外周血HLA-DR^(+)/CD14+水平对重症急性胰腺炎预后评估的价值

Value of peripheral blood HLA-DR^(+)/CD14^(+)levels in prognostic evaluation of severe acute pancreatitis

目的探讨外周血CD14^(+)单核细胞人类白细胞DR抗原(HLA-DR^(+)/CD14^(+))水平对重症急性胰腺炎(SAP)预后评估的价值。方法2016年2月至2018年2月该院收治的97例SAP患者根据预后结局分为预后良好组(46例)和预后不良组(51例)。常规收集血钙、氧合指数(PaO2/FiO2)、尿素氮、肌酐、急性生理与慢性健康(APACHEⅡ)评分、急性胰腺炎严重程度床边指数(BISAP)评分、兰森(Ranson)评分。流式细胞术检测外周血HLA-DR^(+)/CD14^(+)水平并进行相关性分析,logistic回归分析不良预后发生危险因素。结果预后不良组尿素氮水平、肌酐水平、APACHEⅡ评分、BISAP评分、Ranson评分均明显高于预后良好组(P<0.05),血钙、PaO2/FiO2、HLA-DR^(+)/CD14^(+)水平明显低于预后良好组(P<0.05)。外周血HLA-DR^(+)/CD14^(+)水平与肌酐水平、APACHEⅡ评分、BISAP评分、Ranson评分均呈负相关(P<0.05)。高BISAP评分、高APACHEⅡ评分、低HLA-DR^(+)/CD14^(+)水平是影响SAP患者不良预后发生危险因素。外周血HLA-DR^(+)/CD14^(+)水平预测SAP不良预后发生的曲线下面积为0.896,灵敏度为84.30%,特异度为84.80%。结论不良预后SAP患者外周血HLA-DR^(+)/CD14^(+)水平明显降低,可能作为预后评估指标。

Objective To explore the value of peripheral blood CD14^(+)monocyte human leukocyte DR antigen(HLA-DR^(+)/CD14^(+))level in the prognosis evaluation of severe acute pancreatitis(SAP).Methods Ninety-seven patients with SAP admitted in this hospital from February 2016 to February 2018 were divided into the good prognosis group(46 cases)and poor prognosis group(51 cases)according to the prognosis outcomes of the patients.Blood calcium,oxygenation index(PaO2/FiO2),urea nitrogen,creatinine,acute physiology and chronic health evaluation(APACHEⅡ)score,bedside index of severity in acute pancreatitis(BISAP)score and Ranson score were collected.The level of HLA-DR^(+)/CD14^(+)in peripheral blood was detected by flow cytometry and the correlation analysis was performed.The risk factors of poor prognosis were analyzed by logistic regression.Results The levels of serum urea nitrogen,creatinine,APACHEⅡscore,BISAP score and Ranson score in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05),while the levels of serum calcium,PaO2/FiO2 and HLA-DR^(+)/CD14^(+)were significantly lower than those in the good prognosis group(P<0.05).The level of HLA-DR^(+)/CD14^(+)in peripheral blood was negatively correlated with the creatinine level,APACHEⅡscore,BISAP score and Ranson score(P<0.05).High BISAP score,high APACHEⅡscore and low HLA-DR^(+)/CD14^(+)level were the risk factors affecting the poor prognosis occurrence in SAP patients.The area under the curve of peripheral blood HLA-DR^(+)/CD14^(+)for predicting the adverse prognosis of SAP was 0.896,the sensitivity was 84.30%,and the specificity was 84.80%.Conclusion The level of peripheral blood HLA-DR^(+)/CD14^(+)in SAP patients with poor prognosis is significantly reduced,which may serve as a indicator for the prognosis evaluation.