重症急性胰腺炎患者血清PCT、CRP、IL-6变化及与并发细菌感染的关系
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摘要
目的探讨重症急性胰腺炎(SAP)患者血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素6(IL-6)水平变化及其与并发细菌感染的关系。方法选取2015年1月至2018年1月收治的SAP患者220例,依据是否并发细菌感染分为并发组(n=100例)和无发组(n=120例),2组均检测血清PCT、CRP、IL-6水平,分析2组血清PCT、CRP、IL-6水平变化及其与并发细菌感染的关系。结果并发组和无发组第1天血清PCT、CRP、IL-6水平基本相同,差异无统计学意义(P>0.05),并发组第2、3天血清PCT、CRP、IL-6水平及升高值明显高于无发组,差异有统计学意义(P<0.05);ROC曲线分析结果显示,在评估SAP并发细菌感染的敏感度、特异度、准确度、曲线下面积方面,PCT升高值以0.8μg/L为临界值时分别为86.00%、86.67%、86.36%、0.754,CRP升高值以10.0 mg/L为临界值时分别为82.00%、81.67%、81.82%、0.722,IL-6升高值以20.5 mg/L为临界值时分别为84.00%、85.00%、84.55%、0.736,三者联合时分别为96.00%、95.00%、95.45%、0.907,三者联合时明显高于三者单独时,差异有统计学意义(P<0.05)。结论 SAP患者血清PCT、CRP、IL-6水平变化与其并发细菌感染有关,监测三者水平变化可作为评估患者并发细菌感染的重要指标,且三者联合时具有更佳的评估效能,值得临床作进一步推广。
Objective To investigate the changes of serum levels of procalcitonin(PCT), C reactive protein(CRP), interleukin 6(IL-6) and their relationships with with complicated bacterial infection in patients with severe acute pancreatitis(SAP).Methods A total of 220 patients with SAP who were admitted and treated in our hospital from January 2015 to January 2018 were enrolled in the study, according to whether or not the patients have bacterial infection, these patients were divided into complicated infection group(n=100) and non complicated infection group(n=120). The serum levels of PCT, CRP and IL-6 were detected in both groups. The changes of serum levels of PCT, CRP, IL-6 and their relationships with complicated bacterial infection were observed and compared between the two groups.Results There were no significant differences in the serum levels of PCT, CRP, IL-6 at the first day between complicated infection group and non complicated infection group(P>0.05),however,the serum levels of PCT, CRP, IL-6 at the second day and the third day in complicated infection group were significantly higher than those before treatment(P<0.05), moreover the increase degree of the serum levels of PCT, CRP, IL-6 in complicated infection group was more significant than that in non complicated infection group(P<0.05). The ROC curve analysis result showed that in the evaluation of patients complicated bacterial infection, the sensitivity, specificity, accuracy, and the area under the curve were 86.00%, 86.67%, 86.36%, 0.754,respectively.Taking the PCT rising value of 0.8μg/L as critical value, the sensitivity, specificity, accuracy, and the area under the curve were 86.00%,86.67%,86.36%,0.754, respectively,taking CRP rising value of 10.0 mg/L as critical value, the sensitivity, specificity, accuracy, and the area under the curve were 82.00%,81.67%,81.82%,0.722,respectively, taking IL-6 rising value of 20.5 mg/L as critical value, the sensitivity, specificity, accuracy and the area under the curve were were 84.00%, 85%, 84.55%, 0.736 respectively. Moreover when combination detection of the three indexes, the sensitivity, specificity, accuracy and the area under the curve were 96%, 95%, 95.45%, 0.907,respectively, which were significantly higher than those by simple detection of the three indexes(P<0.05).Conclusion The changes of serum levels of PCT, CRP, IL-6 in patients with SAP are related to the bacterial infection, which can be monitored as the important indicators of patients with SAP complicated by bacterial infection.And the combination of the three indexes has better evaluation efficacy, which is worthy of further clinical promotion.
