动态监测3项血清学指标在继发感染性胰腺坏死早期诊断中的价值  

The value of ambulatory monitoring of three serological indicators in the early diagnosis of infectious pancreatic necrosis secondary to moderately severe and severe acute pancreatitis

作　　者：刘禹良 高明[1] LIU Yu-liang;GAO Ming(Department of Emergency Surgery,the Second Hospital of Anhui Medical University,Research Center of Minimally invasive Intervention,Anhui Medical University,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院急诊外科,安徽医科大学微创介入研究中心,安徽合肥230601

出　　处：《中日友好医院学报》2024年第6期333-337,344,共6页Journal of China-Japan Friendship Hospital

摘　　要：目的:探讨急性胰腺炎(AP)患者血清中白介素1β(IL-1β)、血管紧张素Ⅱ(AngⅡ)、纤维蛋白原样蛋白1(FGL-1)动态监测对中度重症及重症急性胰腺炎(MSAP、SAP)继发感染性胰腺坏死(IPN)的早期预测价值。方法:收集2022年1月—2023年6月间安徽医科大学第二附属医院收治的103例MSAP及SAP患者资料,其中35例继发IPN(IPN组),68例未发生IPN(对照组),动态监测2组患者入院后第1d、4d、7d的IL-1β、AngⅡ、FGL-1水平的差异,ROC曲线分析各指标的曲线下面积(AUC)、灵敏度、特异度。结果:2组患者入院第1d降钙素原水平及改良CT严重指数(MCTSI)评分差异有统计学意义(P<0.05)。IPN组入院时IL-1β、AngⅡ、FGL-1水平均高于非IPN组(P<0.05);相关性分析结果显示,早期3项指标与MCTSI评分呈正相关(r=0.6205、0.6163、0.7582,P<0.05)。ROC曲线显示,IL-1β、AngⅡ、FGL-1早期预测MSAP及SAP继发IPN发生的AUC分别为0.698、0.795、0.860,当采用以IL-1β≥6.480pg/ml、AngⅡ≥16.219ng/ml、FGL-1≥20.517μg/L为诊断阈值时,三者联合灵敏度提升至0.997,特异度升至0.966。结论:血清IL-1β、AngⅡ和FGL-1联合动态监测在MSAP及SAP继发IPN早期诊断方面具有一定的临床价值。Objective:To investigate the value of dynamic monitoring of interleukin-1β(IL-1β),angiotensin Ⅱ(AngⅡ)and fibrinogen-like protein 1(FGL-1)in the early prediction of infectious pancreatic necrosis(IPN)secondary to moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)patients.Methods:The data of 103 MSAP and SAP patients admitted to the Second Affiliated Hospital of Anhui Medical University from January 2022 to June 2023 were collected,including 35 cases with secondary IPN(IPN group)and 68 cases without IPN(control group),and the levels of IL-1β,AngⅡ and FGL-1 on the 1st,4th,and 7th days after admission were dynamically monitored.ROC curve was used to analyze the AUC,sensitivity and specificity,and correlation analysis with modified CT severity index(MCTSI)was performed.Results:The difference in procalcitonin levels and MCTSI on the first day of admission between the two groups was statistically significant(P<0.05).The levels of IL-1β,AngⅡ,and FGL-1 in the IPN group were higher than those in the non-IPN group(P<0.05),the early IL-1β,AngⅡ,and FGL-1 were positively correlated with the MCTSI(r=0.6205,0.6163,0.7582,P<0.05).The AUC of the three indexes were 0.698,0.795 and 0.860 for early prediction of MSAP and SAP secondary IPN,respectively,and when IL-1β≥6.480pg/ml,AngⅡ≥16.219ng/ml,and FGL-1≥20.517μg/L were the diagnostic threshold.The sensitivity of the three tests could be increased to 0.997,specificity could be increased to 0.966 when the combination of the three tests were performed in parallel tests.Conclusion:Dynamic monitoring of serum IL-1β,AngⅡ,and FGL-1 has certain clinical value in the early diagnosis of IPN secondary to MSAP and SAP.

关 键 词：急性胰腺炎 感染性胰腺坏死 白介素1Β 血管紧张素Ⅱ 纤维蛋白原样蛋白1 

分 类 号：R657.5[医药卫生—外科学] R576[医药卫生—临床医学]