表面加强激光解析电离-飞行时间-质谱技术在急性重症胰腺炎预后相关蛋白质谱检测中的应用

Detection of specific protein spectra related with severe acute pancreatitis prognosis using surface-enhanced laser desorptionionization time-of-flight mass spectrometry

目的应用蛋白芯片表面加强激光解析电离-飞行时间-质谱（SELDI-TOF-Ms）技术检测急性重症胰腺炎不同预后相关蛋白质谱，探讨急性重症胰腺炎轻重程度及预后评估的新方法。方法用SELDI-TOF-MS方法检测浙江省人民医院2008年3月至2010年10月23例急性重症胰腺炎患者的蛋白质谱，按是否发生器官功能衰竭、胰腺脓肿、腹内压异常、死亡将全部患者分组进行蛋白指纹图谱比较。结果蛋白质峰谱特征显示，在1094U、2751U、5904U处并发胰腺脓肿（13例）的重症胰腺炎患者峰值（13．21±3．73，45．62±10．31，48．37±9．24）明显高于未并发胰腺脓肿组（70例）（4．33±1．79，8．87±3．21，4．45±1．59），差异有统计学意义，均P〈0．05。在635U并发器官功能衰竭组（11例）峰值（8．56±3．21）明显低于未并发器官功能衰竭组（12例）（37．82±12．65）；而在4103U、4187U处并发器官功能衰竭组（21．63±8．23，9．81±2．32）峰值则高于未并发器官功能衰竭组（3．32±1．29，1．14±0．49）。在4173U处并发腹内压增高组（10例）峰值（8．94±3．58）明显高于无腹内压增高组（13例）（1．97±0．73）；而在5635U处并发腹内压增高组峰值（0．62±0．23）则低于无腹内压增高组（15．78±6．34）。2例死亡患者蛋白指纹表现为血清蛋白全面合成功能减退，峰值降低。结论蛋白指纹图谱技术可筛选出有意义的生物标记蛋白，为急性重症胰腺炎并发症的早期诊断与治疗提供了新的路径，对急性重症胰腺炎预后评估具有重要意义。

Objective To analyze the serum proteomic pattern in different severe acute pancreatitis complication by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry（SELDI-TOF-MS） for evaluating the stage and prognosis of severe acute pancreatitis. Methods Serum samples were collected from 23 severe acute pancreatitis. Serum from organ nonfunetion, pancreatic abscess, intra-abdominal hypertension and death were profiled using WCX Proteinchip and analyzed by mass spectrometry. Results Protein peak in the spectrum characteristics showed that at 1094u, 2751 u, 5904u, the peak value of concurrent pancreas abscess pancreatitis [ 13.21 ± 3.73, 45.62 ± 10.31,48.37± 9.24 ] were significantly higher than those in none-pancreas abscess group [ 4.33 ±1.79, 8.87 ±3.21,4.45± 1.59] （P 〈0.05）. At 635u, the peak value of concurrent organ failure group（8.56 ± 3.21 ）was obviously lower than those in none-organ failure group（37.82 ±2.65）. At 4103u and 4187u, the peak value of in complicated organ failure group [21.63 ±8.23, 9.81 ±2.32] were higher than those in none-organ failure group [ 3.32 ±1.29, 1.14 ± 0.49 ]. At 4173 u, the peak value of concurrent increased intraabdominal pressure group（ 8.94 ±3.58 ） was significantly higher than that in none-intraabdominal pressure group （ 1. 97 ± 0.73 ）, while at 5635u the peak value of concurrent increased intraabdominal pressure groups（0.62 ± 0.23 ）was lower than that without intraabdominal pressure group（ 15.78 ± 6.34 ）. Two cases died. Protein fingerprints showed that overall serum protein composite function dropped and the peak value reduced. Conclusion Proteomic technology can significantly identify novel significant biomarkers in the serum, which provides a new way to diagnose and treat the different complication of severe acute pancreatitis early and has clinical significance in evaluating the prognosis of severe acute pancreatitis.