急性胰腺炎患者外周血细胞焦亡相关因子表达及与预后的关系研究

Study on the expression of pyrolysis-related factors in peripheral blood of patients with acute pancreatitis and its relationship with prognosis

目的检测急性胰腺炎(AP)患者血清细胞焦亡相关因子核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体、半胱氨酸天冬氨酸蛋白酶-1(Caspase-1)、白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)水平,并探讨其与AP患者病情严重程度及预后的关系。方法选取2020年4月—2021年2月于本院住院治疗的264例AP患者为研究对象,根据严重程度将其分为重症AP(SAP)组86例、中重症AP(MSAP)组89例和轻症AP(MAP)组89例,根据SAP患者和MSAP患者28 d生存情况将其分为生存组145例和死亡组30例。采用酶联免疫吸附(ELISA)法检测血清细胞焦亡相关因子NLRP3、Caspase-1、IL-1β、IL-18水平,采用多因素Logistic回归分析影响AP患者预后的因素。结果SAP组血清NLRP3、Caspase-1、IL-1β、IL-18水平均高于MSAP组和MAP组,MSAP组血清NLRP3、Caspase-1、IL-1β、IL-18水平均高于MAP组(P<0.05)。死亡组血清NLRP3、Caspase-1、IL-1β、IL-18水平及APACHEⅡ评分均高于生存组(P<0.05)。死亡患者血清NLRP3、Caspase-1、IL-1β、IL-18水平与APACHEⅡ评分呈正相关关系(P<0.05)。血清NLRP3、Caspase-1、IL-1β、IL-18水平及四者联合预测AP患者预后的曲线下面积(AUC)分别为0.902、0.870、0.869、0.894、0.986,特异度分别为88.3%、89.7%、89.0%、86.2%、98.6%,敏感度分别为80.0%、80.0%、76.7%、76.7%、80.0%。NLRP3、Caspase-1是影响AP患者死亡的独立危险因素(P<0.05)。结论血清细胞焦亡相关因子NLRP3、Caspase-1、IL-1β、IL-18水平与AP患者病情严重程度有关,且可作为早期预测AP患者预后的良好参考指标。

Objective To detect the serum NLR family pyrin domain containing 3(NLRP3),cysteine aspartate specific protease-1(Caspase-1),interleukin-1β(IL-1β),interleukin-18(IL-18)levels in patients with acute pancreatitis(AP),and explore their relationship with the severity and prognosis of AP patients.Methods A total of 264 AP patients who were hospitalized in our hospital from April 2020 to February 2021 were selected as the research objects,and they were divided into 86 cases in the severe AP(SAP)group,89 cases in the moderate and severe AP(MSAP)group,and 89 cases in the mild AP(MAP)group according to their severity.According to the 28-day survival status of SAP patients and MSAP patients,they were divided into 145 cases in survival group and 30 cases in death group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of serum pyrolysis-related factors NLRP3,Caspase-1,IL-1β,and IL-18.Multivariate Logistic regression was used to analyze the factors affecting the prognosis of AP patients.Results The levels of serum NLRP3,Caspase-1,IL-1β,and IL-18 in the SAP group were higher than those in the MSAP group and the MAP group,and the levels of serum NLRP3,Caspase-1,IL-1β,and IL-18 in the MSAP group were higher than those in the MAP group(P<0.05).Serum levels of NLRP3,Caspase-1,IL-1β,IL-18 and APACHE II score in the death group were higher than those in the survival group(P<0.05).The serum NLRP3,Caspase-1,IL-1β,and IL-18 levels of the dead patients were positively correlated with the APACHEⅡscore(P<0.05).The area under the curve(AUC)of serum NLRP3,Caspase-1,IL-1β,IL-18 levels and the combination of the four to predict the prognosis of AP patients was 0.902,0.870,0.869,0.894,0.986,respectively,and the specificity was 88.3%,89.7%,89.0%,86.2%,98.6%,the sensitivity was 80.0%,80.0%,76.7%,76.7%,80.0%,respectively.NLRP3 and Caspase-1 were independent risk factors affecting the death of AP patients(P<0.05).Conclusion The levels of serum pyrolysis-related factors NLRP3,Caspase-1,IL-1β,and IL-18 are related to the severity of the disease in AP patients,and can be used as good reference indexes for early prediction of the prognosis of AP patients.