急性胰腺炎患者血浆游离线粒体DNA水平变化及临床意义  

Changes of plasma free mitochondrial DNA in the patients with acute pancreatitis and clinical significance

作　　者：梁转霞 杨泽华[2] Liang Zhuan-xia;Yang Ze-hua(Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,山西太原030001 [2]山西医科大学第六医院检验科,山西太原030008

出　　处：《中国急救医学》2020年第10期966-971,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血浆游离线粒体DNA(mitochondrial DNA,mtDNA)拷贝数在急性胰腺炎(acute pancreatitis,AP)患者诊断、预后及病情评估中的应用价值.方法分别收集40例健康体检者,20例轻度急性胰腺炎(mild acute pancreatitis,MAP)和20例中重度急性胰腺炎(moderate-severe acute pancreatitis,M-SAP)患者标本以及6例急性胰腺炎患者的住院第1、3、7天标本,应用实时荧光定量聚合酶链反应(polymerase chain reaction,PCR)测定所有标本血浆游离mtDNA拷贝数,比较实验组和对照组一般临床指标及血浆游离mtDNA拷贝数,并分析血浆游离mtDNA拷贝数与临床常用指标以及临床评分的相关性,动态监测AP患者住院后血浆游离mtDNA拷贝数变化,受试者工作特征(ROC)曲线评估血浆游离mtDNA对AP的诊断价值.结果健康对照组、MAP组和M-SAP组血浆游离mtDNA拷贝数分别为5.0×10^4(3.1×10^4)、1.2×10^5(1.6×10^5)和7.8×10^5(5.0×10^5)copies/mL,MAP组明显高于健康对照组,M-SAP组明显高于MAP组,三组间差异均有统计学意义(P<0.05).AP患者血浆游离mtDNA拷贝数与白细胞(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、甘油三酯(TG)、病情严重程度(Ranson)评分及急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分呈正相关(r=0.453、0.539、0.562、0.513、0.653、0.869,P<0.05).AP患者在住院治疗后病情好转,血浆游离mtDNA拷贝数先上升后下降.ROC曲线显示,以8.5×10^4 copies/mL为截断值,血浆游离mtDNA诊断AP的敏感度为90%,特异度为97.5%,ROC曲线下面积为0.989(95%CI0.97~1.00).结论AP患者血浆游离mtDNA水平升高,血浆游离mtDNA拷贝数有助于诊断AP,也可作为预测AP病情严重程度及预后判断的一种标志物.Objective To explore the value of plasma free mitochondrial DNA(mtDNA)copy number in the diagnosis,prognosis and disease assessment of the patients with acute pancreatitis.Methods Samples from forty healthy subjects,twenty patients with mild acute pancreatitis(MAP)and twenty patients with moderate-severe acute pancreatitis(M-SAP)and six patients with acute pancreatitis on the first,third and seventh day of hospitalization were collected,and their plasma free mtDNA copy number were measured by real-time fluorescent quantitative PCR.The general clinical indexes and plasma free mtDNA copy number were compared between the experimental group and the control group,and the correlation of plasma free mtDNA copy number with common clinical indexes and clinical scores of acute pancreatitis was analyzed.The changes of plasma free mtDNA copy number in the patients with acute pancreatitis after hospitalization were dynamically monitored.The receiver operating characteristic(ROC)curve was used to assess the diagnostic value of plasma free mtDNA copy number for acute pancreatitis.Results The copy number of plasma free mtDNA in the healthy control group,MAP group and M-SAP group were 5.0×10^4(3.1×10^4),1.2×10^5(1.6×10^5),7.8×10^5(5.0×10^5)copies/mL,respectively.The copy number of plasma free mtDNA in the MAP group was significantly higher than that in the control group,and the copy number of plasma free mtDNA in the M-SAP group was significantly higher than that in the MAP group,the difference among the three groups was statistically significant(P<0.05).The copy number of plasma free mtDNA was positively correlated with WBC,CRP,PCT,TG,Ranson scores and APACHEⅡ scores in the patients with acute pancreatitis(r=0.453,0.539,0.562,0.513,0.653,0.869,P<0.05).The condition of patients with acute pancreatitis improved after hospitalization,and the copy number of plasma free mtDNA increased first and then decreased.The ROC curve showed that 8.5×10^4 copies/mL was regarded as the cut off value,the sensitivity of the free mtDNA in

关 键 词：急性胰腺炎(AP) 血浆游离线粒体DNA(mtDNA) 实时荧光定量PCR 

分 类 号：R576[医药卫生—消化系统]