Objective To investigate the changes of serum levels of procalcitonin(PCT), C reactive protein(CRP), interleukin 6(IL-6) and their relationships with with complicated bacterial infection in patients with severe acute pancreatitis(SAP).Methods A total of 220 patients with SAP who were admitted and treated in our hospital from January 2015 to January 2018 were enrolled in the study, according to whether or not the patients have bacterial infection, these patients were divided into complicated infection group(n=100) and non complicated infection group(n=120). The serum levels of PCT, CRP and IL-6 were detected in both groups. The changes of serum levels of PCT, CRP, IL-6 and their relationships with complicated bacterial infection were observed and compared between the two groups.Results There were no significant differences in the serum levels of PCT, CRP, IL-6 at the first day between complicated infection group and non complicated infection group(P>0.05),however,the serum levels of PCT, CRP, IL-6 at the second day and the third day in complicated infection group were significantly higher than those before treatment(P<0.05), moreover the increase degree of the serum levels of PCT, CRP, IL-6 in complicated infection group was more significant than that in non complicated infection group(P<0.05). The ROC curve analysis result showed that in the evaluation of patients complicated bacterial infection, the sensitivity, specificity, accuracy, and the area under the curve were 86.00%, 86.67%, 86.36%, 0.754,respectively.Taking the PCT rising value of 0.8μg/L as critical value, the sensitivity, specificity, accuracy, and the area under the curve were 86.00%,86.67%,86.36%,0.754, respectively,taking CRP rising value of 10.0 mg/L as critical value, the sensitivity, specificity, accuracy, and the area under the curve were 82.00%,81.67%,81.82%,0.722,respectively, taking IL-6 rising value of 20.5 mg/L as critical value, the sensitivity, specificity, accuracy and the area under the curve were were 84.00%, 85%, 84.55%, 0.736 respectively. Moreover when combination detection of the three indexes, the sensitivity, specificity, accuracy and the area under the curve were 96%, 95%, 95.45%, 0.907,respectively, which were significantly higher than those by simple detection of the three indexes(P<0.05).Conclusion The changes of serum levels of PCT, CRP, IL-6 in patients with SAP are related to the bacterial infection, which can be monitored as the important indicators of patients with SAP complicated by bacterial infection.And the combination of the three indexes has better evaluation efficacy, which is worthy of further clinical promotion.
引文
1 李懋,胡伟明,陈阳,等.PCT在重症急性胰腺炎的临床应用初探.中国普外基础与临床杂志,2015,22:28-32.
2 Yadav J,Yadav SK,Kumar S,et al.Predicting morbidity and mortal-ity in acute pancreatitis in an Indian population:a comparative study of the BISAP score,Ranson′s score and CT severity index.Gas-troanterol Rep (Oxf),2016,4:216-220.
3 朱求实,胡炎军,李盛.降钙素原和炎性因子预测重症急性胰腺炎继发肺部感染的价值.临床急诊杂志,2016,17:682-684.
4 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014).全科医学临床与教育,2015,13:365-367.
5 Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology Guideline:Management of acute pancreatitis.AmJ Gastroenterol,2013,108:1400-1415,1416.
6 GuPta AK,Raj S,Chaudhary P,et al.A prospective comparative study of bedside index for assessing severity in acute pancreatitis,APACHE Ⅱ and computed tomography severity index scoring in predicting outcome in acute pancreatitis.Hellenic J Sur,2015,87:473-478.
7 Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreat- itis 2012:revision of the Atlanta classification and definitions by international consensus.Gut,2013,62:102-111.
8 Vasseur P,Devaure I,Sellier J,et al.High plasma levels of the pro-inflammatory cytokine IL-22 and the anti-inflammatory cytokines IL-10 and IL-lra in acute pancreatitis.Pancreatology,2014,14:465-469.
9 王朝燕,禹露.血清PCT检测对急性胰腺炎合并感染患者的诊断价值分析.中国医药导刊,2015,17:1155-1156.
10 Pirolla EH,de Barros Filho TE,Godoy-Santos AL,et al.Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury:aprospective study.Spinal Cord,2015,53:495.
11 张天卿,沈淑男,胡哲清,等.降钙素原对脓毒症鉴别诊断及预后监测的方法评价.中华实验和临床病毒学杂志,2015,29:87-89.
12 Kitagawa K,Yane K,Katanuma A,et al.Evaluation of therapeutic outcomes of acute necrotic collection and walled-off necrosis in patients with acute pancreatitis.Pancreatology,2016,16:S48.
13 Meyer A,Kubrusly MS,Salemi VM,et al.Severe acute panereatitis:a possible role of intramyoeardial eytoklne production.JOP,2014,15:237-242.
14 庞凌峰.血清B7-H3、PCT、sICAM-1水平和NF-κB表达在重症急性胰腺炎合并感染诊断中的价值.检验医学与临床,2017,14:660-662.
15 刘京伟,陈玲玲,赵安成.血清SAA、CRP、PCT及TAP联合检测在急性重症胰腺炎早期诊治中的临床意义.国际检验医学杂志,2016,37:1811-1813.
