NLRP3炎性小体与重症急性胰腺炎的临床相关性及诊断价值  

Clinical correlation and diagnostic value of NLRP3 inflammasome in patients with severe acute pancreatitis

作　　者：魏卿[1] 王昌明[2] WEI Qing;WANG Changming(Department of intensive Care Unit,Pengzhou People's Hospital,Pengzhou,611930,China)

机构地区：[1]彭州市人民医院重症医学科,彭州611930 [2]彭州市人民医院老年科,彭州611930

出　　处：《中国急救复苏与灾害医学杂志》2020年第5期594-597,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体与重症急性胰腺炎(SAP)的临床相关性及诊断价值。方法选择2014年10月-2018年10月于我院就诊住院的SAP患者80例为观察组,80例普通轻型急性胰腺炎(AP)患者为对照组。采用实时荧光定量聚合酶链反应技术(qRT-PCR)检测两组外周血单个核细胞(PBMCs)中NLRP3、半胱氨酸蛋白酶l(Caspase-1)的mRNA水平;酶联免疫吸附法检测相关因子及炎性指标如白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)、淀粉酶(AMY)及内毒素水平。分别比较两组上述指标的差异,评价NLRP3水平与SAP患者临床指标的相关性及早期诊断价值。结果与对照组比较,观察组患者PBMCs NLRP3和Caspase-1 mRNA水平显著高于对照组,同时外周血IL-1β、IL-18、AMY及内毒素水平也显著高于对照组(P<0.05)。相关性分析显示,SAP患者PBMCs NLRP3 mRNA表达与Caspase-1 mRNA、外周血IL-1β、IL-18、AMY及内毒素水平呈显著正相关(r=0.842,P=0.000;r=0.802,P=0.002;r=0.750,P=0.008;r=0.815,P=0.000;r=0.640,P=0.016)。ROC曲线分析显示,NLRP3mRNA水平曲线下面积为0.889(95%CI 0.805~0.974),其最佳工作点为1.88,此时评估SAP患者早期诊断价值的敏感度和特异度分别为80.00%和82.50%。结论NLRP3炎性小体与SAP患者的机体炎症反应密切相关,对于SAP患者早期诊断的评估,具有一定的临床应用价值。Objective To study the clinical correlation and diagnostic value of NLRP3 inflammasome in patients with severe acute pancreatitis(SAP).Methods 80 patients with SAP were selected as observation group and 80 patients with general mild acute pancreatitis(AP)were selected as control group,which were admitted to our hospital form October 2014 to October 2018.The mRN A levels of NLRP3 and Caspase-1 in mononuclear cells were measured by qRT-PCR.The levels of related factors and inflammatory markers such as interleukin-1β(IL-1β),interleukin-18(IL-18),amylase(AMY)and endotox-in were detected by enzyme-linked immunosorbent assay(ELISA).The differences of the above indicators between the two groups were compared and the correlation between NLRP3 levels and clinical indicators of SAP patients and the early diagnostic value of NLRP3 was evaluated.Results Compared with the control group,the levels of NLRP3 and Caspase-1 mRN A in PBMCs of the observation group were significantly higher than those of the control group,and the levels of IL-1β,IL-18,AMY and endotoxin in peripheral blood were also significant higher than those in the control group(P<0.05).The correlation analysis showed that NLRP3 mRNA in PBMCs of SAP patients was positively correlated with Caspase-1 mRN A,IL-1β,IL-18,AMY and endotoxin levels in peripheral blood(r=0.842,P=0.000;r=0.802,P=0.002;r=0.750,P=0.008;r=0.815,P=0.000;r=0.640,P=0.016).ROC curves analysis showed that the area under curve of NLRP3 was 0.889(95%CI 0.805-0.974),and optimal operating point(OOP)was 1.88,which had 80.00%sensiticity and 82.50%specificity in predicting the early diagnostic value of AP patients.Conclusion NLRP3 inflammasome is closely related to the inflammatory response of SAP patients,and there is certain application value for the evaluation of early diagnostic value of SAP patients.

关 键 词：核苷酸结合寡聚化结构域样受体蛋白3 炎性小体 重症急性胰腺炎 白细胞介素-1Β 

分 类 号：R576[医药卫生—消化系统]