炎症因子对重症急性胰腺炎的预测价值评估  

Evaluation of the predictive value of inflammatory factors for severe acute pancreatitis

作　　者：葛凯杰 孟佳 王化强 GE Kaijie;MENG Jia;WANG Huaqiang(Department of Critical Care Medicine,Xuchang Central Hospital,Henan 461000)

机构地区：[1]许昌市中心医院重症医学科,河南461000

出　　处：《南通大学学报(医学版)》2025年第1期30-34,共5页Journal of Nantong University(Medical sciences)

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210945)。

摘　　要：目的:研究血、胸腔积液中炎症因子与急性胰腺炎(acute pancreatitis,AP)合并急性肺损伤(acute lung injury,ALI)患者预后的相关性,并评估炎症因子对重症急性胰腺炎(severe acute pancreatitis,SAP)患者的预测价值。方法:收集在许昌市中心医院住院的AP合并ALI患者82例。根据修订版Atlanta分级,将患者分为轻症急性胰腺炎(mild acute pancreatitis,MAP)组(36例)、中重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)组(29例)和SAP组(17例)。检测胸腔积液及血中IL-6及TNF-α水平,计算氧合指数,进行APACHEⅡ评分、急性胰腺炎严重程度床边指数(bedside index for severity in acute pancreatitis,BISAP)评分、改良的CT严重指数评分(modified CT severity index,MCTSI评分)和B线评分。Pearson相关分析胸腔积液及血中IL-6及TNF-α与临床预后指标的相关性,绘制ROC曲线评价炎症因子对SAP患者的预测价值。结果:血IL-6、血TNF-α、胸腔积液IL-6和胸腔积液TNF-α在SAP组水平显著高于MAP和MSAP组(P<0.001)。胸腔积液及血中的IL-6、TNF-α水平均与氧合指数呈负相关,与APACHEⅡ评分、BISAP评分、MCTSI评分和B线评分均呈正相关(均P<0.05)。血IL-6、血TNF-α、胸腔积液IL-6和胸腔积液TNF-α预测SAP的ROC曲线AUC分别为0.886、0.883、0.794和0.731,敏感度分别为82.4%、76.5%、76.5%和64.7%,特异度分别为98.5%、98.5%、100.0%和100.0%。结论:炎症因子IL-6和TNF-α与AP合并ALI患者预后具有较强的相关性,血中的炎症因子对SAP的预测价值更优。Objective:To investigate the correlation between inflammatory factors in blood and pleural effusion and the prognosis of patients with acute pancreatitis(AP)complicated with acute lung injury(ALI),and to evaluate the predictive value of inflammatory factors in patients with severe acute pancreatitis(SAP).Methods:Eighty-two patients with AP combined with ALI admitted to our hospital were collected.According to the revised Atlanta classification,patients were divided into mild acute pancreatitis(MAP)group(36 cases),moderately severe acute pancreatitis(MSAP)group(29 cases),and SAP group(17 cases).The levels of IL-6 and TNF-αin pleural effusion and blood were detected,and the oxygenation index was calculated,and APACHEⅡscore,bedside index for severity in acute pancreatitis(BISAP)score,modified CT severity index(MCTSI)score and B-line score were investigated.Pearson correlation analysis was conducted to assess the correlation between IL-6 and TNF-αin pleural effusion and blood with clinical prognostic indicators.ROC curves were plotted to evaluate the predictive value of inflammatory factors for SAP patients.Results:The levels of IL-6 and TNF-αin blood and pleural effusion were significantly higher in the SAP group than in the MAP group and MSAP group(P<0.001).The levels of IL-6 and TNF-αwere negatively correlated with oxygenation index,and positively correlated with APACHEⅡscore,BISAP score,MCTSI score,and B-line score(all P<0.05).The AUC of ROC for predicting SAP using blood IL-6,blood TNF-α,pleural effusion IL-6,and pleural effusion TNF-αwere 0.886,0.883,0.794,and 0.731,respectively.The sensitivities were 82.4%,76.5%,76.5%,and 64.7%,and the specificities were 98.5%,98.5%,100.0%,and 100.0%,respectively.Conclusions:Inflammatory factors IL-6 and TNF-αhave strong correlation with the prognosis of patients with AP complicated with ALI,and inflammatory factors in the blood have a better predictive value for SAP.

关 键 词：急性胰腺炎 急性肺损伤 重症急性胰腺炎 炎症因子 预后指标 

分 类 号：R576[医药卫生—消化系统]