急性胰腺炎早期血清SAA、TNF-α的变化与新分类关系的研究
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摘要
目的研究急性胰腺炎血清淀粉样蛋白A(SAA)及肿瘤坏死因子(TNF-α)在急性胰腺炎早期病程中的变化与新分类的关系,探讨SAA、TNF-α在急性胰腺炎早期病程中的临床实用价值。方法严格按照急性胰腺炎的新型分型标准,165例急性胰腺炎患者分为三组:轻症胰腺炎组(MAP,n=105)、中度胰腺炎组(MSAP,n=35)、重症胰腺炎组(SAP,n=25),分别测定患者入院时、入院后第24、48、72h共4个不同时期SAA、TNF-α的浓度,比较分析不同组患者各个时期血清中SAA、TNF-α的水平差异有无统计学意义。结果 (1)轻症组与中度、重症组的SAA、TNF-α在入院时均有显著异常增高。(2)入院48h,中度组与轻症组的SAA水平已经无显著性差异(P> 0.05),但中度组与重症组有显著性差异(P <0.05);而中度组与重症组的TNF-α水平仍然无显著性差异,中度组与轻症组有显著性差异(P <0.05)。(3)入院72h,中度组与轻症两组SAA、TNF-α之间的差异无著性(P> 0.05),中度组与重症组均有显著性差异(P <0.05)。结论联合检测血清SAA、TNF-α水平对早期判断急性重症胰腺炎的严重程度及转归有重要参考价值。其中SAA的变化更加反应急性胰腺炎的变化。
Objective To study the relationship between the changes of serum amyloid A protein(SAA) and tumor Necrosis Factor(TNF-α) in early stage of acute pancreatitis and its new classification.To explore the clinical value of SAA and TNF-α in the early course of acute pancreatitis. Methods Strictly according to the new classification criteria for acute pancreatitis,165 patients with acute pancreatitis were divided into 3 groups,mild pancreatitis group(MAP,n=105),moderate pancreatitis group(MSAP,n=35),and severe pancreatitis group(SAP,n=25).The concentrations of SAA and TNF-α were measured in four different periods,at admission,at 24 h,48 h and 72 h after admission.The serum levels of SAA and TNF-αin different groups were compared and analyzed. Results(1)SAA and TNF-α in the mild group,the moderate and severe group were significantly abnormally increased at admission.(2)At 48 hours after admission,there was no significant difference in SAA levels between the moderate group and the mild group(P> 0.05),but there was a significant difference between the moderate group and the severe group(P < 0.05).There was no significant difference in TNF-α levels between the moderate group and the severe group.There was a significant difference between the moderate group and the mild group(P < 0.05).(3)At 72 hours after admission,the difference between SAA and TNF-α in the moderate group and the mild group was not significant(P > 0.05),and there was significant difference between the moderate group and the severe group(P < 0.05). Conclusion Combined detection of serum levels of SAA and TNF-α has important reference value for determining the severity and outcome of acute severe pancreatitis.The changes in SAA are more responsive to changes in acute pancreatitis.
Objective To study the relationship between the changes of serum amyloid A protein(SAA) and tumor Necrosis Factor(TNF-α) in early stage of acute pancreatitis and its new classification.To explore the clinical value of SAA and TNF-α in the early course of acute pancreatitis. Methods Strictly according to the new classification criteria for acute pancreatitis,165 patients with acute pancreatitis were divided into 3 groups,mild pancreatitis group(MAP,n=105),moderate pancreatitis group(MSAP,n=35),and severe pancreatitis group(SAP,n=25).The concentrations of SAA and TNF-α were measured in four different periods,at admission,at 24 h,48 h and 72 h after admission.The serum levels of SAA and TNF-αin different groups were compared and analyzed. Results(1)SAA and TNF-α in the mild group,the moderate and severe group were significantly abnormally increased at admission.(2)At 48 hours after admission,there was no significant difference in SAA levels between the moderate group and the mild group(P> 0.05),but there was a significant difference between the moderate group and the severe group(P < 0.05).There was no significant difference in TNF-α levels between the moderate group and the severe group.There was a significant difference between the moderate group and the mild group(P < 0.05).(3)At 72 hours after admission,the difference between SAA and TNF-α in the moderate group and the mild group was not significant(P > 0.05),and there was significant difference between the moderate group and the severe group(P < 0.05). Conclusion Combined detection of serum levels of SAA and TNF-α has important reference value for determining the severity and outcome of acute severe pancreatitis.The changes in SAA are more responsive to changes in acute pancreatitis.
引文
[1]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].中国实用外科杂志,2015,35(1):4-7.
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[3]宋新苗,杜奕奇,陈燕.等.重症急性胰腺炎新分类再评价的单中心临床研究[J].中华胰腺病杂志,2014,14(1):8-11.
[4]宋新苗,杜奕奇,李兆申.急性胰腺炎诊断和分类[J].中华胰腺病杂志,2013,13(1):49-54.
