血清白细胞介素-6对急性胰腺炎患者并发持续器官功能衰竭的预测作用

Serum interleukin-6,a valuable indicator of persistent organ failure in acute pancreatitis

[目的]评价血清白细胞介素-6(IL-6)对急性胰腺炎(AP)患者发生持续器官功能衰竭(POF)的预测价值。[方法]回顾性收集2017年2月～2018年6月于我院急诊内科住院、发病≤72h且入院次日采用酶促化学发光免疫法行血清IL-6检测的AP患者86例。依据是否合并持续48h以上不能自行恢复的器官功能衰竭分为2组,其中POF组患者10例(11.6%);Spearman秩相关分析AP患者血清IL-6与其病情严重程度的相关性;应用受试者工作特征曲线(ROC)计算血清IL-6预测AP患者发生POF的最佳分界值、敏感性及特异性。[结果]POF组AP患者血清IL-6中位水平为141.0(87.8～338.0)pg/ml,明显高于非POF组患者,20.6(4.9～45.9)pg/ml(P<0.05)。AP患者血清IL-6水平与其病情严重程度、C反应蛋白、Ranson评分、EPIC评分、住院天数及住院费用呈正相关,而与血清白蛋白呈负相关(P<0.05);ROC曲线分析显示血清IL-6预测AP患者发生POF的曲线下面积为0.934(95%CI:0.873～0.996,P<0.01),当血清IL-6≥59.7pg/ml时,其预测AP患者发生POF的敏感性为0.900,特异性为0.868。[结论]AP患者血清IL-6水平与其病情严重程度密切相关,其预测AP患者发生POF的敏感性及特异性高,可作为早期评估患者病情的有力指标。

[Objective]Serum interleukin-6(sIL-6)has been proposed as a biomarker to predict the severity of acute pancreatitis(AP),however,the predictive accuracy varied significantly across numerous studies.Meanwhile the methods applied to detect the sIL-6 in previous studies were difficult to implement in clinical routine assay.The aim of this study was to evaluate the predictive value of real-time sIL-6 levels for persistent organ failure(POF)in AP.[Methods]Data from 86 hospitalized AP patients between Feb2017 and Jun 2018 were retrospectively reviewed and analyzed.All the patients enrolled were admitted within 72 hours from the onset of symptoms and the sIL-6 was assayed on day 1 after admission using enzyme chemiluminescence immunoassay.Severity of AP was defined according to 2012 revised Atlanta classification for AP.The correlations between sIL-6 and selected laboratory markers were studied by Spearman’s rank correlation test.ROC curves,area under the curve(AUC)and optimal cut off values were calculated to assess diagnostic utility of IL-6 in predicting POF in AP.[Results]The median age of the all the patients was 47 years,and 49(57.0%)were male.There were 10 patients of the 86(11.6%)developed POF.The median(IQR)level of sIL-6 of AP patients with POF was significantly higher than that inthe patients without POF [141.0(87.8-338.0)pg/ml20.6(4.9-45.9)pg/ml,U=710.0,P<0.01].The levels of sIL-6 were positively correlated with CRP levels,Ranson’s Scores,EPIC Scores,hospitalization expenses,length of hospital stay and severity of AP,but negatively correlated with serum ALB levels(P<0.01).The optimal cut-off value of sIL-6 was 59.7 pg/ml,with an AUC of 0.934(95%CI:0.873-0.996,P<0.01).The sensitivity and specificity were 90.0% and 86.8%,respectively.[Conclusion]The present study indicated that automatically measured sIL-6 was a useful real-time biomarker to predict the severity and POF of acute pancreatitis.