急性胰腺炎患者血清降钙素原和协同刺激分子B7家族及可溶性细胞间黏附分子-1水平变化及意义

Changes and significances of serum procalcitonin,B7-H3 and soluble intercellular adhesion molecule-1 levels in patients with severe acute pancreatitis

目的探讨急性胰腺炎患者血清降钙素原(procalcitonin,PCT)、协同刺激分子B7家族(serum costimulatory molecule B7family,B7-H3)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)水平变化,及其在急性胰腺炎病情严重程度评估中的价值。方法 90例重症急性胰腺炎(severe acute pancreatitis,SAP)患者为SAP组,90例轻症急性胰腺炎(mild acute pancreatitis,MAP)患者为MAP组,100例体检健康者为对照组。检测3组血清PCT、B7-H3、sICAM-1水平;对SAP组、MAP组行急性生理与慢性健康评估系统(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)和急性胰腺炎RANSON评分评定病情严重程度;Pearson法分析血清PCT、B7-H3、sICAM-1与APACHEⅡ、RANSON评分的相关性。结果 SAP组、MAP组血清PCT[(9.9±3.2)、(5.6±2.2)μg/L]、B7-H3[(181.7±26.6)、(67.2±10.2)ng/L]、sICAM-1[(1 036.9±68.4)、(448.6±50.2)g/L]水平均高于对照组[(1.2±0.4)μg/L、(53.0±2.7)ng/L、(29.8±16.5)g/L](P<0.05),且SAP组高于MAP组(P<0.05);MAP组APACHEⅡ评分[(7.8±1.3)分]、RANSON评分[(2.7±1.0)分]低于SAP组[(13.0±2.6)、(5.3±1.8)分](P<0.05);Pearson相关分析结果显示,SAP组APACHEⅡ、RANSON评分与血清PCT(r=0.761,P=0.017;r=0.751,P=0.013)、B7-H3(r=0.710,P=0.016;r=0.701,P=0.012)、sICAM-1(r=0.645,P=0.010;r=0.668,P=0.007)均呈正相关;MAP组患者APACHEⅡ、RANSON评分与血清PCT(r=0.793,P=0.015;r=0.775,P=0.010)、B7-H3(r=0.738,P=0.014;r=0.730,P=0.013)、sICAM-1(r=0.730,P=0.011;r=0.680,P=0.012)均呈正相关。结论急性胰腺炎患者血清PCT、B7-H3、sICAM-1水平增高程度与APACHEⅡ、RANSON评分呈正相关,血清PCT、B7-H3、sICAM-1可作为判断急性胰腺炎病情严重程度的指标。

Objective To investigate the levels of serum procalcitonin（PCT）,serum costimulatory molecule B7 family（B7-H3）and soluble intercellular adhesion molecule-1（sICAM-1）in patients with severe acute pancreatitis（SAP）and their value to the evaluation of the severity of pancreatitis.Methods The levels of PCT,B7-H3 and sICAM-1 were detected in 90 patients with SAP（SAP group）,90 patients with mild acute pancreatitis（MAP）and 100 healthy volunteers（control group）.The severity of pancreatitis was evaluated by Acute Physiology and Chronic Health EvaluationⅡ（APACHEⅡ）and RANSON scores in SAP group and MAP group,and the correlations of serum PCT,B7-H3 and sICAM-1 with APACHEⅡ and RANSON scores were evaluated by Pearson method.Results The levels of serum PCT（（9.9±3.2）,（5.6±2.2）μg/L）,B7-H3（（181.7±26.6）,（67.2±10.2）ng/L）and sICAM-1（（1 036.9±68.4）,（448.6±50.2）g/L）in SAP group and MAP group were significantly higher than those in control group（（1.2±0.4）μg/L,（53.0±2.7）ng/L,（29.8±16.5）g/L）（P〈0.05）,and in SAP group than those in MAP group（P〈0.05）.The APACHEⅡ score（7.8±1.3）and RANSON score（2.7±1.0）in MAP group were significantly lower than those in SAP group（13.0±2.6,5.3±1.8）（P〈0.05）.The Pearson correlation analysis showed that the APACHEⅡ and RANSON scores were positively correlated with PCT（r=0.761,P=0.017;r=0.751,P=0.013）,B7-H3（r=0.710,P=0.016;r=0.701,P=0.012）and sICAM-1（r=0.645,P=0.010;r=0.668,P=0.007）in SAP group,and also positively with PCT（r=0.793,P=0.015;r=0.775,P=0.010）,B7-H3（r=0.738,P=0.014;r=0.730,P=0.013）and sICAM-1（r=0.730,P=0.011;r=0.680,P=0.012）in MAP group.Conclusion The serum levels of PCT,B7-H3 and sICAM-1 in patients with SAP are positively correlated with the scores of APACHEⅡ and RANSON,and can be used as the indicators for evaluating the severity of SAP.