重症胰腺炎继发脓毒症患者血清eNAMPT、sPD-L1的变化及临床预后意义  

Changes and clinical prognostic significance of serum eNAMPT and sPD-L1 in patients with sepsis secondary to severe pancreatitis

作　　者：冀乃喜 崔云云 李尚真 王先奎 刘景隆 JI Naixi;CUI Yunyun;LI Shangzhen;WANG Xiankui;LIU Jinglong(Department of Intensive Care Medicine,Xining Second People′s Hospital,Xining,Qinghai 810003,China;Department of Geriatrics,Xining Second People′s Hospital,Xining,Qinghai 810003,China)

机构地区：[1]西宁市第二人民医院重症医学科,青海西宁810003 [2]西宁市第二人民医院老年病科,青海西宁810003

出　　处：《国际检验医学杂志》2024年第22期2737-2742,共6页International Journal of Laboratory Medicine

基　　金：青海省卫生健康委卫生健康科研课题(2022-wjzxd-100)。

摘　　要：目的研究重症胰腺炎(SAP)继发脓毒症患者血清细胞外尼克酰胺磷酸核糖转移酶(eNAMPT)、可溶性程序性死亡配体-1(sPD-L1)的表达及临床意义。方法选择2019年2月至2022年2月该院收治的92例SAP患者作为SAP组,将其进一步分为脓毒症亚组(42例)和非脓毒症亚组(50例)。以50例轻中度胰腺炎患者为疾病对照组,另选择同期于该院体检的50例体检健康者为健康对照组。采用酶联免疫吸附试验检测血清eNAMPT、sPD-L1水平。采用Pearson相关分析进行相关性分析。采用多因素Logistic回归分析影响SAP继发脓毒症发生的因素。绘制受试者工作特征(ROC)曲线分析血清eNAMPT,sPD-L1及联合对SAP继发脓毒症的预测价值。结果SAP组血清eNAMPT、sPD-L1水平高于疾病对照组和健康对照组,差异有统计学意义(P<0.05)。脓毒症组SAP患者急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、白细胞计数、C反应蛋白、胰腺坏死、全身炎症反应综合征、多器官功能衰竭、血清eNAMPT、sPD-L1高于非脓毒症组SAP患者,差异均有统计学意义(P<0.05)。脓毒症SAP患者血清eNAMPT,sPD-L1与APACHEⅡ评分,SOFA评分呈正相关(均P<0.05)。血清eNAMPT、sPD-L1是影响SAP患者继发脓毒症发生的独立危险因素。血清eNAMPT、sPD-L1联合对SAP患者继发脓毒症预测的曲线下面积(AUC)为0.916(95%CI:0.868~0.947),大于单项指标检测的0.846(95%CI:0.791~0.879)、0.830(95%CI:0.774~0.861),差异有统计学意义(Z=4.129、4.885,均P<0.001)。结论SAP继发脓毒症患者血清eNAMPT,sPD-L1升高,与病情程度有关,二者联合对SAP继发脓毒症的具有较高的预测价值。Objective To investigate the expression and clinical significance of extracellular nicotinamide phosphate ribose transferase(eNAMPT)and soluble programmed death ligand 1(sPD-L1)in serum of patients with sepsis secondary to severe pancreatitis(SAP).Methods A total of 92 SAP patients admitted to the hospital from February 2019 to February 2022 were selected as(SAP grou),and divided into a sepsis group(42 cases)and a non-sepsis group(50 cases).Moreover,50 patients with mild to moderate pancreatitis who were diagnosed and treated at the same time were selected as the disease control group,and 50 healthy individuals who underwent the physical examination in the hospital during the same pariod were selected as the healthy control group.Enzyme linked immunosorbent assay was used to detect serum levels of eNAMPT and sPD-L1.Pearson correlation analysis was used for correlation analysis.Multivariate Logistic regression analysis was used to analyze factors affecting the occurrence of secondary sepsis in SAP.The predictive value of serum eNAMPT,sPD-L1 and their combination in the secondary sepsis of SAP was conducted by receiver operating characteristic(ROC)curve.Results The serum levels of eNAMPT and sPD-L1 in the SAP group were higher than those in the disease control group and the healthy control group,and the differences were statistically significant(P<0.05).The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,white blood cell count,C-reactive protein,pancreatic necrosis,systemic inflammatory response syndrome,multiple organ failure,serum eNAMPT and sPD-L1 in the sepsis group were higher than those in the non-sepsis group,and the differences were statistically significant(P<0.05).There was a positive correlation between serum eNAMPT,sPD-L1 and APACHEⅡscore,SOFA score in sepsis SAP patients(P<0.05).Serum eNAMPT and sPD-L1 were independent risk factors for secondary sepsis in SAP patients.The area under the curve(AUC)of the combination of serum eNAMPT and s

关 键 词：重度胰腺炎 脓毒症 细胞外尼克酰胺磷酸核糖转移酶 可溶性程序性死亡配体-1 预后 

分 类 号：R576[医药卫生—消化系统] R446.1[医药卫生—内科学]