血清SFRP4对重症急性胰腺炎患者预后的预测价值

Predictive value of serum SFRP4 in patients with severe acute pancreatitis

目的探讨血清分泌型卷曲相关蛋白4(SFRP4)对重症急性胰腺炎(SAP)患者预后评估的价值.方法从GEO数据库下载正常对照组和急性胰腺炎组GSE77858基因芯片数据,通过GEO2R在线工具筛选差异表达基因(DEG),筛选出潜在因子SFRP4.收集2017年7月至2020年12月安徽省立医院收治的114例SAP患者根据预后结局分为预后良好组(68例)和预后不良组(46例).常规收集一般资料(性别、年龄、BMI、既往病史、病因)、血淀粉酶、CRP、肌酐、血钙、空腹血糖、血脂、SFRP4、氧合指数(PaO_(2)/FiO_(2))、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.单因素分析筛选潜在因素后进一步logistic回归分析不良预后发生危险因素,并进行ROC曲线评估诊断性能以及筛选最佳切点.结果1、预后不良组CRP、SFRP4、APACHEⅡ评分、BISAP评分明显高于预后良好组,PaO_(2)/FiO_(2)反之(均P<0.05);2、高SFRP4、高APACHEⅡ评分是影响SAP患者不良预后发生相对独立的危险因素;3、外周血SFR';4水平预测SAP不良预后发生的曲线下面积为0.862,敏感性83.4%,特异性89.6%,约登指数73.4%,对应的切点值为2.095 ng/ml4、SFRP4与APACHEⅡ评分高度相关(r=0.78,P<0.001).结论不良预后SAP患者外周血SFRP4水平明显升高,该值超过2.95 ng/ml可能作为预后不良评估指标.

Objective To investigate the prognostic value of serum secreted curl associated protein 4(SFRP4)in patients with severe acute pancreatitis(SAP).Methods The GSE77858 gene chip data of normal control group and acute pancreatitis group were downloaded from GEO database,and the differential expression gene(DEG)was screened by GEO2R online tool,and the potential factor SFRP4 was screened.A total of 114 PATIENTS with SAP admitted to Anhui Provincial Hospital from July 2017 to December 2O_(2)0 were divided into good prognosis group(68 cases)and bad prognosis group(46 cases)according to the outcome of prognosis.General data(gender,age,BMI,past medical history,etiology),serum amylase,CRP,creatinine,serum calcium,fasting glucose,lipid,SFRP4,oxygenation index(PaO_(2)/FiO_(2)),acute physiology and chronic health(APACHEⅡ)score,and acute pancreatitis severity bed index(BISAP)score were collected.The potential factors were screened by univariate analysis,and the risk factors of poor prognosis were analyzed by logistic regression.The diagnostic performance was evaluated by ROC curve and the best cut-off point was selected.Results 1.CRP,SFRP4,APACHEⅡ score and BISAP score in the poor prognosis group were significantly higher than those in the good prognosis group,while PaO_(2)/FiO_(2) was the same(all P<0.05).2.High SFRP4 and high APACHEⅡ score were relatively independent risk factors for poor prognosis in SAP patients;3.The area under the curve,sensitivity,specificity and Youdon index of peripheral blood SFRP4 level were 0.862,83.4%,89.6%and 73.4%,respectively.The corresponding cut-off point value was 2.095 ng/ml4.P<0.001;Conclusions The level of SFRP4 in peripheral blood with poor prognosis is significantly increased,and the value over 2.95ng/mL may be used as an indicator of poor prognosis.