急性胰腺炎患者血清Toll样受体9和基质金属蛋白酶-9与继发感染及器官功能衰竭的相关性  

Correlations of serum Toll-like receptor 9and matrix metalloproteinase-9 with secondary infection and organ failure in patients with acute pancreatitis

作　　者：谢栩硕[1] 朱汉平[2] 彭亮[3] 梁增伟[1] 杨玲[1] 曾文铤[1] XIE Xu-shuo;ZHU Han-ping;PENG Liang;LIANG Zeng-wei;YANG Ling;ZENG Wen-ting(Department of Infectious Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,China;Department of Integrated Traditional Chinese and Western Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,China;Department of Gastroenterology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,China)

机构地区：[1]广州医科大学附属第一医院感染内科,广东广州510120 [2]广州医科大学附属第一医院中西医结合科,广东广州510120 [3]广州医科大学附属第一医院消化内科,广东广州510120

出　　处：《中华实用诊断与治疗杂志》2021年第3期276-279,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广东省自然科学基金(2018A030313970);广州市卫生和计划生育科技项目(20192A011014)。

摘　　要：目的观察急性胰腺炎患者血清Toll样受体9(Toll-like receptor 9,TLR9)、基质金属蛋白酶-9(matrix metallopeptidase-9,MMP-9)水平变化,探讨其预测继发感染、器官功能衰竭的价值。方法72例急性胰腺炎患者,均给予改善微循环、解痉止痛、抑制胰酶分泌、抗感染等规范治疗。治疗7d后,发生继发感染者31例为感染组,未发生继发感染者41例为未感染组;发生器官功能衰竭者8例为衰竭组,未发生器官功能衰竭者64例为未衰竭组。比较感染组与未感染组、衰竭组与未衰竭组一般资料及血清TLR9、MMP-9、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平;多因素logistic回归分析急性胰腺炎患者发生继发感染及器官功能衰竭的影响因素;绘制ROC曲线评估血清TLR9、MMP-9预测急性胰腺炎患者继发感染及器官功能衰竭发生风险的效能。结果感染组与未感染组,衰竭组与未衰竭组年龄、性别比例及合并糖尿病、高血压、高脂血症比率比较差异均无统计学意义(P>0.05);感染组血清TLR9[(17.30±2.37)μg/L]、MMP-9[(29.42±9.82)μg/L]、TNF-α[(66.40±5.37)μg/L]水平高于未感染组[(14.49±1.71)、(17.02±4.02)、(63.22±1.79)μg/L](P<0.05),血清IL-6[(56.45±4.32)μg/L]水平与未感染组[(57.21±4.29)μg/L]比较差异无统计学意义(P>0.05);衰竭组血清TLR9[(19.23±2.12)μg/L]、MMP-9[(65.56±30.91)μg/L]、IL-6[(59.67±7.60)μg/L]水平高于未衰竭组[(15.07±2.13)、(23.57±18.63)、(54.11±2.11)μg/L](P<0.05),血清TNF-α[(62.35±3.23)μg/L]水平与未衰竭组[(61.95±3.18)μg/L]比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,血清TLR9(OR=1.558,95%CI:1.428~2.727,P<0.001)、MMP-9(OR=1.818,95%CI:1.748~1.895,P<0.001)、TNF-α(OR=1.372,95%CI:1.211~1.979,P<0.001)是急性胰腺炎患者发生继发感染的影响因素;血清TLR9(OR=1.942,95%CI:1.933~3.012,P<0.001)、MMP-9(OR=1.978,95%CI:1.926~3.969,P<0.001)、IL-6(OR=1.950,9Objective To observe the changes of serum Toll-like receptor 9(TLR9)and matrix metalloproteinase-9(MMP-9)levels in patients with acute pancreatitis,and to investigate the values of them two to the prediction of secondary infection and organ failure.Methods Seventy-two patients with acute pancreatitis received standard treatment including improving microcirculation,relieving spasm and pain,inhibiting pancreatic enzyme secretion and anti-infection.After 7-day treatment,there were 31patients with secondary infection(infection group)and 41patients without secondary infection(non-infection group),and there were 8patients with organ failure(failure group)and 64patients without organ failure(non-failure group).The general data and serum levels of TLR9,MMP-9,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared between infection group and non-infection group,and between failure group and non-failure group.Multivariate logistic regression analysis was used to analyze the influencing factors of secondary infection and organ failure,and ROC was drawn to evaluate the efficacies of serum TLR9and MMP-9 on predicting the risk of secondary infection and organ failure in patients with acute pancreatitis.Results The age,sex ratio,and the percentages of diabetes mellitus,hypertension and hyperlipidemia showed no significant differences between infection group and non-infection group,and between failure group and non-failure group(P>0.05).The levels of TLR9,MMP-9and TNF-αwere higher in infection group((17.30±2.37),(29.42±9.82),(66.40±5.37)μg/L)than those in non-infection group((14.49±1.71),(17.02±4.02),(63.22±1.79)μg/L)(P<0.05),and the level of serum IL-6showed no significant difference between infection group((56.45±4.32)μg/L)and non-infection group((57.21±4.29)μg/L)(P>0.05).The levels of TLR9,MMP-9and IL-6were higher in failure group((19.23±2.12),(65.56±30.91),(59.67±7.60)μg/L)than those in non-failure group((15.07±2.13),(23.57±18.63),(54.11±2.11)μg/L)(P<0.05),and the level of serum TNF-αshowed

关 键 词：急性胰腺炎 继发感染 器官功能衰竭 TOLL样受体9 基质金属蛋白酶-9 

分 类 号：R576[医药卫生—消化系统]