可溶性程序死亡配体1对重症急性胰腺炎后期胰周坏死感染的预测作用

Predictive role of sPD-L1 on peripancreatic necrosis infection in the late stage of severe acute pancreatitis

目的:探讨可溶性程序死亡配体1(sPD-L1)是否可为重症急性胰腺炎(SAP)病人后期胰周坏死感染的预测提供帮助。方法:收集2017年3月1日至2019年3月31日在发病24 h内首诊于武汉大学人民医院胰腺外科、住院时间≥14 d且年龄≥18岁SAP病人10^(9)例,将其分为后期胰周坏死感染组(41例)和后期无胰周坏死感染组(68例)。收集统计相关实验室资料和临床数据。采用SPSS 16.0统计软件进行统计分析。结果:两组病人的性别、年龄、BMI和入院24 h内的sPD-L1、绝对淋巴细胞计数(ALCs)、Balthazar CT评分均无明显差异(P>0.05)。但后期胰周坏死感染组2周左右的sPD-L1、Balthazar CT评分明显高于后期无胰周坏死感染组[108.32(100.92,118.13)ng/mL vs 88.76(80.97,97.14)ng/mL,P<0.01;8(6,8)分vs 6(5,8)分,P<0.01],ALCs明显偏低[0.85(0.71,1.07)×10^(9)个/L vs 1.07(0.88, 1.28)×10^(9)个/L,P<0.01]。发病2周左右的sPD-L1≥95 ng/mL(OR=1.08,95%CI:1.04~1.13,P<0.01)、Balthazar CT评分≥6分(OR=1.52,95%CI:1.10~2.09,P<0.05)是SAP后期胰周坏死感染的独立危险因素。结论:SAP发病2周左右的sPD-L1≥95 ng/mL和Balthazar CT评分≥6分是后期胰周坏死感染的独立危险因素。

Objective:To explore whether soluble programmed death-ligand 1(sPD-L1) can help to predict peripancreatic necrosis infections in the late stage of severe acute pancreatitis(SAP).Methods:We collected the clinical data of 10^(9) SAP patients over 18 years old from 1 st March 2017 to 31 th March 2019,who were first diagnozed in Renmin Hospital of Wuhan University within 24 hours after onset of disease and hospitalized for more than 14 days.They were divided into late peripancreatic infection group(n=41) and non-infection group(n=68).The relative laboratory and clinical informatins were collected and analyzed by SPSS 16.0.Results:There was no difference between the two groups in gender,age,BMI,and sPD-Ll,ALCs,and Balthazar CT scores within 24 hours after the onset of SAP.However,after twoweek,sPD-L1 levels(108.32(100.92,118.13) ng/mL vs 88.76(80.97,97.14) ng/mL,P<0.01) and Balthazar CT scores(8(6,8) vs 6(5,8),P<0.01) were higher,and ALCs in 2 weeks was lower(0.85(0.71,1.07) × 10~9/L vs 1.07(0.88,1.28) × 10~9/L,P<0.01) in late peripancreatic infection group.The level of sPD-L1≥95 ng/mL(OR=1.08,95% CI:1.04-1.13,P<0.01) and Balthazar CT scores≥6(OR=1.52,95%CI:1.10-2.09,P<0.05) were independent risk factors of secondary infections.Conclusion:sPD-L1≥95 ng/mL and Balthazar CT scores≥6 scores about 2 weeks after admission are independent risk factors of secondary infections of SAP.