急性胰腺炎早期的体液免疫改变

Change of Humoral Immunity in Early Stage of Acute Pancreatitis

背景:急性胰腺炎(AP)患者病程早期即出现免疫功能紊乱。目的:探讨AP发病早期血清免疫球蛋白的变化及其对AP严重程度的预测价值。方法:纳入2014年1月—2014年12月苏州大学附属第一医院收治的AP患者164例,其中轻度(MAP)、中度(MSAP)、重度AP(SAP)分别为103例、47例和14例,22例健康体检者作为对照组。所有患者均于发病24 h内确诊,并于48 h内采集血清标本,检测IgG、IgA、IgM、κ轻链和λ轻链水平。以ROC曲线和曲线下面积(AUC)评估各指标对AP严重程度的预测价值。结果:AP患者发病48 h内血清IgA、IgM、κ轻链和λ轻链水平均有不同程度的下降,其中IgM水平在MSAP组和SAP组中降低较MAP组更为明显(P <0. 05)。ROC曲线分析显示,血清IgM对于鉴别中、重度AP有一定意义(AUC=0. 723,95%CI:0. 634～0. 812),cut-off值取≤1. 055 g/L,敏感性和特异性分别为0. 806和0. 689。结论:AP早期即存在血清IgA、IgM、κ轻链和λ轻链水平降低,提示体液免疫功能受损。血清IgM可能用于AP严重程度的早期预测。

Background： Impaired immune function occurs in the early stage of acute pancreatitis （AP）. Aims： To explore the changes of serum immunoglobulins in the early stage of AP and their values in predicting the severity of the disease. Methods： A total of 164 AP patients diagnosed within 24 hours of onset from Jan. 2014 to Dec. 2014 at the First Affiliated Hospital of Soochow University were enrolled. The number of patients with mild, moderately severe, and severe AP （MAP, MSAP and SAP） were 103, 47 and 14, respectively. Twenty-two healthy subjects were served as controls. Serum samples were collected within 48 hours of onset for detection of IgG, IgA, IgM, κ light chain and λ light chain levels. ROC curve and area under the curve （AUC） were used to assess the performance of these indices for predicting the disease severity. Results： A decline in varying degrees was observed in serum levels of IgA, IgM, κ light chain and λ light chain within 48 hours of onset of AP. The difference was statistically significant in serum IgM between MSAP, SAP groups and MAP group （ P 〈0.05）. ROC curve showed that serum IgM had a moderate accuracy for differentiating MSAP and SAP from MAP （AUC=0.723, 95% CI： 0.634-0.812）; with cut-off value ≤1.055 g/L, the sensitivity and specificity were 0.806 and 0.689 , respectively. Conclusions： Serum levels of IgA, IgM, κ light chain and λ light chain decrease obviously in the early stage of AP, which suggests humoral immune dysfunction. Serum level of IgM may be used as a predictor for severity of AP in early stage of the disease.