急性胰腺炎患者促炎细胞因子与空腹胃肠激素关系分析

Relationship Between Proinflammatory Cytokines and Fasting Gastrointestinal Hormones in Patients With Acute Pancreatitis

背景:肠道动力障碍是急性胰腺炎(AP)病情进展的重要环节,兴奋性与抑制性胃肠激素失衡可能是重度AP(SAP)患者出现肠道动力障碍的关键原因之一。目的:探讨AP患者血清促炎细胞因子与空腹胃肠激素之间的关系及其临床意义。方法:2016年6月—2017年6月深圳市龙华区人民医院收治的90例AP患者纳入研究,其中轻度AP(MAP) 60例,SAP 30例,同期健康体检者65例作为对照组。以ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8和空腹5-羟色胺(5-HT)、胃动素(MTL)、胆囊收缩素(CCK)水平,分析促炎细胞因子与胃肠激素之间以及两者与AP严重程度之间的相关性。结果:MAP组和SAP组血清TNF-α、IL-6、IL-8和5-HT水平高于对照组,MTL、CCK水平低于对照组,SAP组改变更为显著,与MAP组间差异有统计学意义(P <0. 05)。各促炎细胞因子与各胃肠激素之间均存在显著相关性(P <0. 05),且两者均与AP严重程度相关(P <0. 05)。结论:胃肠激素5-HT、MTL、CCK与AP严重程度和血清促炎细胞因子之间存在显著相关性,可能为AP的临床诊断和病情评估提供参考。

Background: Intestinal dysmotility is an important step in progression of acute pancreatitis( AP). Imbalance of excitatory and inhibitory gastrointestinal hormones might contribute to the intestinal dysmotility in severe acute pancreatitis( SAP). Aims: To investigate the relationship between serum proinflammatory cytokines and fasting gastrointestinal hormones in AP patients and its clinical significance. Methods: A total of 90 AP patients,including 60 mild acute pancreatitis( MAP) and 30 SAP,admitted from Jun. 2016 to Jun. 2017 at People’s Hospital of Longhua,Shenzhen,Guangdong Province were enrolled. Sixty-five healthy subjects were served as controls. Serum levels of tumor necrosis factor-α( TNF-α), interleukin-6( IL-6), IL-8, and fasting 5-hydroxytryptamine( 5-HT), motilin( MTL) and cholecystokinin( CCK) were measured by ELISA. Relationship between these proinflammatory cytokines and gastrointestinal hormones,as well as their correlations with the severity of AP were analyzed. Results: Serum levels of TNF-α,IL-6,IL-8 and 5-HT in MAP and SAP groups,especially in SAP group,were higher than those in control group,whereas serum levels of MTL and CCK were lower in MAP and SAP groups than in control group. Significant differences were found between MAP group and SAP group( P < 0. 05). Significant correlations could be observed between proinflammatory cytokines and gastrointestinal hormones( P < 0. 05),and they both were correlated with the severity of AP( P < 0. 05).Conclusions: 5-HT,MTL and CCK are closely correlated with the disease severity and serum proinflammatory cytokines in AP patients. These gastrointestinal hormones might be used as reference for clinical diagnosis and disease severity assessment of AP.