[5]Sarr MG.2012 revision of the Atlanta classification of acute pancreatitis[J].Pol Arch Med Wewn,2013,123(3):118-124.
[6]Jin T,Huang W,Yang XN,et al.Validation of the moderate severity category of acute pancreatitis defined by determinant based classification[J].Hepatobiliary Pancreat Dis Int,2104,13(3):323-327.
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[8]张海伶,马春华,蒋小军,等.急性胰腺炎早期联用BISAP评分及血清CRP、TNF-α评估患者病情及预后的临床价值[J].胃肠病学和肝病学杂志.2017,26(3):327-330.
[9]郭文君,杨明,雷鸣.急性胰腺炎患者血清IL-33和TNF-α水平与病情严重程度及预后的关系国际检验医学杂志[J].国际检验医学杂志,2017,38(15):2071-2073.
[10]张延龄.血清淀粉样蛋白A是比C反应蛋白更好的检查急性胰腺炎严重性的预测指标[J].国外医学外科学分册,2005,14(2):246.
[11]姚洁.急性胰腺炎患者血清降钙素原测定的临床意义[J].重庆医学,2008,37(21):2648-2649.
[12]沈贵生.血清钙和C反应蛋白联合检测对急性胰腺炎危重度的早期预测价值[J].肝胆外科杂志,2012,20(5):352-354.
[13]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[J].国际检验医学杂志2016,37(13):1811-1814.
[14]Dambrauskas Z,Gulbinas A,Pundzius J,et a1.Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis.Scand J Gastroenteml[J]. Scandinavian Jaurnal of Gastroenterology,2010,45(78):959-970.
[15]公呸平,孙杰,牛春茂,等.急性胰腺炎患者TNF-Q基因多态性与病情严重程度及I晦床预后的相关性分析[J].重庆医学,2017,46(27):3858-3860.
[16]蒋翠玲,庞博,郭凤芹.中西医临床路径用于急性胰腺炎内镜微创治疗的研究[J].现代消化及介入诊疗,2018(3):334-336.
[2]张再重,王烈.中度急性胰腺炎独立分类及其临床意义[J].肝胆胰外科杂志,2015,27(3):259-260.
[3]宋新苗,杜奕奇,陈燕.等.重症急性胰腺炎新分类再评价的单中心临床研究[J].中华胰腺病杂志,2014,14(1):8-11.
[4]宋新苗,杜奕奇,李兆申.急性胰腺炎诊断和分类[J].中华胰腺病杂志,2013,13(1):49-54.
[5]Sarr MG.2012 revision of the Atlanta classification of acute pancreatitis[J].Pol Arch Med Wewn,2013,123(3):118-124.
[6]Jin T,Huang W,Yang XN,et al.Validation of the moderate severity category of acute pancreatitis defined by determinant based classification[J].Hepatobiliary Pancreat Dis Int,2104,13(3):323-327.
[7]蒲虹,康焰.APACHE II,Ranson与Bahhazar CT评分在重症急性胰腺炎患者预后评估中的应用价值[J].中国循证医学杂志,2009,9(9):946-948.
[8]张海伶,马春华,蒋小军,等.急性胰腺炎早期联用BISAP评分及血清CRP、TNF-α评估患者病情及预后的临床价值[J].胃肠病学和肝病学杂志.2017,26(3):327-330.
[9]郭文君,杨明,雷鸣.急性胰腺炎患者血清IL-33和TNF-α水平与病情严重程度及预后的关系国际检验医学杂志[J].国际检验医学杂志,2017,38(15):2071-2073.
[10]张延龄.血清淀粉样蛋白A是比C反应蛋白更好的检查急性胰腺炎严重性的预测指标[J].国外医学外科学分册,2005,14(2):246.
[11]姚洁.急性胰腺炎患者血清降钙素原测定的临床意义[J].重庆医学,2008,37(21):2648-2649.
[12]沈贵生.血清钙和C反应蛋白联合检测对急性胰腺炎危重度的早期预测价值[J].肝胆外科杂志,2012,20(5):352-354.
[13]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[J].国际检验医学杂志2016,37(13):1811-1814.
[14]Dambrauskas Z,Gulbinas A,Pundzius J,et a1.Value of the different prognostic systems and biological markers for predicting severity and progression of acute pancreatitis.Scand J Gastroenteml[J]. Scandinavian Jaurnal of Gastroenterology,2010,45(78):959-970.
[15]公呸平,孙杰,牛春茂,等.急性胰腺炎患者TNF-Q基因多态性与病情严重程度及I晦床预后的相关性分析[J].重庆医学,2017,46(27):3858-3860.
[16]蒋翠玲,庞博,郭凤芹.中西医临床路径用于急性胰腺炎内镜微创治疗的研究[J].现代消化及介入诊疗,2018(3):334-336.