血清PCT、IL-6及hsTnT动态变化对急性胰腺炎病情预测价值

VALUE OF DYNAMIC CHANGES OF SERUM PROCALCITONIN, INTERLEUKIN-6, AND HIGH-SENSITIVITY TROPONIN T IN PREDICTING DISEASE PROGRESSION OF ACUTE PANCREATITIS

目的探讨血清降钙素原(PCT)、白细胞介素-6(IL-6)和高敏肌钙蛋白T(hsTnT)在急性胰腺炎病人中的动态变化及其对病情变化的预测价值。方法选取符合条件的轻度急性胰腺炎(MAP)病人42例、中度急性胰腺炎(MSAP)病人39例和重症急性胰腺炎(SAP)病人41例,分别于入院第1、3、7天采集静脉血测定血清PCT、IL-6和hsTnT水平,同时对所有病人进行急性生理和慢性健康评分系统Ⅱ(APACHEⅡ)评分和BalthazarCT严重指数(CTSI)评分。根据是否发生感染性胰腺坏死,将41例SAP病人分为感染组(23例)和未感染组(18例)。比较不同组间病人血清PCT、IL-6和hsTnT水平,并用ROC曲线分析3个指标对SAP的预测能力。结果胰腺炎病人血清PCT、IL-6、hsTnT水平于入院第3天达到高峰,之后逐渐下降,但第7天的水平仍高于第1天。SAP病人入院第1、3、7天血清PCT、IL-6、hsTnT水平均高于MAP及MSAP病人,差异有统计学意义(F=2.359~74.066,P<0.05)。Pearson相关分析显示,SAP病人血清PCT、IL-6水平及APACHEⅡ、CTSI评分与血清hsTnT水平均呈正相关(r=0.673~0.787,P<0.05)。感染组各时间点血清PCT、IL-6、hsTnT水平均显著高于未感染组(F=11.072~126.414,P<0.05)。ROC曲线分析显示,hsTnT对SAP的预测能力最强(AUC=0.892),IL-6对SAP的预测能力最弱(AUC=0.782),上述3个指标联合检测比传统指标联合检测对SAP有更高的预测能力(AUC=0.935vsAUC=0.917)。结论血清PCT、IL-6、hsTnT水平的动态监测有助于对急性胰腺炎病情严重程度的判断和预后的评估。

Objective To investigate the dynamic changes of serum procalcitonin (PCT), interleukin-6 (IL-6), and high-sensitivity troponin T (hsTnT) in patients with acute pancreatitis and their value in predicting disease progression. Methods A total of 42 patients with mild acute pancreatitis (MAP), 39 patients with moderate severe acute pancreatitis (MSAP), and 41 patients with severe acute pancreatitis (SAP) who met the criteria were enrolled in this study. Venous blood samples were collected from patients on days 1, 3, and 7 after admission to determine the levels of PCT, IL-6, and hsTnT. Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) and Balthazar Computed Tomography Severity Index (CTSI) scores were determined for all the patients. The 41 patients with SAP were divided into infection group (23 cases) and uninfected group (18 cases) according to the presence or absence of infectious pancreatic necrosis. Serum levels of PCT, IL-6, and hsTnT were compared between different groups, and the predictive value of the three indicators for SAP was analyzed by the receiver operating characteristic (ROC) curve. Results The serum levels of PCT, IL-6, and hsTnT in patients with pancreatitis reached the peak on day 3 after admission, and were higher on day 7 than on day 1 after admission. The serum levels of PCT, IL-6, and hsTnT on days 1,3, and 7 after admission in patients with SAP were significantly higher than those in patients with MAP and MSAP ( F= 2.359-74.066, P <0.05). Pearson correlation analysis showed that the serum levels of PCT and IL-6 and APACHE Ⅱ and CTSI scores were positively correlated with serum level of hsTnT in 41 patients with SAP ( r =0.673-0.787, P <0.05). Serum levels of PCT, IL-6, and hsTnT were significantly higher in the infected group than in the uninfected group at each time point ( F =11.072-126.414, P <0.05). ROC curve analysis showed that hsTnT was the best predictor for SAP, with an area under the ROC curve (AUC) of 0.892, and IL-6 was the worst predictor for SAP with an AUC of 0.782. A combination of the three indicators had a higher predictive value for SAP compared with a combination of traditional indicators (AUC=0.935 vs AUC= 0.917 ).Conclusion Dynamic monitoring of serum PCT, IL-6, and hsTnT levels contributes to the disease evaluation and prognostic prediction in acute pancreatitis.