急性胰腺炎患者外周血α-MSH IL-2 TNF-α及IFN-γ的动态检测及临床意义

Dynamic detection and clinical significance of α-MSH, IL-2, TNF-α and IFN-γ in peripheral blood of patients with acute pancreatitis

目的探讨急性胰腺炎(AP)患者外周血α-黑色素细胞刺激素(α-MSH)、白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)及γ干扰素(IFN-γ)含量的动态变化及其评估病情严重程度的临床意义。方法选取2016年1月至2018年1月安徽医科大学第二附属医院急诊外科收治的AP患者60例,轻症组30例、非轻症组30例,另选取30例健康志愿者作为对照组。所有患者在入院后第1、3、7天取静脉血,采取酶联免疫吸附法对α-MSH、IL-2、TNF-α及IFN-γ含量进行测定。结果入院后第1、3、7天轻症组、非轻症组血清α-MSH含量总体逐渐下降,且非轻症组α-MSH含量一直较低;各时间点非轻症组α-MSH含量均明显低于轻症组,同时两组患者第1、3、7天α-MSH含量明显低于对照组,差异有统计学意义(P<0.05)。入院后第1、3、7天轻症组、非轻症组血清IL-2含量逐渐上升,且非轻症组IL-2含量一直较高;各时间点非轻症组IL-2含量均明显高于轻症组,同时两组患者第1、3、7天IL-2含量明显高于对照组,差异有统计学意义(P<0.05)。入院后第1、3、7天轻症组、非轻症组血清TNF-α含量逐渐上升,且非轻症组TNF-α含量一直较高;各时间点非轻症组TNF-α含量均明显高于轻症组,同时两组患者第1、3、7天TNF-α含量明显高于对照组,差异有统计学意义(P<0.05)。入院后第1、3、7天轻症组、非轻症组血清IFN-γ含量总体逐渐下降,且非轻症组IL-γ含量一直较低;各时间点非轻症组IFN-γ含量均明显低于轻症组,同时两组患者第1、3、7天IFN-γ含量明显低于对照组,差异有统计学意义(P<0.05)。α-MSH、IL-2、TNF-α、IFN-γ及四者联合的曲线下面积分别为0.769、0.697、0.691、0.688及0.886。结论AP患者外周血α-MSH、IL-2、TNF-α及IFN-γ含量在评估患者病情严重程度方面具有不同程度的临床意义,外周血α-MSH在病情评估方面的敏感度、特异度及准确性均高于另外的三个指标,患者较低的外周血α-MSH含量表明患者病情严重,预后较差,四个指标联合检测在评估病情严重程度方面存在更佳的临床价值。

Objective To investigate the dynamic changes of α-melanocyte stimulating hormone (α-MSH),interleukin -2 (IL -2),tumor necrosis factor -α ( TNF -α)and.interferon -γ (IFN-γ)in peripheral blood of patients with acute pancreatitis and their clinical significance. Methods We selected 60 cases of acute pancreatitis in emergency surgery of our hospital from January 2016 to January 2018,of which 30 cases of light disease,30 cases of severe group,and 30 healthy volunteers as control group.All patients were sampled venous blood on the first,third,seventh day after admission,and the levels of α-MSH,IL -2,TNF -α and IFN -γ were measured by ELISA.Results On the first,third,seventh day after admission,the level of serum α-MSH in the light disease group arid the severe group decreased gradually,and the level of α-MSH in the severe group had been lower, and the level of α-MSH in the severe group at each time poifit was significanfly lower than'that of the light disease group,and the concentration of α-MSH on the first,third,seventh day of the two groups was significantly lower than that in the control group,the difference was statistically significant (P < 0.05).On the first,third,seventh day after admission,the serum levels of IL -2 in the light disease group and the severe group increased gradually,and the level of IL -2 in the severe group had been higher,and the level of IL -2 in the severe group was significantly higher than that of the light disease group.At the same time,the concentration of IL -2 in the two groups was significantly higher than that of the control group.The difference was statistically significant (P <0.05 ).On the 3 and 7 day,the levels of serum TNF -α in the light disease group and the severe group increased gradually,and the level of TNF -α in the severe group had been higher,arid the level of TNF -a in the severe group was significantly higher than that of the light disease group.At the same time,the concentration of TNF -α in the two groups was significantly higher than that of the control group.The difference was statistically significant (P <0.05 ),on the first,third day after admission.The content of serum IFN -γ in the 7 day light group and the severe group gradually decreased;and the IL --γ level in the severe group was lower,and the average IFN -γ level,in the severe group was significantly lower than that of the light disease group at all time points,and the concentration of IFN -γ on the first,third,seventh day of the two groups was significantly lower than that of the control group,and the difference Was statistically significant (P <0.05).As a longitudinal coordinate,the ROC curve drawn by the 1 -specificity as the ordinate shows that the area under the combined curves of α-MSH,IL -2,TNF -α and IFN -γ four are 0.769,0.697,0.691,0.688 and 0.886,respectively.Conclusion The levels of α-MSH,IL - 2,TNF -α,and IFN -γ in peripheral blood of patients with acute pancreatitis have different clinical significance in assessing the severity of the patient's condition.The sensitivity,specificity and accuracy of α-MSH in the assessment of the disease are higher than those of the other three indicators.The lower peripheral blood α-MSH content of the patients indicates that the patient ,is severe in the patient's condition.In addition,the combined detection of the four drugs has better clinical value in assessing the severity of the disease,and is worthy of clinical application.