可溶性程序性死亡配体1对重症急性胰腺炎患者并发持续炎症-免疫抑制-分解代谢综合征的预测价值  

Predictive value of soluble programmed death ligand 1 in persistent inflammation-immunosuppression-catabolism syndrome of patients with severe acute pancreatitis

作　　者：陶京 方琦 常剑 陶缘发 荣愈平[1] 梅佩 朱孔凡 刘垒[1] Tao Jing;Fang Qi;Chang Jian;Tao Yuanfa;Rong Yuping;Mei Pei;Zhu Kongfan;Liu Lei(Department of Pancreatic Surgery and Panereatic Intensive-care Unit,Renmin Hospital,Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胰腺外科及胰腺重症监护室,430060

出　　处：《中华实验外科杂志》2020年第3期537-540,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金 (81702368)。

摘　　要：目的探讨可溶性程序性死亡配体1(sPD-L1)是否能够预测重症急性胰腺炎(SAP)患者持续炎症-免疫抑制-分解代谢综合征(PICS)的发生。方法收集2017年3月1日至2019年10月31日发病24 h内首诊于武汉大学人民医院胰腺外科且住院时间≥14 d的131例成年SAP患者,依照PICS诊断标准,将SAP患者分为PICS组(45例)和非PICS组(86例),收集统计入院24 h内、(14±2)d时的sPD-L1等实验室数据资料及其他相关临床数据和预后。非正态分布的连续变量采用中位数和四分位数表示,通过U-Whitney检验进行分析。分类变量以频率和百分数表示,采用χ2检验。结果PICS组和非PICS组患者的性别、年龄、体重指数(BMI)、发病病因以及入院Balthazar CT评分、白蛋白(ALB)、白细胞计数(WBC)、ALCs计数、sPD-L1水平差异均无统计学意义。但PICS组患者入院时C反应蛋白(CRP),入院24 h内的正平衡量、入院急性生理功能及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、发病2周左右时的sPD-L1水平、Balthazar CT评分高于非PICS组患者[175.50(128.00,212.25)mg/L比135.26(108.06,171.93)mg/L,Z=-2.823,P<0.05;(1914.7±668.2)ml比(1600.5±613.1)ml,t=-2.410,P<0.05;(12.12±2.31)分比(10.91±2.75)分,t=-2.237,P<0.05;108.93(101.35,118.96)μg/L比90.03(81.57,99.36)μg/L,Z=-5.599,P<0.05;8(6~8)分比6(5~8)分,Z=-3.251,P<0.05]。发病2周左右时的淋巴细胞计数(ALCs)计数明显低于非PICS组[0.87(0.71,1.09)比1.04(0.84,1.27),Z=-2.663,P<0.05]。2周左右的sPD-L1水平和Balthazar CT评分是SAP患者并发PICS的独立危险因素[比值比(OR)=1.07,95%可信区间(CI):1.03~1.12,P<0.01;OR=1.52,95%CI:1.10~2.12,P<0.05]。结论2周左右的sPD-L1水平和Balthazar CT评分是SAP患者并发PICS的独立危险因素。Objective Some of patients with severe acute pancreatitis(SAP),especially those complicated with peripancreatic necrotic infection may develop into persistent inflammation-immunosuppression-catabolism syndrome(PICS).Soluble programmed death ligand 1(sPD-L1)plays an important role in the negative regulation of immunological functions.This article aims to observe and search whether sPD-L1 can predict PICS in patients with PICS.Methods This study collected the clinical data of 131 patients with SAP first treated in Renmin Hospital within 24 h after outset of disease and spending more than 14 days in hospital from Mar.1,2017 to Oct.31st,2019.They were divided into PICS group(n=45)and non-PICS group(n=86).We collected the data of sPD-L1 in 24 h and around 2 weeks and other relative statistics.Statistical analysis was done using SPSS 16.0 statistics software.Results There was no significant difference in aspects of gender,age,body mass index(BMI),sPD-L1,white blood cells(WBC),albumin(ALB),ALCs,Balthazar CT scores with in 24 h after the onset of SAP between two groups.The C-reactive protein(CRP)level on the admission,liquid in positive equilibrium within 24 h after 24 h,acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores on the admission,sPD-L1 and Balthazar CT scores 2 weeks after onset were significantly higher in PICS group than in non-PICS group[175.50(128.00,212.25)mg/L vs.135.26(108.06,171.93)mg/L,Z=-2.823,P<0.05;(1914.7±668.2)ml vs.(1600.5±613.1)ml,t=-2.410,P<0.05;(12.12±2.31)scores vs.(10.91±2.75)scores,t=-2.237,P<0.05;108.93(101.35,118.96)μg/L vs.90.03(81.57,99.36)μg/L,Z=-5.599,P<0.05;8(6-8)scores vs.6(5-8)scores,Z=-3.251,P<0.05].At about 2nd week after onset,sPD-L1 level and Balthazar CT scores were independent risk factor of PICS[odds ratio(OR)=1.07,95%confidence interval(CI):1.03-1.12,P<0.01;OR=1.52,95%CI:1.10-2.12,P<0.05].Conclusion sPD-L1 and Balthazar CT scores at 2nd week after onset were independent risk factors of PICS.

关 键 词：重症急性胰腺炎 可溶性程序性死亡配体1 Balthazar CT评分 免疫抑制 

分 类 号：R576[医药卫生—消化系统]