血清胆碱酯酶水平联合炎性反应因子对重症急性胰腺炎并发肺部感染的预测价值  

Predictive Value of Serum Cholinesterase Levels Combined with Inflammatory Response Factors for Pulmonary Infection Complicating Severe Acute Pancreatitis

作　　者：樊斌 李庆贺 李伟 张家耀 FAN Bin;LI QingHe;LI Wei(Enshi Tujia and Miao Autonomous Prefecture Central Hospital,Hubei Enshi 445000,China)

机构地区：[1]湖北省恩施土家族苗族自治州中心医院,湖北恩施445000

出　　处：《河北医学》2024年第6期1003-1007,共5页Hebei Medicine

基　　金：湖北省卫健委科研项目,(编号:WJ2021F092);恩施州科技计划项目,(编号:D20220074)。

摘　　要：目的:探讨血清胆碱酯酶(ChE)、C反应蛋白(CRP)和白细胞介素-6(IL-6)对重症急性胰腺炎(SAP)患者并发肺部感染(PI)的预测价值。方法:选取2018年1月至2024年1月期间本院诊治的80例SAP患者作为SAP组。根据SAP患者是否发生PI,分为PI组(40例)和非PI组(40例)。根据临床PI评分将观察对象分为轻、中、重度组,并选择60例健康体检者作为对照组。采用ELISA实验检测血清ChE、CRP和IL-6水平。比较各组受试者肺通气功能指标(机械通气时间(d))。采用Logistic回归分析SAP并发PI的危险因素。ROC评估血清ChE、CRP和IL-6对SAP并发PI发生的预测价值。结果:与对照组相比,SAP组血清ChE水平显著降低,CRP和IL-6水平显著升高(P<0.05)。血清ChE水平在不同PI评分患者中,轻度>中度>重度,而CRP、IL-6水平呈相反趋势,差异均有统计学意义(P<0.05)。PI组CRP和IL-6水平明显高于非PI组,PI组血清ChE水平显著低于非PI组(P<0.05)。PI组机械通气时间较非PI组均降低(P<0.05)。Logistic回归分析显示,CRP和IL-6升高以及低血清ChE与SAP合并PI预后不良独立相关(P<0.05),其AUC为0.807;大于血清ChE、CRP和IL-6单独检测的AUC值(分别为0.716、0.749和0.732),差异均有统计学意义(P<0.05)。联合检测对SAP并发PI发生预测的灵敏度为87.5%,特异度为67.5%。结论:SAP并发PI患者血清ChE水平降低、CRP和IL-6水平升高是影响SAP并发PI发生的独立危险因素,3项联合对SAP并发PI的发生具有较高的预测价值。Objective:To explore the predictive value of serum cholinesterase(ChE),C-reactive protein(CRP),and interleukin-6(IL-6)for pulmonary infection(PI)in patients with severe acute pancreatitis(SAP).Methods:Eighty SAP patients treated at our hospital from January 2018 to January 2024 were selected as the SAP group.Based on whether these patients developed PI,they were divided into the PI group(40 cases)and the non-PI group(40 cases).According to clinical PI scores,the subjects were categorized into mild,moderate,and severe groups,and 60 healthy individuals were selected as controls.Serum ChE,CRP,and IL-6 levels were measured using ELISA.The pulmonary ventilation function index(mechanical ventilation time(days))was compared among groups.Logistic regression analysis was used to identify risk factors for PI in SAP patients.The predictive value of serum ChE,CRP,and IL-6 for PI in SAP was assessed using ROC curves.Results:Compared with the control group,the SAP group had significantly lower serum ChE levels and significantly higher CRP and IL-6 levels(P<0.05).Among patients with different PI scores,serum ChE levels showed a pattern of mild>moderate>severe,whereas CRP and IL-6 levels exhibited the opposite trend,with statistically significant differences(P<0.05).The PI group had significantly higher CRP and IL-6 levels and significantly lower serum ChE levels than the non-PI group(P<0.05).The mechanical ventilation time was shorter in the PI group compared to the non-PI group(P<0.05).Logistic regression analysis revealed that increased CRP and IL-6 levels and low serum ChE were independently associated with poor prognosis in SAP patients with PI(P<0.05),with an AUC of 0.807,which was greater than the AUC values of serum ChE,CRP,and IL-6 alone(0.716,0.749,and 0.732,respectively),all statistically significant(P<0.05).Combined detection had a sensitivity of 87.5%and a specificity of 67.5%for predicting PI in SAP patients.Conclusion:In patients with SAP complicated by PI,decreased serum ChE levels and increased CRP and IL-6 leve

关 键 词：急性胰腺炎 肺部感染 胆碱酯酶 C反应蛋白 白细胞介素-6 呼吸衰竭 

分 类 号：R576[医药卫生—消化系统] R563.1[医药卫生—内科学]