急性胰腺炎患者血清IL-33和TNF-α水平与病情严重程度及预后的关系

The correlation between serum levels of IL-33,TNF-α and disease severity,prognosis in patients with acute pancreatitis

目的探讨动态监测血清白细胞介素(IL)-33和肿瘤坏死因子(TNF)-α水平对急性胰腺炎(AP)早期诊断、病情评估及预后的参考价值。方法将发病后立即入院的AP患者86例按病情轻重分为2组,其中59例轻症者为MAP组,27例重症者为SAP组;根据有无全身炎性反应综合征(SIRS)分为SIRS组52例与非SIRS组34例;根据预后将其分为存活组75例和死亡组11例;所有患者于入院48h内进行急性胰腺炎严重程度床边指数(BISAP)评分,并分别于入院后第1、3、7和14天动态监测其血清IL-33和TNF-α水平。选择同期63例健康体检者为对照组。结果 MAP组和SAP组在不同时间监测点血清IL-33和TNF-α水平均高于对照组,其中SAP组升高更明显。SAP组血清IL-33和TNF-α水平在入院后第1、3、7、14天4个时段均高于MAP组,差异有统计学意义(P<0.05),入院第3天时SAP组血清IL-33和TNF-α水平均达到高峰,经治疗后(入院第7天)开始逐渐降低;SIRS组血清IL-33、TNF-α水平高于非SIRS组,差异有统计学意义(P<0.05);死亡组血清IL-33、TNF-α水平及BISAP评分高于存活组,差异有统计学意义(P<0.05)。Spearman相关分析提示,AP患者血清IL-33、TNF-α水平与BISAP评分呈正相关。结论动态监测AP患者血清IL-33和TNF-α水平结合BISAP评分,在AP的早期诊断,严重程度的分级,指导临床治疗,预后评估等方面都具有重要的临床价值。

Objective To explore the reference value of interleukin（IL）-33 and tumor necrosis factor-alpha（TNF）-αin early diagnosis,illness evaluation and prognosis of acute pancreatitis（AP）by dynamically monitoring the serum levels of IL-33 and TNF-α.Methods A total of 86 patients with AP were selected as objectives which were divided into two groups according the severity of illness which include 59 cases of mild AP group（MAP）and 27 cases of severe AP group（SAP）,52 cases of systemic inflammatory response syndrome（SIRS）group and 34 cases of non SIRS group distinguished by SIRS,75 cases of survival group and 11 cases of death group identified by prognosis of AP.All of patients were assessed by Bedside Index of Severity in Acute Pancreatitis（BISAP）score within 48 hafter admission and detected the serum levels of IL-33 and TNF-αat the first day,third day,seventh day and fourteenth day during hospital.A total of 63 healthy persons were recruited into control group.Results The serum levels of IL-33,TNF-αand BISAP score of SAP group and MAP group were higher than those of the control group in different monitoring time,but the SAP group increased more obviously than MAP group.The serum levels of IL-33 and TNF-αof SAP group were higher than those of MAP group at the first day,third day,seventh day and fourteenth day during hospital,and the differences between them had statistical significance（P〈0.05）.The serum levels of IL-33 and TNF-αof SAP group increased to peak at the third day and reduced gradually after conventional treatment（the seventh day in the hospital）.The serum levels of IL-33 and TNF-αof SIRS group were significant higher than those of non SIRS group（P〈0.05）.The serum levels of IL-33,TNF-αand BISAP score of death group were significant higher than those of survival group（P〈0.05）.Spearman correlation analysis suggested that there were positive correlations between BISAP and the serum levels of IL-33 and TNF-αof AP patients.Conclusion There is an important clinical value to the early diagnosis,severity classification,guiding clinical treatment and the assessment of prognosis of AP by dynamically monitoring the serum levels of IL-33 and TNF-αof AP patients.