重症急性胰腺炎患者早期血清可溶性致癌抑制因子2和肽素、心型脂肪酸结合蛋白的水平变化及其临床意义  

Changes of serum soluble suppression of tumorigenicity 2,copeptin,heart-type fatty acid-binding protein levels and their clinical significance among patients in early stage of severe acute pancreatitis

作　　者：杨蕾 王雅霄 周长静 YANG Lei;WANG Ya-xiao;ZHOU Chang-jing(Emergency ICU,the People′s Hospital of Hengshui City,Hengshui 053000,China)

机构地区：[1]河北省衡水市人民医院急诊重症监护室,衡水市053000

出　　处：《广西医学》2021年第4期398-402,共5页Guangxi Medical Journal

基　　金：河北省医学科学研究重点课题(20191767)。

摘　　要：目的探讨重症急性胰腺炎(SAP)患者早期血清可溶性致癌抑制因子2(sST2)、和肽素、心型脂肪酸结合蛋白(H-FABP)的水平变化及其临床意义。方法根据病情严重程度将240例急性胰腺炎患者分为轻症急性胰腺炎(MAP)组122例和SAP组118例,根据预后将SAP组进一步分为存活组62例和死亡组56例。比较SAP组和MAP组之间以及SAP两个亚组(存活亚组和死亡亚组)之间患者入院2 h、6 h、48 h时的心肌肌钙蛋白I(cTnI)、H-FABP、和肽素、sST2、N-末端B型钠肽前体(NT-proBNP)水平的差异,分析sST2、H-FABP、和肽素、cTnI水平与SAP患者死亡的相关性,并采用受试者工作特征(ROC)曲线分析sST2、H-FABP、和肽素、cTnI水平预测SAP患者死亡的价值。结果入院2 h时,MAP组和SAP组之间、存活组和死亡组之间的cTnI和NT-proBNP水平差异均无统计学意义(均P>0.05),SAP组和死亡组的sST2、H-FABP、和肽素水平分别高于MAP组和存活组(均P<0.05);入院6 h、48 h时,SAP组、死亡组的cTnI、NT-proBNP、sST2、H-FABP、和肽素水平分别高于MAP组和存活亚组(均P<0.05)。入院后2 h、6 h、48 h,SAP组、死亡组、存活组患者的cTnI、H-FABP、和肽素、sST2、NT-proBNP水平均随时间延长而升高(均P<0.05)。相关性分析结果显示,sST2、H-FABP、和肽素和cTnI水平均与SAP患者的死亡率呈正相关(均P<0.05),sST2、H-FABP、和肽素、cTnI水平预测SAP患者死亡的ROC曲线下面积分别为0.860、0.737、0.680、0.751(均P<0.05)。结论SAP患者的心肌损伤随时间延长逐渐加重,且发病早期的sST2、H-FABP、和肽素水平越高,心肌损伤越重,患者死亡率越高,sST2、H-FABP、和肽素、cTnI水平均对SAP患者的预后有预测价值,其中sST2水平的预测价值最大。Objective To investigate the changes of serum soluble suppression of tumorigenicity 2(sST2),copeptin and heart-type fatty acid-binding protein(H-FABP)levels and their clinical significance among patients in early stage of severe acute pancreatitis(SAP).Methods A total of 240 patients with acute pancreatitis were divided into mild acute pancreatitis(MAP)group(n=122)and SAP group(n=118)according to the severity of the disease,and the SAP group was further divided into survival group(n=62)and death group(n=56)based on the prognosis.The data of the patients were compared between the SAP group and the MAP group,or between the two subgroups of SAP(the survival group and the death group),including changes in the levels of cardiac troponin I(cTnI),H-FABP,copeptin,sST2,N-terminal pro-B-type natriuretic peptide(NT-proBNP)two,six and 48 hours after admission,and the correlation of sST2,H-FABP,copeptin or cTnI level with mortality was analyzed in SAP patients.In addition,receiver operating characteristic(ROC)curve was employed to analyze the value of sST2,H-FABP,copeptin or cTnI level for predicting the mortality of SAP patients.Results Two hours after admission,there was no statistically significant difference in cTnI or NT-proBNP level between the MAP group and the SAP group,or between the survival group and the death group(all P>0.05),the SAP group and the death group had higher sST2,H-FABP and copeptin levels than the MAP group and the survival group,respectively(all P>0.05);six and 48 hours after admission,the SAP and death groups reported elevated levels of cTnI,NT-proBNP,sST2,H-FABP and copeptin as compared with the MAP and survival groups respectively(all P<0.05).The levels of cTnI,H-FABP,copeptin,sST2 and NT-proBNP increased over time in the SAP group,the death group and the survival group two,six and 48 hours after admission(all P<0.05).The results of correlation analysis revealed that sST2,H-FABP,copeptin and cTnI levels positively correlated with mortality in SAP patients(all P<0.05),and the areas under ROC curve

关 键 词：重症急性胰腺炎 可溶性致癌抑制因子2 和肽素 心型脂肪酸结合蛋白 预后 

分 类 号：R576.1[医药卫生—消化系统]