血清LXA4、Card9、PTX-3水平在重症急性胰腺炎患者中的变化及对并发MODS预测价值

Changes of serum LXA4,Card9 and PTX-3 in patients with severe acute pancreatitis and their predictive value for complicated MODS

目的探讨血清脂氧素A4(LXA4)、胱天蛋白酶募集域蛋白9(Card9)、穿透素3(PTX-3)表达水平在重症急性胰腺炎(SAP)患者中的变化及对并发多器官功能障碍综合征(MODS)的预测价值。方法选取2018年1月-2020年10月陕西省商洛职业技术学院附属医院和兵器工业五二一医院收治的99例急性胰腺炎患者,根据严重程度分为非重症组(n=60)和重症组(SAP组)(n=39),比较两组血清LXA4、Card9、PTX-3水平,Pearson相关性分析血清LXA4、Card9、PTX-3水平与SAP患者临床资料的相关性;根据SAP患者是否并发MODS分为MODS组(n=28)和非MODS组(n=11),受试者工作特征(ROC)曲线分析LXA4、Card9、PTX-3对于SAP患者并发MODS的预测价值。结果非重症组与重症组患者性别、年龄、白细胞计数、血钙、病因比较差异无统计学意义(P>0.05);重症组C反应蛋白(CRP)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、急性生理学与慢性健康状况评分(APACHEⅡ)、Ranson评分均显著高于非重症组,急性胰腺炎严重程度床边指数评分(BISAP)显著低于非重症组,差异有统计学意义(P<0.05)。重症组血清PTX-3及Card9相对表达水平显著高于非重症组,LXA4水平明显低于非重症组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,血清LXA4、Card9、PTX-3分别与APACHEⅡ、BISAP、Ranson评分、CRP存在显著相关性(P<0.05),与其他指标无显著相关性(P>0.05)。血清LXA4、Card9、PTX-3及三者联合用于诊断SAP患者并发MODS的ROC曲线下面积分别为0.713(95%CI:0.622~0.803)、0.877(95%CI:0.820~0.935)、0.850(95%CI:0.777~0.924)、0.936(95%CI:0.897~0.974)。结论血清LXA4、Card9、PTX-3水平在SAP患者病情评估及预测SAP并发MODS中具有较好的临床价值。

Objective To investigate the changes of serum lipoxin A4(LXA4),caspase recruitment domain containing protein 9(Card9),and pentraxin 3(PTX-3)in patients with severe acute pancreatitis(SAP)and their predictive value of multiple organ dysfunction syndrome(MODS).Methods 99 cases of acute pancreatitis in Affiliated Hospital of Shangluo Vocational and Technical College of Shaanxi Province and 521 Hospital of Norinco Group from January 2018 to October 2020 were selected and divided into non-severe group(n=60)and severe group(SAP group)(n=39)according to their severity-Serum levels of LXA4,Card9 and PTX-3 were compared between the two groups.Pearson correlation was used to analyze the correlation between serum LXA4,Card9,PTX-3 and clinical data of SAP patients;according to whether SAP patients were complicated with MODS,they were divided into MODS group(n=28)and non-MODS group(n=11),receiver operating characteristic(ROC)curve analysis of the predictive value of LXA4,Card9,PTX-3 for SAP patients with MODS.Results There was no significant difference in gender,age,white blood cell count,blood calcium,etiology between the non-severe group and the severe group(P>0.05).The C-reactive protein(CRP),lactate dehydrogenase(LDH),aspartate aminotransferase(AST),acute physiology and chronic health evaluation score(APACHEⅡ)score,Ranson scores of the severe group were significantly higher than those of the non-severe group,and the bedside index for severity in acute pancreatitis(BISAP)score was significantly lower than that of the non-severe group,the difference was statistically significant(P<0.05).The relative expression levels of serum PTX-3 and Card9 in the severe group were significantly higher than those of the non-severe group,and the level of LXA4 was significantly lower than that of the non-severe group.The differences between the two groups were statistically significant(P<0.05).Pearson correlation analysis showed that serum LXA4,Card9,PTX-3 were significantly correlated with APACHEⅡ,BISAP,Ranson score and CRP(P<0.05),but there was no significant correlation with other indicators(P>0.05).The AUC of the ROC curve of serum LXA4,Card9,PTX-3 and the combination of the three for the diagnosis of SAP patients with MODS were 0.713(95%CI:0.622-0.803),0.877(95%CI:0.820-0.935),0.850(95%CI:0.777-0.924)and 0.936(95%CI:0.897-0.974),respectively.Conclusion Serum LXA4,Card9 and PTX-3 had good clinical value in assessing the condition of SAP patients and predicting SAP complicated with MODS.