重症急性胰腺炎cf-DNA/NETs、sTREM-1及GP-2α水平与病情关系  

Correlations of serum cf-DNA/NETs,sTREM-1 and GP-2αlevels with the severity of acute pancreatitis

作　　者：陈广生 赵琳 何凤棣 许海 CHEN Guangsheng;ZHAO Lin;HE Fengdi;XU Hai(Department of Emergency,the First People's Hospital of Xining,Xining 810000,China;Department of Surgery,the First People's Hospital of Xining,Xining 810000,China;Department of Critical Care Medicine,the First People's Hospital of Xining,Xining 810000,China;Medical Administration Section,Huangjiahu Hospital of Hubei University of Traditional Chinese Medicine,Wuhan 430070,China)

机构地区：[1]西宁市第一人民医院急诊科,810000 [2]西宁市第一人民医院外科,810000 [3]西宁市第一人民医院重症医学科,810000 [4]湖北省中医药大学黄家湖医院医务科,武汉430070

出　　处：《中华实用诊断与治疗杂志》2020年第6期584-587,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省自然科学基金(2018CFC808);西宁市科学技术局资助项目(2016-K-11)。

摘　　要：目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)患者血清游离DNA/中性粒细胞胞外诱捕网(cell-free DNA/nertrophil extracellular traps,cf-DNA/NETs)、可溶性髓系细胞触发受体-1(soluble triggering receptor expresses on myeloid cell-1,sTREM-1)、糖蛋白-2α(glycoprotein-2,GP-2α)水平变化,分析cf-DNA/NETs、sTREM-1、GP-2α与SAP病情进展的关系。方法105例胰腺炎患者,其中58例SAP患者为SAP组,47例单纯急性胰腺炎患者为胰腺炎组,根据28 d生存情况将SAP组分为生存组46例和死亡组12例。采用ELISA法检测血清sTREM-1和GP-2α水平,采用PicoGreen荧光染料定量分析检测cf-DNA/NETs表达水平;绘制ROC曲线,评估cf-DNA/NETs、sTREM-1、GP-2α单独和联合检测预测SAP病情严重程度的效能;采用多因素logistic回归分析影响SAP患者预后的因素。结果SAP组患者入院第1天血清cf-DNA/NETs[(1175.53±274.26)μg/L]、sTREM-1[(91.66±20.49)ng/L]、GP-2α[(5.09±1.82)u]水平均高于胰腺炎组[(623.17±178.35)μg/L、(63.25±15.92)ng/L、(3.53±1.26)u](P<0.05);入院第1、3、7天,死亡组血清cf-DNA/NETs、sTREM-1、GP-2α水平均高于生存组(P<0.05);当cf-DNA/NETs、sTREM-1、GP-2α最佳截断值分别为1262.15μg/L、98.19 ng/L、6.88 u时,预测SAP病情严重程度的AUC分别为0.824(95%CI:0.706~0.943,P=0.001)、0.857(95%CI:0.705~1.000,P<0.001)、0.689(95%CI:0.506~0.873,P=0.045),灵敏度分别为75.00%、91.7%、60.00%,特异度分别为80.4%、80.4%、93.4%,三者联合预测SAP病情严重程度的AUC为0.940,敏感度为91.7%、特异度为82.6%;cf-DNA/NETs(OR=2.37,95%CI:1.45~3.89,P=0.006)、sTREM-1(OR=2.32,95%CI:1.24~4.36,P=0.004)和GP-2α(OR=3.19,95%CI:1.72~5.91,P<0.001)是SAP患者预后的影响因素。结论SAP患者血清cf-DNA/NETs、sTREM-1、GP-2α呈高表达,且随病情加重而升高,均是影响SAP患者预后的危险因素,可用于评估SAP病情严重程度。Objective To investigate the changes of cell-free DNA/neutrophil extracellular traps(cf-DNA/NETs),soluble triggering receptor expresses on myeloid cell-1(sTREM-1)and glycoprotein-2α(GP-2α)levels in patients with severe acute pancreatitis(SAP),and to analyze their relationships with the progression of SAP.Methods Totally 105 patients with pancreatitis were divided into SAP group(n=58)and acute pancreatitis(AP)group(n=47),and were divided into survival group(n=46)and death group(n=12)according to the 28-day survival.The levels of sTREM-1 and GP-2α were detected by ELISA,and the level of cf-DNA/NETs was detected by PicoGreen fluorescent dye quantitative analysis.ROC was drawn to evaluate the efficacies of single and joint detection of cf-DNA/NETs,sTREM-1 and GP-2α on predicting the severity of SAP.Multivariate logistic regression analysis was used to analyze the influencing factors for the prognosis of SAP.Results The levels of cf-DNA/NETs,sTREM-1 and GP-2αwere significantly higher in SAP group((1175.53±274.26)μg/L,(91.66±20.49)ng/L,(5.09±1.82)u)than those in AP group((623.17±178.35)μg/L,(63.25±15.92)ng/L,(3.53±1.26)u)on the 1 st day of admission(P<0.05),and were higher on the 1st,3rd and 7th day of admission in death group than those in survival group(P<0.05).When the optimal cut-off values of cf-DNA/NETs,sTREM-1 and GP-2αwere 1262.15μg/L,98.19 ng/L and 6.88 u,the AUCs for predicting the severity of SAP were 0.824(95%CI:0.706-0.943,P=0.001),0.857(95%CI:0.705-1.000,P<0.001)and 0.689(95%CI:0.506-0.873,P=0.045),with the sensitivities of 75.00%,91.7% and 60.00%,and the specificities of 80.4%,80.4% and 93.4%,respectively.The AUCof joint detection of them three for predicting the severity of SAP was 0.940,with a sensitivity of 91.7%,and a specificity of 82.6%.cf-DNA/NETs(OR=2.37,95%CI:1.45-3.89,P=0.006),sTREM-1(OR=2.32,95%CI:1.24-4.36,P=0.004)and GP-2α(OR=3.19,95%CI:1.72-5.91,P<0.001)were the influencing factors for the prognosis of SAP.Conclusion The levels of serum cf-DNA/NETs,sTREM-1 and GP-2αin SAP p

关 键 词：重症急性胰腺炎 游离DNA/中性粒细胞胞外诱捕网 可溶性髓系细胞触发受体-1 糖蛋白-2α 

分 类 号：R576[医药卫生—消化系统]