血清CRP、WBC、IL-17及TGF-β_(1)水平对重症急性胰腺炎患者预后的评估价值研究

Study on the predictive value of serum CRP、WBC、IL-17 and TGF-β_(1) levels for the prognosis of patients with severe acute pancreatitis

目的探究血清C-反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-17(IL-17)、转化生长因子β_(1)(TGF-β_(1))水平对重症急性胰腺炎(SAP)患者预后的评估价值。方法选取2017年2月-2020年4月于宜昌市某医院诊治的112例SAP患者为SAP组,另选取该院同期诊治的轻度急性胰腺炎(MAP)、中度急性胰腺炎(MSAP)患者各40例,分别为MAP组、MSAP组。检测3组患者的血清CRP、WBC、IL-17及TGF-β_(1)水平,比较3组患者血清CRP、WBC、IL-17及TGF-β_(1)水平差异和随访3月时的不良预后发生情况,根据随访结果将SAP患者分为存活组及死亡组,比较存活组及死亡组患者的血清CRP、WBC、IL-17及TGF-β_(1)水平差异,利用受试者工作特征曲线(ROC)分析CRP、WBC、IL-17及TGF-β_(1)水平对SAP患者预后的预测价值。结果SAP组患者的血清CRP、WBC、IL-17及TGF-β_(1)水平均明显高于MSAP组和MAP组,MSAP组患者的血清CRP、WBC、IL-17及TGF-β_(1)水平也明显高于MAP组,差异均有统计学意义(P<0.05)。SAP组患者不良预后发生率为58.93%,明显高于MAP组的8.00%及MSAP组的27.50%,差异均有统计学意义(P<0.05)。生存组SAP患者血清CRP、WBC、IL-17及TGF-β_(1)水平明显低于死亡组,差异均有统计学意义(P<0.001)。ROC曲线分析结果显示,血清CRP、WBC、IL-17及TGF-β_(1)水平对SAP患者预后预测的截断值及曲线下面积(AUC)分别为(142.35 mg/L,0.734)、(27.11×10^(9)/L,0.870)、(326.69 pg/mL,0.736)、(110.41 pg/mL,0.884)。结论随着急性胰腺炎患者病情严重程度的增加,其血清CRP、WBC、IL-17及TGF-β_(1)水平均显著升高,尤其是SAP预后不良患者的血清CRP、WBC、IL-17及TGF-β_(1)水平升高明显,因此在临床上可利用上述指标对SAP患者进行预后预测。

Objective To investigate the predictive value of serum C-reactive protein(CRP),white blood cells(WBC),interleukin-17(IL-17),and transforming growth factorβ_(1)(TGF-β_(1))levels for the prognosis of patients with severe acute pancreatitis(SAP).Methods One hundred and twelve patients with SAP treated in a hospital in Yichang from February 2017 to April 2020 were selected as the SAP group,and another 40 patients with mild acute pancreatitis(MAP)and moderately severe acute pancreatitis(MSAP)treated in the same period in the hospital were selected as the MAP and MSAP groups,respectively.Serum CRP,WBC,IL-17 and TGF-β_(1) levels were measured in the three groups,and the differences in serum CRP,WBC,IL-17 and TGF-β_(1) levels between the three groups and the occurrence of adverse prognosis at the 3-month follow-up were compared,and SAP patients were divided into surviving and deceased groups according to the follow-up results.The differences in serum CRP,WBC,IL-17 and TGF-β_(1) levels between the surviving and deceased groups were compared,and the predictive value of CRP,WBC,IL-17 and TGF-β_(1) levels on the prognosis of SAP patients was analyzed using the receiver operating characteristic curve(ROC).Results The serum CRP,WBC,IL-17 and TGF-β_(1) levels of patients in the SAP group were significantly higher than those in the MSAP and MAP groups,and the serum CRP,WBC,IL-17 and TGF-β_(1) levels of patients in the MSAP group were also significantly higher than those in the MAP group,with statistically significant differences(P<0.05).In the SAP group,serum CRP,WBC,IL-17 and TGF-β_(1) levels were significantly lower in the surviving group than in the deceased group,with statistically significant differences(P<0.001).The results of ROC curve analysis showed that the cut-off values and AUC of serum CRP,WBC,IL-17 and TGF-β_(1) levels for prognosis prediction in SAP patients were(142.35 mg/L,0.734),(27.11×10^(9)/L,0.870),(326.69 pg/mL,0.736),and(110.41 pg/mL,0.884),respectively.Conclusion As the severity of AP patients increased,their serum CRP,WBC,IL-17 and TGF-β_(1) levels increased significantly,especially in patients with poor prognosis of SAP,so the above indexes can be used in clinical practice to predict the prognosis of SAP patients.