人血清S100A12水平与急性胰腺炎严重程度的相关性研究

Human sermn S100A12 level and severity of acute pancreatitis

目的分析急性胰腺炎患者发病早期血清S100A12水平与疾病严重程度的相关性及其临床应用价值。方法以酶联吸附法测定64例不同严重程度的AP患者发病24h时血清S100A12水平，分析其预测AP严重程度的临床价值。结果AP患者早期血清S100A12水平高于健康对照（P〈0．05）。不同MCTSI评分AP患者的血清S100A12水平为：MCTSI7～8分组〉4—6分组〉低于4分组（均P〈0．01）。单器官与多器官功能衰竭患者血清S100A12水平无明显差异，但均高于无器官功能衰竭患者（均P〈0．01）。以发病24h血清S100A12水平筛选中度急性胰腺炎患者的AUC为0．80，诊断界值为61．83ng／ml，敏感度为70．01％，特异度为73．52％。SAP患者血清S100A12水平高于MSAP患者（P=0．01），其区分重症急性胰腺炎和中度重症急性胰腺炎患者的AUC为0．84，诊断界值为285．32ng／ml，敏感度为76．94％，特异度为94．12％，Youden指数为71．00％，诊断性能优于APACHE．Ⅱ、Ranson、Marshall评分及血清C反应蛋白水平。结论AP发病早期，人血清S100A12水平升高与胰腺坏死、器官功能衰竭程度相关。当发病24h血清S100A12〉285．32ng／ml时，提示患者发生重症急性胰腺炎的可能性较高，其诊断价值优于APACHE—Ⅱ和Marshall评分。

Objective To evaluate the correlation between human serum S100A12 level and severity of acute panereatitis （AP）. Methods Serum S100A12 were tested in 64 AP patients in 24 hours after the onset. S100A12 levels was compared to the severity of AP ,and the area under the curve （AUC）of the receiver operating characteristic curve（ROC） of serum S100A12 levels for estimating the severity of AP were made and compared with laboratory parameters and APACHE-1I , Ranson＇ s scoring system. Results S100A12 levels in early AP patients were higher than healthy controls （ P 〈 0. 05 ）. SIOOA12 levels increased and correlated with MCTSI scores： patients scored 7 -8 〉 patients scored 4 -6 〉 patients scored less than 4（P 〈0. 01 ）. S100A12 levels increased with organ failure （P 〈0. 01 ）. The AUC of S100A12 in 24 hours after onset for distinguishing MAP between MSAP and SAP was 0. 80, cut-off point was 61.83 ng/ml,sensitivity was 70. 01%o and the specificity was 73.52%. Serum S100A12 levels were higher in SAP than in MSAP（P =0. 01 ）. The AUC of SIOOA12 in early AP for distinguishing between MSAP and SAP was 0. 84,cut-off point was 285.32 ng/ml, the sensitivity was 76. 94% and the specificity was 94.12% , Youden index was 71.00%, positive likelihood ratio was 13.00, negative likelihood ratio was 0. 20, the diagnostic performance was better than APACHE-Ⅱ , Ranson and Marshall scoring systems and serum CRP concentration. Conclusions Human serum S100A12 levels elevated at early stage of AP. S100A12 〉 285.32 ng/ml represents high risk of SAP, which is more sensitive and accurate than APACHE-Ⅱ and Marshall scoring system.