血清PTX-3及PAF联合预测ERCP术后胰腺炎的临床价值  

Clinical significance of serum PTX-3 and PAF in predicting postoperative pancreatitis following ERCP in patients with cirrhosis and choledocholithiasis

作　　者：卿小松[1] 陈杰[1] 何晓非[1] 郑英俊 QING Xiao-song;CHEN Jie;HE Xiao-fei;ZHENG Ying-jun(Department of Hepatobiliary Surgery,The Fourth People’s Hospital of Zigong City,Zigong 643000)

机构地区：[1]自贡市第四人民医院肝胆外科,四川643000

出　　处：《肝脏》2024年第10期1277-1280,共4页Chinese Hepatology

基　　金：四川省卫生健康委员会科研项目(20PJ271)。

摘　　要：目的探讨血清穿透素(PTX-3)及血小板活化因子(PAF)联合预测内镜逆行胰胆管造影(ERCP)术后胰腺炎的临床价值。方法选取自贡市第四人民医院肝胆胰脾诊疗中心2017年4月至2022年10月收治行ERCP术治疗的120例肝硬化合并胆总管结石患者,术后48 h未发生胰腺炎95例,发生胰腺炎25例。多因素logistis回归分析ERCP术后发生胰腺炎的影响因素;受试者工作特征曲线下面积(AUC)评估血清淀粉酶、PAF、PTX-3、TPS-2联合检测胰腺炎的效能。结果胰腺炎组血清PTX-3(13.52±0.85)ng/mL、淀粉酶(166.80±13.52)U/L、PAF(65.32±3.52)μg/L、CRP(44.63±3.74)mg/L、TPS-2(189.26±4.56)μg/L水平高于无胰腺炎组(1.89±0.41)ng/mL、(63.52±4.78)U/L、(4.26±0.85)μg/L、(7.20±2.06)mg/L、(37.52±4.05)μg/L,差异有统计学意义(P<0.05)。经多因素Logistic回归分析,血清PTX-3、淀粉酶、PAF、TPS-2指标可作为预测ERCP术后发生胰腺炎的主要因素。PTX-3、PAF、血清淀粉酶、TPS-2和联合检测诊断ERCP术后发生胰腺炎的AUC分别为0.763、0.756、0.788、0.706和0.924。结论PTX-3、PAF、TPS-2、血清淀粉酶联合检测诊断ERCP术后发生胰腺炎的价值较高。Objective To evaluate the clinical significance of serum penetrating-3(PTX-3)and platelet-activating factor(PAF)in predicting post-ERCP pancreatitis(PEP)in patients with cirrhosis and choledocholithiasis.Methods A total of 120 patients with cirrhosis and choledocholithiasis who underwent ERCP at the Liver,Biliary,Pancreatic,and Spleen Diagnosis and Treatment Center of Zigong Fourth People’s Hospital between April 2017 and October 2022 were enrolled in this stuydy.Patients were divided into two groups based on the occurrence of PEP within 48 hours after the procedure:the control group(n=95,no PEP)and the observation group(n=25,PEP occurred).The factors influencing the occurrence of PEP after ERCP were analyzed through both univariate and multicariate analyses.Additionally,the diagnostic efficacy of combined serum amylase,PAF,PTX-3,and TPS-2 levels in detecting PEP was evaluated.Results①The levels of PTX-3(13.52±0.85 ng/ml),amylase(166.80±13.52 U/L),PAF(65.32±3.52μg/L),CRP(44.63±3.74 mg/L),and TPS-2(189.26±4.56μg/L)in the observation group were significantly higher than those in the control group[PTX-3(1.89±0.41 ng/mL),amylase(63.52±4.78 U/L),PAF(4.26±0.85μg/L),CRP(7.20±2.06 mg/L),and TPS-2(37.52±4.05μg/L)](P<0.05).②Multivariate Logistic regression analysis identified serum PTX-3,amylase,PAF,and TPS-2 as independent predictors of PEP after ERCP(P<0.05).③The combined diagnostic efficacy of PTX-3,PAF,serum amylase,and TPS-2 was superior to that of any individual marker,indicating that the combined detection of these four markers has greater value in predicting the occurrence of PEP after ERCP.Conclusion The combined detection of PTX-3,PAF,TPS-2 and serum amylase has significant value in predicting the occurrence of PEP after ERCP,.This approach can facilitate the early diagnosis of PEP,making it a strategy worth promoting in clinical practive.

关 键 词：血清PTX-3 血小板活化因子 肝硬化 胆总管结石 内镜逆行胰胆管造影 术后胰腺炎 

分 类 号：R657.31[医药卫生—外科学] R657.51[医药卫生—临床医学]