的AP患者组血浆s B7-H2水平显著高于健康对照组(P<0.01),MSAP和SAP组血浆s B7-H2显著高于健康对照组和MAP组(P<0.05和P<0.01);SAP组血浆s B7-H2显著高于MSAP组(P<0.05)。s B7-H2与乳酸脱氢酶(LDH)(r=0.4789,P<0.01)、超敏C反应蛋白(hs-CRP)(r=0.246,P<0.05),脂肪酶(LPS)(r=0.2357,P<0.05)以及白细胞总数(WBC)(r=0.4007,P<0.05)均呈线性相关。ROC曲线分析,s B7-H2对判断中度以上胰腺炎敏感度77.8%,特异度80.0%;判断SAP,敏感度为92.0%,特异度为86.0%。结论 AP和健康人体内存在不同水平的s B7-H2;s B7-H2对AP严重程度鉴别有重要临床价值,具有较好的敏感度、特异度,在AP诊断中具有潜在临床应用价值。Objective To explore the clinical value of soluble B7 Homolog 2（sB7-H2） on severity of patients with acute pancreatitis. Methods A total of 75 patients with AP were recruited to the study,along with 20 healthy volunteer controls（HC）. Peripheral blood from patients with AP was collected at the first 24 hours after the onset of abdominal pain. The sB7-H2 levels were measured by ELISA. The association between sB7-H2 and clinical parameters were analyzed. Additionally,the sensitivity and specificity were examined through Receiver operating characteristic（ROC） analysis. Results The plasma level of sB7-H2 at 24 h of the patients in AP group was significantly higher than that in healthy control group（P〈0.01）,It was no markedly different between in group of MAP and healthy control group（P〉0.05）; The Plasma level of sB7-H2 in MSAP and SAP group were significantly higher than that in HC group（P〈0.05 and P〈0.001）and MAP group（P〈0.05 and P〈0.01）; The Plasma level of sB7-H2 in SAP group was also obviously higher than that of MSAP group（P〈0.05）. sB7-H2 was linear positive correlation with LDH（Lactate dehydragenase）（r=0.4789）,hs-CRP（High-sensitivity）（r=0.246）,WBC（White Blood Cell）（r=0.4007） and LPS（lipase）（r=0.2357）（P〈0.05,respectively）. By the cutoff of sB7-H2,the sensitivity and specificity to judge above moderate pancreatitis were 88.9% and 83.3%,to judge SAP were 96% and 96%. Conclusion sB7-H2 has important clinical value in judging the severity of AP at early time with high sensitivity and specificity,and is linear correlated to the clinical severity indexes.

关 键 词：急性胰腺炎 血浆检测 sB7-H2 

分 类 号：R576[医药卫生—消化系统]