急性胰腺炎患者血清瘦素、血清淀粉样蛋白A及降钙素原的动态变化及临床意义

Dynamic changes of serum leptin,SAA and PCT in patients with acute pancreatitis and their clinical significance

目的观察急性胰腺炎患者瘦素(leptin)、血清淀粉样蛋白A(SAA)以及降钙素原(PCT)的动态改变,探讨其在急性胰腺炎早期病程中的临床实用价值.方法选取2012年3月至2012年12月本院收治的急性胰腺炎患者42例,其中轻型急性胰腺炎(MAP)患者32例,重症胰腺炎(SAP)患者10例,酶联免疫吸附法动态检测人院后第1、3、5、7天血清leptin、SAA及PCT的水平,与42例健康对照组比较,分析各指标在各组间的差异,并应用受试者工作特征(ROC)曲线评价各指标对急性胰腺炎的诊断价值.结果急性胰腺炎患者各个不同时间点leptin、SAA及PCT均显著高于对照组(P<0.01),且SAP组明显高于MAP组(P<0.01).入院首日leptin、SAA、PCT的最佳截断值分别为25.45μg/L、594.35 mg/L、3.585μg/L,以最佳截断值为准,3种指标的敏感度、特异性、阳性预测值和阴性预测值均在70.00%以上.结论血清leptin、SAA及PCT水平的变化反应了急性胰腺炎患者病情严重程度,对急性胰腺炎早期病程判断具有一定的临床意义.

Objective To determine the dynamic changes of serum leptin,serum amyloid A(SAA)and procalcitonin(PCT)in patients with acute pancreatitis,and to investigate their clinical values in the early phase of acute pancreatitis.Methods Forty-two patients with acute pancreatitis admitted to our hospital between March 2012 and December 2012 were divided into two groups,including 32 of mild acute pancreatitis and 10 of severe acute pancreatitis.Enzyme-linked immunoassay(ELISA)was used to measure the serum levels of leptin,SAA and PCT at1,3,5,7d after admission.Compared with 42 healthy controls,the differences in the indexes between the two groups were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of each index for acute pancreatitis.Results The levels of leptin,SAA and PCT were significantly higher in the patients with acute pancreatitis than those in the control group at different time points(P<0.01),and the indexes in the SAP group were significantly higher than those in the MAP group(P<0.01).The optimal cut-off values of leptin,SAA and PCT at the first day of admission were 25.45μg/L,594.35 mg/L and 3.585μg/L,respectively.Based on the optimal cut-off value,the sensitivity,specificity,positive predictive value and negative predictive value of the three indexes were all above 70.00%.Conclusion The changes of serum leptin,SAA and PCT levels reflect the severity of acute pancreatitis,and show certain clinical significance for the early course of acute pancreatitis.