外周血应激障碍相关指标水平对外科性、非外科性急腹症的鉴别诊断价值  

Value of peripheral blood stress disorder related indexes in differential diagnosis of surgical and non-surgical acute abdomen in emergency

作　　者：孟青[1] 李强 蒋丽娜[1] MENG Qing;LI Qiang;JIANG Lina(Dazhou Hospital of Integrated Chinese and Western Medicine,Dazhou 635002,China)

机构地区：[1]四川省达州市中西医结合医院,635002

出　　处：《临床外科杂志》2025年第2期139-143,共5页Journal of Clinical Surgery

基　　金：四川省科技厅重点研发计划(2022YFS0963)。

摘　　要：目的 探讨外周血应激障碍相关指标水平对外科性、非外科性急腹症的鉴别诊断价值。方法 2018年1月~2020年6月收治的急性腹痛病人300例(腹痛组)。入院时检测外周血脯氨酸肽酶活性、总氧化剂状态水平(TOS)、总抗氧化状态水平(TAS)和氧化应激指数(OSI),根据病人治疗结局,将其分为手术治疗组(ST组,99例)、非手术治疗组(MT组,102例)和非特异性腹痛组(NSAP组,99例)。100例同期我院行健康体检的志愿者为对照组。采用单因素和多因素logistic回归分析病人手术治疗的独立预测因素。采用受试者工作特征(ROC)曲线评价TOS、脯氨酸肽酶水平对外科性腹痛的诊断价值。结果 (1)腹痛组病人外周血TAS水平[(36.84±10.08)μmol Trolox equiv./L比(25.51±7.34)μmol Trolox equiv./L]、OSI水平[(3.68±1.77)比(2.48±0.89)]、脯氨酸肽酶活性[(1 013.58±296.84)U/L比(842.65±147.25)U/L]均高于对照组(P>0.05),腹痛组和对照组病人外周血TOS水平[(1.10±0.22)μmol H_(2)O_(2) equiv./L比(1.06±0.24)μmol H_(2)O_(2) equiv./L]比较,差异无统计学意义(P>0.05)。(2)ST组的TAS水平[(41.06±9.75)μmol Trolox equiv./L比(34.81±10.50)μmol Trolox equiv./L比(26.95±6.57)μmol Trolox equiv./L]、脯氨酸肽酶活性[(1 207.58±254.12)U/L比(998.65±248.96)U/L比(873.65±132.04)U/L]均显著高于MT组及NSAP组。ST组的OSI水平[(3.90±3.87)比(2.42±0.65)]显著高于NSAP组,差异有统计学意义(P>0.05),但与MT组(3.85±1.08)比较差异无统计学意义(P>0.05)。(3)多因素logistic回归分析显示,血浆TOS水平(OR=1.383)和脯氨酸肽酶水平(OR=1.235)是急诊腹痛病人手术治疗的独立预测因子,血浆TOS水平及脯氨酸肽酶水平越高,病人手术治疗的风险就越高。(4)ROC曲线分析显示,血浆TOS诊断外科性腹痛的ROC曲线下面积(AUC)为0.652,最佳诊断值为39.65μmol H_(2)O_(2) equiv./L;脯氨酸肽酶的AUC为0.664,最佳诊断值为1 696.58 U/L;二者联合诊断的AUC为0.813,灵敏度为78.2Objective To explore the value of peripheral blood stress disorder related indexes in the differential diagnosis of acute abdomen.Methods 300 patients with acute abdominal pain admitted from January 2018 to June 2020(abdominal pain group).Proline peptidase activity,total oxidant status level(TOS),total antioxidant status level(TAS)and oxidative stress index(OSI)in peripheral blood were detected upon admission.According to the treatment outcome,the patients were divided into surgical treatment group(ST group,99 cases),non-surgical treatment group(MT group,102 cases)and non-specific abdominal pain group(NSAP group,99 cases).100 volunteers who underwent physical examination in our hospital were the control group.Univariate and multivariate Logistic regression were used to analyze the independent predictors of surgical treatment.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of TOS and proline peptidase levels in surgical abdominal pain.Results(1)Peripheral blood TAS level[(36.84±10.08)μmol Trolox equiv./L VS(25.51±7.34)μmol Trolox equiv./L],OSI level[(3.68±1.77)VS(2.48±0.89)]and proline peptidase activity[(1013.58±296.84)U/L vs.(842.65±147.25)U/L]in patients with abdominal pain group were higher than those in control group Group(P>0.05).There was no significant difference in TOS level in peripheral blood between abdominal pain group and control group[(1.10±0.22)μmol H_(2)O_(2) equiv./L vs.(1.06±0.24)μmol H_(2)O_(2) equiv./L](P>0.05).(2)TAS level[(41.06±9.75)μmol Trolox equiv./L vs.(34.81±10.50)μmol Trolox equiv./L vs.(26.95±6.57)μmol Trolox equiv./L]and proline peptidase activity[(1207.58±254.12)U/L vs.(998.65±248.96)U/L vs.(873.65±132.04)U/L]in ST group were significantly higher than those in MT group And NSAP group.The OSI level of ST group was significantly higher than that of NSAP group[(3.90±3.87)vs.(2.42±0.65)],with statistical significance(P>0.05),but there was no statistical significance compared with MT group(3.85±1.08)(P>0.05).(3)Multifactorial

关 键 词：急腹症 氧化应激 脯氨酸酶 

分 类 号：R73[医药卫生—肿瘤]