外周血LDH和PTX3及TLR4在糖尿病酮症酸中毒合并急性胰腺炎预后预测中的价值

Value of peripheral blood LDH,PTX3 and TLR4 levels on predicting prognosis in diabetic ketoacidosis with acute pancreatitis

目的探讨外周血乳酸脱氢酶(LDH)、正五聚蛋白3(PTX3)、Toll样受体4(TLR4)在糖尿病酮症酸中毒(DKA)合并急性胰腺炎(AP)预后预测中的价值。方法选取2020年1月-2022年1月期间重庆市大足区人民医院100例DKA合并AP患者作为研究对象,根据预后情况将其分为死亡组(n=25)和存活组(n=75),比较2组一般资料及临床指标[血糖、糖化血红蛋白、血淀粉酶、尿淀粉酶、总胆固醇、甘油三酯、序贯性器官功能衰竭(SOFA)评分]及外周血LDH、PTX3、TLR4水平,采用Pearson相关性分析外周血LDH、PTX3、TLR4水平与患者临床指标的相关性,绘制受试者工作特征(ROC)曲线评估外周血LDH、PTX3、TLR4单独及联合检测预测DKA合并AP患者预后的效能。结果2组性别、年龄、糖尿病分型、AP病因、血糖、糖化血红蛋白、总胆固醇比较差异均无统计学意义(P均>0.05);死亡组血淀粉酶、尿淀粉酶、甘油三酯、SOFA评分、LDH、PTX3、TLR4水平[(501.64±40.29)U/L、(984.25±84.03)U/L、(11.92±3.78)mmol/L、(4.13±1.09)分、(496.82±67.43)U/L、(15.79±2.80)ng/mL、(37.69±4.92)ng/mL]均高于存活组[(452.19±79.43)U/L、(917.06±102.05)U/L、(8.40±2.39)mmol/L、(2.47±0.82)分、(304.48±92.09)U/L、(11.04±3.48)ng/mL、(29.65±8.74)ng/mL],差异均有统计学意义(P均<0.05)。Pearson相关性分析显示,外周血LDH、PTX3、TLR4水平与血淀粉酶、尿淀粉酶、甘油三酯、SOFA评分均成正相关(r=0.674、0.685、0.722、0.703,0.680、0.672、0.710、0.742,0.667、0.703、0.696、0.719,P均<0.05)。ROC曲线分析显示,外周血LDH、PTX3、TLR4单独及联合检测预测DKA合并AP患者不良预后的敏感度分别为84.00%、88.00%、80.00%、96.00%,特异度分别为78.70%、73.30%、62.70%、61.30%,对应的曲线下面积分别为0.882、0.870、0.771、0.969。结论外周血LDH、PTX3、TLR4水平与DKA合并AP患者的病情和预后有关,联合检测对预后具有较高的预测价值。

Objective To explore the value of peripheral blood lactate dehydrogenase(LDH),pentraxin 3(PTX3)and Toll-like receptor 4(TLR4)on predicting prognosis in diabetic ketoacidosis(DKA)with acute pancreatitis(AP).Methods A total of 100 patients with DKA complicated with AP between January 2020 and January 2022 in the People's Hospital of Dazu,Chongqing were selected as the study subjects,and they were divided into death group(n=25)and survival group(n=75)according to the prognosis.General data,clinical indicators[blood glucose,glycated hemoglobin,blood amylase,urinary amylase,total cholesterol,triglyceride,sequential organ failure assessment(SOFA)score]and levels of peripheral blood LDH,PTX3 and TLR4 were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between peripheral blood LDH,PTX3 and TLR4 levels and clinical indicators of patients,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficiency of peripheral blood LDH,PTX3 and TLR4 alone and in combination on predicting prognosis in patients with DKA and AP.Results There were no statistical significant differences in gender,age,type of diabetes mellitus,AP etiology,blood glucose,glycosylated hemoglobin and total cholesterol between the two groups(all P>0.05).The blood amylase,urinary amylase,triglyceride,SOFA score LDH,PTX3 and TLR4 in the death group[(501.64±40.29)U/L,(984.25±84.03)U/L,(11.92±3.78)mmol/L,(4.13±1.09)score,(496.82±67.43)U/L,(15.79±2.80)ng/mL,(37.69±4.92)ng/mL]were higher than those in the survival group[(452.19±79.43)U/L,(917.06±102.05)U/L,(8.40±2.39)mmol/L,(2.47±0.82)score,(304.48±92.09)U/L,(11.04±3.48)ng/mL,(29.65±8.74)ng/mL];the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that the levels of LDH,PTX3 and TLR4 in peripheral blood were positively correlated with blood amylase,urinary amylase,triglyceride and SOFA score(r=0.674,0.685,0.722,0.703;0.680,0.672,0.710,0.742;0.667,0.703,0.696,0.719;all P<0.05).ROC curve analysis showed that the sensitivities of peripheral blood LDH,PTX3 and TLR4 levels alone and in combination in predicting poor prognosis of patients with DKA complicated with AP were 84.00%,88.00%,80.00%and 96.00%respectively;the specificities were 78.70%,73.30%,62.70%and 61.30%,respectively,and the corresponding area under curve values were 0.882,0.870,0.771 and 0.969,respectively.Conclusion The levels of LDH,PTX3 and TLR4 in peripheral blood were related to the disease condition and prognosis of patients with DKA and AP,and combined detection had high predictive value on prognosis.