降钙素原和肿瘤坏死因子对评估急性胰腺炎的病情严重程度和预后预测的临床价值

Clinical value of PCT and TNF-α in predicting severity of disease and predicting prognosis of acute pancreatitis

目的探讨降钙素原和肿瘤坏死因子在评估急性胰腺炎(AP)病情严重程度和预后的临床价值。方法选取2012年1月-2017年6月本院收治的急性胰腺炎患者108例,分为轻症组80例(APACHEⅡ评分≤8分)和重症组28例(APACHEⅡ评分>8分),对比入院后1 d、3 d和5 d的血清PCT和TNF-α的变化情况,制作ROC曲线,用灵敏度和特异度来评价二者的临床价值。结果入院后1 d、3 d和5 d,AP重症患者外周血的PCT和TNF-α水平明显高于轻症组。Pearson相关分析显示,AP患者外周血的PCT、TNF-α与APACHEⅡ评分呈正相关。以ROC曲线下面积计算灵敏度及特异度,PCT以2.720μg/L为截断值时,其灵敏度和特异度分别为78.57%和83.75%,TNF-α以5.797μg/L截断值时,其灵敏度和特异度分别为82.14%和86.25%。结论急性胰腺炎患者的外周血PCT和TNF-α的水平与疾病严重程度呈正相关,可以用来作为判断预后的血清学指标。

Objective To investigate the clinical value of procalcitonin and tumor necrosis factor in assessing the severity of acute pancreatitis and prognosis. Methods A total of 108 patients with acute pancreatitis and admitted to our hospital from January 2012 to June 2017 were divided into two groups according to the APACHEⅡ score： 80 cases（ APACHEⅡ score ≤8）in mild group and 28 cases in severe group（ APACHEⅡ score 〉8）. The changes of serum PCT and CRP at 1 d,3 d,5 d and7 d after operation were compared to make the ROC curve. Sensitivity and specificity were used to evaluate the clinical value.Results The levels of PCT and TNF-α in peripheral blood of AP critically ill patients at 1 d,3 d and 5 d after admission were significantly higher than those of mild ones. Pearson correlation analysis showed that there was a positive correlation of PCT and TNF-α with APACHEⅡ score in AP patients. The sensitivity and specificity of the area under the ROC curve were calculated.The sensitivity and specificity of PCT,when the cut-off was 2. 720 μg/L,were 78. 57% and 83. 75%,respectively. The sensitivity and specificity of TNF-α at 5. 797 μg/L were 82. 14% and 86. 25%,respectively. Conclusion The levels of PCT and TNF-α in peripheral blood of patients with acute pancreatitis are positively correlated with the severity of the disease,and can be used as a serological marker for prognosis.