重症急性胰腺炎患者血清SAA、CRP、ACE2水平变化及临床意义

Changes and clinical significance of serum serum amyloid A,C-reactive protein,and angiotensin-converting enzyme 2 in patients with severe acute pancreatitis

目的探讨重症急性胰腺炎(SAP)患者血清淀粉样蛋白(SAA)、C反应蛋白(CRP)、血管紧张素转化酶2(ACE2)水平变化及临床意义。方法选取2017年1月至2019年12月间西安大兴医院消化内科收治的92例SAP患者作为研究对象(SAP组),并纳入同期收治的45例轻中症急性胰腺炎患者(轻中症组)和45例体检健康者(对照组)进行研究。采集三组受检者的血清标本,检测并比较其SAA、CRP、ACE2水平,采用Pearson相关分析法分析SAA、CRP、ACE2水平与患者病情严重程度的相关性,绘制受试者工作特征曲线(ROC)评估各血清学检测指标诊断SAP的效能,并比较SAP继发感染者与非感染者血清学指标水平。结果SAP组和轻中症组患者的SAA、CRP水平分别为(376.58±90.11)mg/L、(40.11±8.12)mg/L和(201.56±48.24)mg/L、(25.12±5.22)mg/L,明显高于对照组的(7.08±0.99)mg/L、(3.71±1.01)mg/L,ACE2水平分别为(189.55±45.54)pg/mL和(266.23±78.24)pg/mL,明显低于对照组的(354.53±95.22)pg/mL,而SAP组患者的SAA、CRP明显高于轻中症组,ACE2明显低于轻中症组,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示:SAA、CRP与急性生理与慢性健康评分Ⅱ(APACHEⅡ)、早期预警评分(NEWS)均呈正相关(r=0.514、0.398,P<0.001;r=0.587、0.422,P<0.001),ACE2与APACHEⅡ呈负相关(r=-0.354,P<0.001);ROC曲线显示,SAA、CRP和ACE2及三者联合诊断SAP的AUC分别为0.886、0.923、0.512和0.981,联合诊断的敏感度均高于SAA、CRP、ACE2单项诊断结果,差异均有统计学意义(P<0.05);SAP合并感染者SAA、CRP水平分别为(494.12±88.25)mg/L、(52.54±8.56)mg/L,明显高于非感染者的(315.66±67.55)mg/L、(26.54±6.77)mg/L,ACE2水平为(164.85±41.05)pg/mL,明显低于非感染者的(288.36±69.25)pg/mL,差异均有统计学意义(P<0.05)。结论监测SAP患者血清SAA、CRP、ACE2水平有利于把握患者病情严重程度,预测其继发感染风险。

Objective To explore the changes and clinical significance of serum amyloid A(SAA),C-reac-tive protein(CRP),and angiotensin-converting enzyme 2(ACE2)in patients with severe acute pancreatitis(SAP).Methods Ninety-two patients with SAP admitted to Department of Gastroenterology,Xi'an Daxing Hospital between January 2017 and December 2019 were selected as the research subjects(SAP group),and 45 patients with mild-to-moderate acute pancreatitis(mild-to-moderate group)and 45 healthy subjects with physical examination(control group)during the same time period were included for study.Serum samples of the three groups of subjects were collected to detect and compare the levels of SAA,CRP and ACE2,and the correlation between SAA,CRP and ACE2 levels and disease severity of patients was analyzed by Pearson correlation analysis.Receiver operating characteristic curves(ROC)were drawn to evaluate the efficacy of serological test indexes in the diagnosis of SAP,and the levels of serological indexes were compared between SAP secondary infected patients and non-infected patients.Results The levels of SAA and CRP were(376.58±90.11)mg/L and(40.11±8.12)mg/L of SAP group and(201.56±48.24)mg/L and(25.12±5.22)mg/L of mild-to-moderate group,significantly higher than(7.08±0.99)mg/L and(3.71±1.01)mg/L of control group;the level of ACE2 were(189.55±45.54)pg/mL and(266.23±78.24)pg/mL,significantly lower than(354.53±95.22)pg/mL of control group;the SAA and CRP of SAP group were significantly higher than those of mild-to-moderate group,while the ACE2 was significantly lower than that of mild-to-moderate group;the differences were all statistically significant(P<0.05).Pearson correlation analysis showed that SAA and CRP were positively correlated with Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and National Early Warning Score(NEWS)(r=0.514,0.398,P<0.001;r=0.587,0.422,P<0.001),and ACE2 was negatively correlated with APACHEⅡ(r=-0.354,P<0.001).ROC curve showed that the AUC values of SAA,CRP,ACE2 and the combination of the three in the diagnosis of SAP were 0.886,0.923,0.512,and 0.981 respectively,and the sensitivity of combined diagnosis was higher than that of SAA,CRP or ACE2(P<0.05).The levels of SAA and CRP were(494.12±88.25)mg/L and(52.54±8.56)mg/L of patients with SAP complicated with infection,significantly higher than(315.66±67.55)mg/L and(26.54±6.77)mg/L of non-infected patients,while the ACE2 level was(164.85±41.05)pg/mL,significantly lower than(288.36±69.25)pg/mL of non-infected people(P<0.05).Conclusion Monitoring serum SAA,CRP,and ACE2 levels in patients with SAP is helpful to grasp the disease severity of patients and predict the risk of secondary infection.