CRP、IL-6、IL-8、TNF-α表达水平对ERCP术后胰腺炎的诊断及与病情程度的相关性  

CRP,IL-6,IL-8,TNF-α in the diagnosis of post-ERCP pancreatitis and the correlation study of disease severity

作　　者：王杰民 庄剑波 凌成军 刘春[1] 居伟[1] 陈玉兰 WANG Jie-min;ZHUANG Jian-bo;LING Cheng-jun;LIU Chun;JU Wei;CHEN Yu-lan(Department of Gastroenterology,the People's Hospital of SND,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州高新区人民医院消化内科,江苏苏州215000

出　　处：《热带医学杂志》2021年第6期757-761,共5页Journal of Tropical Medicine

基　　金：苏州科技教育基金(GHF-20170509854)。

摘　　要：目的探讨C反应蛋白(CRP)、白介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)表达水平在内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)患者中的表达及与病情程度的关系。方法收集苏州高新区人民医院2017年3月至2020年3月择期开展ERCP术患者80例,根据血清淀粉酶(术后24 h)水平、胰腺炎影像学特征分为胰腺炎组(淀粉酶>420 U/L,n=29)、高淀粉酶组(淀粉酶136420 U/L,n=25)和正常对照组(淀粉酶35135 U/L,n=26),比较三组术前,术后6、24 h血清淀粉酶、CRP、IL-6、IL-8、TNF-α等水平,ROC曲线分析ERCP术后6、24 h血清淀粉酶单独检测及联合CRP、IL-6、IL-8、TNF-α预测诊断PEP的价值。根据PEP患者24 h急性生理学与慢性健康状况(APACHEⅡ)评分情况分为轻度组(n=17)和重度组(n=12),比较两组CRP、IL-6、IL-8、TNF-α水平及APACHEⅡ评分。Pearson相关性分析胰腺炎患者血清CRP、IL-6、IL-8、TNF-α与APACHEⅡ评分的相关性。结果胰腺炎组、高淀粉酶组和正常对照组术前血清淀粉酶、CRP、IL-6、IL-8、TNF-α水平比较,差异无统计学意义(P>0.05);各组术后CRP均明显升高,胰腺炎组、高淀粉酶组术后血清淀粉酶、IL-6、IL-8、TNF-α水平明显升高,与术前比较差异均有统计学意义(P<0.05);胰腺炎组术后6、24 h血清淀粉酶、CRP、IL-6、IL-8、TNF-α升高幅度均明显高于高淀粉酶组、正常对照组(P<0.05)。基于ERCP术后6 h血清淀粉酶水平绘制ROC工作曲线,单独检测诊断PEP曲线下面积为0.712,准确度73.6%;结合患者ERCP术后6 h CRP、IL-6、IL-8、TNF-α水平联合检测,诊断PEP的曲线下面积为0.856,准确度88.6%,ERCP术后6 h血清淀粉酶单独检测准确度与联合检测比较,差异有统计学意义(P<0.05)。重度组和轻度组术前CRP、IL-6、IL-8、TNF-α水平比较,差异无统计学意义(P>0.05);术后两组CRP、IL-6、IL-8、TNF-α水平均明显升高,与术前比较差异有统计学意义(P<0.05);且重度组术后6、24 h CRP、ILObjective To explore the relationship between the expression of C-reactive protein(CRP), interleukin-6(IL-6),IL-8,tumor necrosis factor-α(TNF-α)in patients with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP). Methods 80 cases of patients undergoing elective ERCP surgery from the People’s Hospital of SND from March 2017 to March 2020 were collected. According to the level of serum amylase(24 h after surgery)and the imaging characteristics of pancreatitis,they were divided into pancreatitis group(amylase>420 U/L,n=29) and high amylase group(amylase 136-420 U/L,n=25)and the control group(amylase 35-135 U/L,n=26). The levels of serum amylase,CRP,IL-6,IL-8,and TNF-α before and at 6 and 24 h after surgery of the three groups were compared. ROC curve was used to analyze the value of serum amylase detection alone and combined with CRP,IL-6,IL-8,and TNF-α in the diagnosis and prediction of PEP at 6 and 24 h after ERCP. According to the 24 h acute physiology and chronic health evaluation scoring system(APACHE Ⅱ)score of PEP patients,they were divided into mild group(n=17)and severe group(n=12);the levels of CRP,IL-6,IL-8,TNF-α and APACHEⅡ score were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between serum CRP,IL-6,IL-8,TNF-α and APACHEⅡ score in patients with pancreatitis. Results The preoperative serum amylase,CRP,IL-6,IL-8,and TNF-α levels in the pancreatitis group,high amylase group and the control group were not significantly different(P>0.05);the CRP levels of each group were all significantly increased. The levels of amylase,IL-6,IL-8 and TNF-α in pancreatitis group and high amylase group increased significantly after operation,and the differences were statistically significant compared with those before operation(P<0.05). The increases of amylase,CRP,IL-6,IL-8 and TNF-α in the pancreatitis group was significantly higher than those in the high amylase group and the normal control group at 6 and 24 h after surgery(P<0.0

关 键 词：内镜逆行胰胆管造影 C反应蛋白 胰腺炎 炎症因子 表达差异 

分 类 号：R657.51[医药卫生—外科学]