铁代谢标志物与急性胰腺炎病情严重程度的相关性研究  

Correlation between iron metabolism markers and severity of acute pancreatitis

作　　者：谢文秀[1] 常艳[1] 张春燕[1] Xie Wenxiu;Chang Yan;Zhang Chunyan(The Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心,北京100048

出　　处：《中国医刊》2021年第5期487-491,共5页Chinese Journal of Medicine

基　　金：国家老年疾病临床医学研究中心课题(NCRCG-PLAGH-2019023)。

摘　　要：目的探讨血清铁(serum iron,SI)、转铁蛋白(transferrin,TF)和血清铁蛋白(serum ferritin,SF)与急性胰腺炎病情严重程度的相关性。方法选择2016年1月至2019年12月解放军总医院第六医学中心收治的312例急性胰腺炎患者作为急性胰腺炎组,根据2012年新亚特兰大急性胰腺炎分类标准分为非重症急性胰腺炎组(234例)和重症急性胰腺炎组(78例)。选取同期健康体检者30例作为对照组。收集所有入组者的一般临床资料以及SI、TF、SF、血淀粉酶(amylase,AMY)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)、血清钙(Ca)水平以及血常规、肝功能、肾功能检查结果,计算急性生理与慢性健康状况评分标准Ⅱ(acute physiologic and chronic health evaluationⅡ,APACHEⅡ)评分;分析SI、TF、SF与APACHEⅡ评分的相关性;采用多元线性回归分析影响APACHEⅡ评分的独立影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评估SI、TF、SF单独及联合检测对重症急性胰腺炎的预测价值。结果与对照组比较,非重症急性胰腺炎组和重症急性胰腺炎组的SI、TF水平显著降低(P<0.01),SF水平显著升高(P<0.01);重症急性胰腺炎组的SI、TF水平显著低于非重症急性胰腺炎组,SF水平显著高于非重症急性胰腺炎组,差异有显著性(P<0.01)。SI、TF、Ca水平与APACHEⅡ评分呈负相关(r=-0.473、r=-0.328、r=-0.482,P均<0.05),SF、CRP、IL-6、尿素氮水平与APACHEⅡ评分呈正相关(r=0.465、r=0.496、r=0.254、r=0.236,P均<0.05)。多元线性回归分析显示,SI、TF、SF、CRP、Ca是APACHEⅡ评分的独立影响因素(P<0.05)。SI、TF、SF三者联合诊断重症急性胰腺炎的AUC为0.865(95%CI 0.794~0.936),灵敏度和特异度分别为86.2%和72.5%。结论急性胰腺炎早期SI、TF下降,SF升高,且与病情严重程度相关,三者联合检测对预测重症急性胰腺炎具有重要参考价值。Objective To investigate the correlation between serum iron(SI),transferrin(TF),serum ferritin(SF)and severity of acute pancreatitis(AP).Method A total of 312 AP patients admitted to the Sixth Medical Center of PLA General Hospital from January 2016 to December 2019 were selected and divided into non severe pancreatitis group(NSAP)with 234 cases and severe pancreatitis group(SAP)with 78 cases according to the 2012 new Atlanta classification of acute pancreatitis.30 healthy patients in the same period were selected as the control group.The general clinical data of the patients were collected,and the laboratory indexes such as SI,TF,SF,AMY,CRP,IL-6,Ca,routine blood test,liver function and renal function were detected,and Acute Physiologic and Chronic Health EvaluationⅡ(APACHE II)score were calculated.The levels of SI,TF and SF were compared among the three groups.The correlation between SI,TF,SF and APACHE II score was analyzed and the independent factors influencing APACHE II score were analyzed by multiple linear regression.The area under the curve(AUC)of receiver operating characteristic(ROC)was used to evaluate the predictive value of single and combined detection SI,TF and SF in severe acute pancreatitis.Result Compared with the control group,SI and TF levels in NSAP group and SAP group were significantly decreased(P<0.01),SF levels were significantly increased(P<0.01);SI and TF levels in SAP group were significantly lower than those in NSAP group,and SF level in SAP group was significantly higher than that in NSAP group(P<0.01);SI,TF and Ca levels were significantly negatively correlated with APACHE II score(r=-0.473,r=-0.328,r=-0.482,all P<0.05).SF,CRP,IL-6,BUN levels were significantly positively correlated with APACHE II score(r=0.465,r=0.496,r=0.254,r=0.236,all P<0.05).Multiple linear regression analysis showed that SI,TF,SF,CRP and Ca were independent factors influencing APACHE II score(P<0.05).ROC curve analysis showed that the AUC of combination of SI,TF and SF in diagnosising SAP was 0.865(95%CI 0.7

关 键 词：急性胰腺炎 血清铁 转铁蛋白 铁蛋白 严重程度 

分 类 号：R576[医药卫生—消化系统]