急性胰腺炎患者血清MCP-1、IL-6水平变化及临床意义
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摘要
目的探讨急性胰腺炎(AP)患者血清单核细胞趋化因子蛋白1(MCP-1)和白细胞介素-6(IL-6)的动态变化及临床意义。方法收集2016年6月至2017年12月该院收治的103例AP患者为研究对象,根据病情将其分为轻症急性胰腺炎(MAP组,n=62)和重症急性胰腺炎(SAP组,n=41),采用放射免疫法测定两组患者入院第1、3、7天血清MCP-1、IL-6水平,并与同期随机选取的40例健康体检者(对照组)比较,并分析血清MCP-1、IL-6对AP预后的预测价值。结果 MAP组、SAP组入院第1天血清MCP-1、IL-6水平及APACHEⅡ评分均高于对照组,且MAP组、SAP组患者入院第3、7天高于第1天,入院第7天低于入院第3天,差异均有统计学意义(P<0.05);SAP组患者入院第1、3、7天血清MCP-1、IL-6水平及APACHEⅡ评分均高于MAP组,差异有统计学意义(P<0.05)。AP患者血清MCP-1、IL-6与APACHEⅡ评分呈不同程度正相关(P<0.05)。入院第3天,血清MCP-1鉴别诊断AP的最佳临界值为31.6pg/mL,ROC曲线下面积0.852,灵敏度、特异度分别为0.87、0.82,准确性为0.85;血清IL-6鉴别诊断AP的最佳临界值为35.9ng/L,ROC曲线下面积0.876,灵敏度、特异度分别为0.91、0.85,准确性为0.87。结论 AP患者血清MCP-1、IL-6异常改变,并与病情严重程度及预后密切相关,早期联合检测有助于判断AP患者病情及评估预后。
Objective To explore the dynamic changes of serum monocyte chemoattractant protein-1(MCP-1)and interleukin-6(IL-6)in patients with acute pancreatitis(AP)and its clinical significance.Methods A total of 103 patients with AP admitted to our hospital from June 2016 to December 2017 were selected,which were divided into mild AP(MAP group,n=62)and severe AP(SAP group,n=41)according to the condition of disease.The levels of serum MCP-1 and IL-6 at 1 st,3 rd,7 th day after admission were determined by the radioimmunoassay.At the same time,a total of 40 healthy volunteers as control group were randomly selected.The predictive value of serum MCP-1 and IL-6 on for AP was analyzed.Results The serum MCP-1,IL-6 level and APACHE Ⅱscore of MAP group and SAP group at 1 st day were higher than those of control group(P<0.05).The serum MCP-1,IL-6 level and APACHE Ⅱ score of MAP group and SAP group at 3 rd,7 th day were higher than those at 1 st,and which at 7 th were lower than those at 3 rd(P<0.05).The serum MCP-1,IL-6 level and APACHE Ⅱscore of SAP group at 1 st,3 rd,7 th were higher than those of MAP group(P<0.05).Among patients with AP,serum MCP-1 and IL-6 were positively associated with APACHE Ⅱ score(P<0.05).The best cutoff value of serum MCP-1 for AP was 31.6 pg/mL,and the area under ROC curve was 0.852,and the sensitivity and specificity was 0.87 and 0.82 respectively,and the accuracy was 0.85.The best cutoff value of serum IL-6 for AP was 35.9 ng/L,and the area under ROC curve was 0.876,and the sensitivity and specificity were 0.91 and 0.85 respectively,and the accuracy was 0.87.Conclusion The serum MCP-1 and IL-6 of patients with AP abnormal changes,which were closely related to the severity and prognosis.Early detection of MCP-1 and IL-6 can help to judge condition and evaluate prognosis.
Objective To explore the dynamic changes of serum monocyte chemoattractant protein-1(MCP-1)and interleukin-6(IL-6)in patients with acute pancreatitis(AP)and its clinical significance.Methods A total of 103 patients with AP admitted to our hospital from June 2016 to December 2017 were selected,which were divided into mild AP(MAP group,n=62)and severe AP(SAP group,n=41)according to the condition of disease.The levels of serum MCP-1 and IL-6 at 1 st,3 rd,7 th day after admission were determined by the radioimmunoassay.At the same time,a total of 40 healthy volunteers as control group were randomly selected.The predictive value of serum MCP-1 and IL-6 on for AP was analyzed.Results The serum MCP-1,IL-6 level and APACHE Ⅱscore of MAP group and SAP group at 1 st day were higher than those of control group(P<0.05).The serum MCP-1,IL-6 level and APACHE Ⅱ score of MAP group and SAP group at 3 rd,7 th day were higher than those at 1 st,and which at 7 th were lower than those at 3 rd(P<0.05).The serum MCP-1,IL-6 level and APACHE Ⅱscore of SAP group at 1 st,3 rd,7 th were higher than those of MAP group(P<0.05).Among patients with AP,serum MCP-1 and IL-6 were positively associated with APACHE Ⅱ score(P<0.05).The best cutoff value of serum MCP-1 for AP was 31.6 pg/mL,and the area under ROC curve was 0.852,and the sensitivity and specificity was 0.87 and 0.82 respectively,and the accuracy was 0.85.The best cutoff value of serum IL-6 for AP was 35.9 ng/L,and the area under ROC curve was 0.876,and the sensitivity and specificity were 0.91 and 0.85 respectively,and the accuracy was 0.87.Conclusion The serum MCP-1 and IL-6 of patients with AP abnormal changes,which were closely related to the severity and prognosis.Early detection of MCP-1 and IL-6 can help to judge condition and evaluate prognosis.
