高脂血症性急性胰腺炎血清细胞因子水平与病情严重程度的相关性

Correlation between serum levels of cytokines and disease severity in HLAP patients

目的研究高脂血症性急性胰腺炎(AP)患者血清细胞因子水平与病情严重程度的相关性。方法纳入2013年1月~2015年8月收治的200例急性胰腺炎患者,按照患者发病原因分成观察组(60例)与对照组(140例),观察组为高脂血症性急性胰腺炎(HLAP),对照组为非急性高脂血症性急性胰腺炎(NHLAP)。观察两组患者甘油三酯(TG)、总胆固醇(TC)、谷草转氨酶(AST)、血淀粉酶、内毒素、肿瘤坏死因子-ɑ(TNF-ɑ)、白介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)水平及其与患者病情严重程度的相关性。结果观察组与对照组的年龄、性别、高血压、糖尿病、脂肪肝及并发症均有差异(P<0.05),两组患者的腹痛持续时间及腹痛至入院时间比较无差异(P>0.05);两组患者血清CRP值呈先升后降的动态变化,血清CRP值均是在发病第3天达到最高值,然后下降,但观察组血清CRP值的变化明显高于对照组(P<0.05);轻型急性胰腺炎患者中,两组患者血清CRP在第1天与第7天比较没有差异(P>0.05),在第2天至第6天均高于对照组(P<0.05);两组中型急性胰腺炎患者中,血清CRP在第1天至第4天比较有差异(P<0.05),在第5天至第7天比较无差异(P>0.05);两组重型急性胰腺炎患者中,血清CRP在第2天至第4天比较有差异(P<0.05),在第1天与第5、6、7天比较无差异(P>0.05);观察组TG、TC、AST明显高于对照组(P<0.05),观察组血淀粉酶值低于对照组(P<0.05);观察组内毒素、TNF-ɑ、IL-6、PCT明显高于对照组(P<0.05);ROC曲线分析,观察组第2天的约登指数明显高于第1、3天,对应的CRP临界值为173.12mg/L,而对照组患者第3天的约登指数明显高于第1、2天,血清CRP临界值为198.00mg/L。结论 HLAP患者血清CRP、TNF-ɑ、IL-6表达水平明显高于其他原因引起的急性胰腺炎,并且这些指标会随着病情严重而变化。

Objective To investigate the relation of Serum levels of cytokines level and disease severity in patients with HLAP. Methods 200 patients with AP in our hospital from January 2013 to August 2015 were selected and divided into observation group （HLAP group） and control group （NHLAP group）. The triglyceride （TG）, total cholesterol （TC） and aspartate aminotransferase （AST）, serum amylase, endotoxin, tumor necrosis factor alpha （TNF- alpha） and interleukin -6 （IL-6） and procalcitonin （PCT） and C- reactive protein （CRP） level and its correlation with the severity of the disease were observed. Results The difference of age, gender, high blood pressure, diabetes, fatty liver and compli- cations between the two groups had statistic significances （P〈0.05）. The stomachache duration and time to hospital of the two groups had no difference （P〉0.05）. CRP of the two groups increased and then declined. The third day reached to maximum, then declined. The changes of CRP of observation group was more obvious than that of control group （P〈 0.05）. CRP in light AP at the first and seventh day had no difference between the two groups （P〉0.05）. CRP in light AP at second and sixth day of observation group were higher than that of the control group （P〈0.05）. CRP in medium AP at the first and forth day had difference between the two groups （P〈0.05）. CRP in medium AP at the fifth and sev- enth day had no difference （P〉0.05）. CRP in severe AP from the second to the fourth day had difference between the two groups （P〈0.05）. CRP in severe AP at the 1st, 5th, 6th and 7th day had no difference between the two groups （P 〉0.05）. TG, TC and AST of observation group were significantly higher than that of the control group （P〈0.05）. The blood amylase of observation group was lower than that of the control group （P〈0.05）. IL-6, endotoxin and TNF- alpha PCT of observation group was significantly higher than that of the control group （P〈0.05）. ROC showed that Youden index of observation group at the second day was higher than that at the first, third day. The corresponding CRP critical value was 173.12mg/L. Youden index of control group at the third day was higher than that at the first, second day. The CRP critical value was 198.00mg/L. Conclusion The serum CRP, TNF- and IL-6 alpha of NHLAP were sig- nificantly higher than that of other causes, and these indicators will vary with the severity of illness.