16 Cardoso FS,Ricardo LB,Oiveira AM,et al.C-reactive proein prognostic accuracy in acute pancreatitis:timing of measurementand cutoff points.Eur J Gasteoenterol Hepatol,2013,25:784 789.
17 张静.BISAP评分联合促炎/抗炎细胞因子检测对重症急性胰腺炎预后的评估价值.解放军医药杂志,2016,28:62-65.
18 Song R,Yu D,Park J.Changes in gene expression of tumor necrosis factor alpha and interleukin 6 in a canine model of caerulein-induced pancreatitis.Can J Vet Res,2016,80:236-241.
19 Zerem E.Treatment of severe acute pancreatitis and its complications.World J Gastroenterol,2014,20:13879-13892.
20 白如雪,杜时雨,段军,等.Th17/Treg免疫平衡在老年人重症急性胰腺炎继发性感染中的变化及意义.中华老年医学杂志,2015,34:630-634.
2 Yadav J,Yadav SK,Kumar S,et al.Predicting morbidity and mortal-ity in acute pancreatitis in an Indian population:a comparative study of the BISAP score,Ranson′s score and CT severity index.Gas-troanterol Rep (Oxf),2016,4:216-220.
3 朱求实,胡炎军,李盛.降钙素原和炎性因子预测重症急性胰腺炎继发肺部感染的价值.临床急诊杂志,2016,17:682-684.
4 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014).全科医学临床与教育,2015,13:365-367.
5 Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology Guideline:Management of acute pancreatitis.AmJ Gastroenterol,2013,108:1400-1415,1416.
6 GuPta AK,Raj S,Chaudhary P,et al.A prospective comparative study of bedside index for assessing severity in acute pancreatitis,APACHE Ⅱ and computed tomography severity index scoring in predicting outcome in acute pancreatitis.Hellenic J Sur,2015,87:473-478.
7 Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreat- itis 2012:revision of the Atlanta classification and definitions by international consensus.Gut,2013,62:102-111.
8 Vasseur P,Devaure I,Sellier J,et al.High plasma levels of the pro-inflammatory cytokine IL-22 and the anti-inflammatory cytokines IL-10 and IL-lra in acute pancreatitis.Pancreatology,2014,14:465-469.
9 王朝燕,禹露.血清PCT检测对急性胰腺炎合并感染患者的诊断价值分析.中国医药导刊,2015,17:1155-1156.
10 Pirolla EH,de Barros Filho TE,Godoy-Santos AL,et al.Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury:aprospective study.Spinal Cord,2015,53:495.
11 张天卿,沈淑男,胡哲清,等.降钙素原对脓毒症鉴别诊断及预后监测的方法评价.中华实验和临床病毒学杂志,2015,29:87-89.
12 Kitagawa K,Yane K,Katanuma A,et al.Evaluation of therapeutic outcomes of acute necrotic collection and walled-off necrosis in patients with acute pancreatitis.Pancreatology,2016,16:S48.
13 Meyer A,Kubrusly MS,Salemi VM,et al.Severe acute panereatitis:a possible role of intramyoeardial eytoklne production.JOP,2014,15:237-242.
14 庞凌峰.血清B7-H3、PCT、sICAM-1水平和NF-κB表达在重症急性胰腺炎合并感染诊断中的价值.检验医学与临床,2017,14:660-662.
15 刘京伟,陈玲玲,赵安成.血清SAA、CRP、PCT及TAP联合检测在急性重症胰腺炎早期诊治中的临床意义.国际检验医学杂志,2016,37:1811-1813.
16 Cardoso FS,Ricardo LB,Oiveira AM,et al.C-reactive proein prognostic accuracy in acute pancreatitis:timing of measurementand cutoff points.Eur J Gasteoenterol Hepatol,2013,25:784 789.
17 张静.BISAP评分联合促炎/抗炎细胞因子检测对重症急性胰腺炎预后的评估价值.解放军医药杂志,2016,28:62-65.
18 Song R,Yu D,Park J.Changes in gene expression of tumor necrosis factor alpha and interleukin 6 in a canine model of caerulein-induced pancreatitis.Can J Vet Res,2016,80:236-241.
19 Zerem E.Treatment of severe acute pancreatitis and its complications.World J Gastroenterol,2014,20:13879-13892.
20 白如雪,杜时雨,段军,等.Th17/Treg免疫平衡在老年人重症急性胰腺炎继发性感染中的变化及意义.中华老年医学杂志,2015,34:630-634.