引文
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[12]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华普通外科学文献:电子版,2015,53(2):86-89.
[13]SKOURAS C,DAVIS Z A,SHARKEY J,et al.Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis[J].HPB(Oxford),2015,18(2):159-169.
[14]朱琼媛,王明春,陶清元,等.单核细胞趋化因子蛋白1,白细胞介素8的动态变化对急性胰腺炎严重度评估价值分析[J].中国普通外科杂志,2017,26(10):1365-1370.
[15]HO L,ZHAO W,DAMS-O D.Connor K,et al.Elevated plasma MCP-1concentration following traumatic brain injury as a potential“predisposition”factor associated with an increased risk for subsequent development of alzheimer′s disease[J].J Alzheimers Dis,2012,31(2):301-313.
[16]KAUR R,MATHAROO K,ARORA P,et al.Association of-2518A>G promoter polymorphism in the monocyte chemoattractant protein-1(MCP-1)gene with type 2diabetes and coronary artery disease[J].Genet Test Mol Biomarkers,2013,7(10):750-755.
[17]丁凯宏,班副植,黄承乐,等.急性胰腺炎患者血清降钙素原、超敏C反应蛋白、白细胞介素6水平变化及临床意义[J].国际检验医学杂志,2013,34(17):2241-2242.
[18]王治伟,迟琼.急性胰腺炎患者血清TNF-α、IL-6及hsCRP水平变化及临床意义[J].白求恩军医学院学报,2012,10(2):85-87.
[2]郭浚,胡刚,曹梦娟.PCT、hs-CRP及IL-6的水平变化对急性胰腺炎的临床意义[J].胃肠病学和肝病学杂志,2014,23(12):1471-1474.
[3]BELYAEV O,HERZOG T,MUNDING J,et al.Protective role of endogenous melatonin in the early course of human acute pancreatitis[J].J Pineal Res,2011,50(1):71-77.
[4]TANG X P,TANG G D,LIANG Z H,et al.Effects of ghrelin miRNA on inflammation and Calcium pathway in pancreatic acinar cells of acute pancreatitis[J].Pancreas,2017,46(10):1305-1313.
[5]BOELS M G,KOUDIJS A,AVRAMUT M C,et al.Systemic monocyte chemotactic protein-1inhibition modifies renal macrophages and restores glomerular endothelial glycocalyx and barrier function in diabetic nephropathy[J].Am J Pathol,2017,187(11):2430-2440.
[6]RAO S A,KUNTE A R.Interleukin-6:an early predictive marker for severity of acute pancreatitis[J].Indian J Crit Care Med,2017,21(7):424-428.
[7]中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J].临床肝胆病杂志,2013,29(9):656-660.
[8]LARVIN M,MCMAHON M J.APACHE-Ⅱscore for assessment and monitoring of acute pancreatitis[J].Lancet,1989,2(8656):201-205.
[9]LUO L Y,ZEN H,XU H R,et al.Clinical characteristics of acute pancreatitis in pregnancy:experience based on121cases[J].Arch Gynecol Obstet,2018,297(2):333-339.
[10]TONSI A F,BACCHION M,CRIPPA S,et al.Acute pancreatitis at the beginning of the 21st century:the state of the art[J].World J Gastroenterol,2009,15(24):2945-2959.
[11]张彦,郝英霞.尿胰蛋白酶原激活肽测定对急性重症胰腺炎诊断价值[J].现代仪器与医疗,2013,19(6):36-39.
[12]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华普通外科学文献:电子版,2015,53(2):86-89.
[13]SKOURAS C,DAVIS Z A,SHARKEY J,et al.Lung ultrasonography as a direct measure of evolving respiratory dysfunction and disease severity in patients with acute pancreatitis[J].HPB(Oxford),2015,18(2):159-169.
[14]朱琼媛,王明春,陶清元,等.单核细胞趋化因子蛋白1,白细胞介素8的动态变化对急性胰腺炎严重度评估价值分析[J].中国普通外科杂志,2017,26(10):1365-1370.
[15]HO L,ZHAO W,DAMS-O D.Connor K,et al.Elevated plasma MCP-1concentration following traumatic brain injury as a potential“predisposition”factor associated with an increased risk for subsequent development of alzheimer′s disease[J].J Alzheimers Dis,2012,31(2):301-313.
[16]KAUR R,MATHAROO K,ARORA P,et al.Association of-2518A>G promoter polymorphism in the monocyte chemoattractant protein-1(MCP-1)gene with type 2diabetes and coronary artery disease[J].Genet Test Mol Biomarkers,2013,7(10):750-755.
[17]丁凯宏,班副植,黄承乐,等.急性胰腺炎患者血清降钙素原、超敏C反应蛋白、白细胞介素6水平变化及临床意义[J].国际检验医学杂志,2013,34(17):2241-2242.
[18]王治伟,迟琼.急性胰腺炎患者血清TNF-α、IL-6及hsCRP水平变化及临床意义[J].白求恩军医学院学报,2012,10(2):85-87.