肿瘤坏死因子受体相关因子3水平与急性胰腺炎病人病情严重程度及预后的相关性研究

Correlation between TRAF3 level and severity and prognosis of patients with acute pancreatitis

目的分析肿瘤坏死因子受体相关因子3(TRAF3)水平与急性胰腺炎病人病情严重程度及预后的相关性。方法前瞻性选取2021年9月至2022年10月在河北省沧州中西医结合医院诊治的165例急性胰腺炎病人为观察组,及同期该院160例健康体检志愿者为对照组。根据临床病重程度将病人分为轻症急性胰腺炎组60例、中重症急性胰腺炎组40例、重症急性胰腺炎组65例。根据急性胰腺炎病人入院28 d的生存情况分为生存组125例和死亡组40例。采用酶联免疫吸附测定(ELISA)检测血清TRAF3、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平;Spearman法分析急性胰腺炎病人血清TRAF3水平与急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)的相关性;对血清TRAF3水平与IL-6、TNF-α、肠道气体容积积分(GVS)的相关性进行Pearson法分析;对影响急性胰腺炎病人预后的因素进行logistic回归分析;受试者操作特征曲线(ROC曲线)分析血清TRAF3水平对急性胰腺炎病人预后的预测价值。结果与对照组(31.42±6.78)ng/L相比,轻症(56.18±9.34)ng/L、中重症(74.45±10.87)ng/L、重症急性胰腺炎组(86.42±11.05)ng/L病人血清TRAF3水平随着危重程度的增加依次显著升高(P<0.05),病情越严重,身体质量指数(BMI)、IL-6、TNF-α、肠道GVS、APACHEⅡ评分越高(P<0.05);急性胰腺炎病人血清TRAF3水平与IL-6、TNF-α、肠道GVS、APACHEⅡ评分均呈正相关(r=0.65、0.64、0.41、0.69,均P<0.05)。与生存组相比,死亡组BMI、IL-6、TNF-α、肠道 GVS、APACHEⅡ评分、TRAF3水平[(87.25±10.52)ng/L比(67.81±10.34)ng/L]明显升高(P<0.05)。BMI、IL-6、TNF-α、 肠道 GVS、APACHEⅡ评分、TRAF3是影响急性胰腺炎病人预后的危险因素(P<0.05)。血清 TRAF3预测急性胰腺炎病人预后 的曲线下面积(AUC)为 0.91,截断值为 75.30 ng/L。结论 急性胰腺炎病人血清 TRAF3水平升高,与病人病情严重程度及预后 密切相关。

Objective To analyze the correlation between the level of tumor necrosis factor receptor associated factor-3(TRAF3)and the severity and prognosis of patients with acute pancreatitis.Methods A total of 165 patients with acute pancreatitis diagnosed and treated in Cangzhou Hospital of Integrated TCM-WM·Hebei from September 2021 to October 2022 were selected as the observation group,and 160 healthy volunteers in this hospital were selected as the control group.The patients were divided into mild acute pancreatitis group(60 cases),moderate and severe acute pancreatitis group(40 cases),and severe acute pancreatitis group(65 cases)according to the severity of clinical symptoms.According to the survival of patients with acute pancreatitis at 28 d of admission,they were divided into 125 cases in the survival group and 40 cases in the death group.The levels of serum TRAF3,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA);Spearman method was used to analyze the correlation between serum TRAF3 level and acute physiology and chronic health evaluation-Ⅱ(APACHEⅡ)score in patients with acute pancreatitis;Pearson method was used to analyze the correlation between serum TRAF3 level and IL-6,TNF-α,intestinal gas volume integral(GVS);Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with acute pancreatitis;the prognostic value of serum TRAF3 level in patients with acute pancreatitis was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group(31.42±6.78)ng/L,the serum TRAF3 level in mild(56.18±9.34)ng/L,moderate(74.45±10.87)ng/L and severe acute pancreatitis group(86.42±11.05)ng/L increased significantly with the increase of severity(P<0.05),the more serious the disease was,the higher the body mass index,IL-6,TNF-α,GVS score and APACHEⅡscore were(P<0.05);serum TRAF3 level was positively correlated with IL-6,TNF-α,GVS score and APACHEⅡscore in patients with acute pancreatitis(r=0.65,0.64,0.41,0.69,all P<0.05).Compared with the survival group,the body mass index,IL-6,TNF-α,GVS score,APACHEⅡscore and TRAF3 level[(87.25±10.52)ng/L vs.(67.81±10.34)ng/L]in the death group were obviously higher(P<0.05).Body mass index,IL-6,TNF-α,GVS score,APACHEⅡscore,and TRAF3 were risk factors affecting the prognosis of patients with acute pancreatitis(P<0.05).The area under the curve(AUC)of serum TRAF3 to predict the prognosis of patients with acute pancreatitis was 0.91,and the cut-off value was 75.30 ng/L.Conclusion The serum TRAF3 level in patients with acute pancreatitis is elevated,which is closely related to the severity and prognosis of patients.