急性胰腺炎患者血清可溶性血管内皮生长因子受体-1、血管内皮生长因子A、肿瘤坏死因子α呈高表达

High expression of serum sFlt-1,vascular endothelial growth factor A and tumor necrosis factor-αin patients with acute pancreatitis

目的:探讨急性胰腺炎(AP)患者血清中可溶性血管内皮生长因子受体-1(sFlt-1)、血管内皮生长因子A(VEGFA)和肿瘤坏死因子α(TNF-α)的表达水平及其临床意义。方法:选取AP患者89例,均在发病24 h内就诊,其中轻型AP患者41例,重症AP患者48例,根据AP患者院内死亡情况,分为预后良好组79例和预后不良组10例。另选取同期健康体检者50例作为正常对照组。利用酶联免疫吸附法(ELISA)检测血清中sFlt-1、VEGFA和TNF-α表达水平;采用受试者工作特征(ROC)曲线分析血清中sFlt-1、VEGFA和TNF-α水平评估AP患者预后的价值。结果:起病第1天,AP患者血清sFlt-1、VEGFA和TNF-α水平高于正常对照组(P均<0.05),且重症AP患者上述3项高于轻型AP患者(P均<0.05);治疗第3、5和7天,轻型AP患者和重症AP患者血清sFlt-1、VEGFA和TNF-α水平呈逐渐降低趋势(P均<0.05)。预后不良AP患者入院时sFlt-1、TNF-α、VEGFA水平显著高于预后良好患者(P均<0.05)。ROC曲线显示,入院时血清sFlt-1、TNF-α和VEGFA水平预测AP患者预后不良的曲线下面积(AUC)分别为0.728(0.634~0.810)、0.753(0.660~0.831)和0.736(0.642~0.816);三者联合预测的AUC为0.868(0.789~0.926),联合预测效果显著优于各单项预测效果(P均<0.05)。结论:AP患者血清中sFlt-1、VEGFA、TNF-α呈高表达,与疾病严重程度有关,治疗后上述各指标水平逐渐降低,且三者联合检测对患者预后不良具有一定预测价值。

Objective:To investigate the expression levels and clinical significance of soluble vascular endothelial growth factor receptor-1(sFlt-1),vascular endothelial growth factor A(VEGFA)and tumor necrosis factor-α(TNF-α)in serum of patients with acute pancreatitis(AP).Methods:A total of 89 patients with AP were selected,all of whom were treated within 24 h of onset,including 41 mild AP patients and 48 severe AP patients.According to the in-hospital death of AP patients,they were divided into 79 cases in the good prognosis group and 10 cases in the poor prognosis group.In addition,50 healthy subjects in the same period were selected as the normal control group.The expression levels of sFlt-1,VEGFA and TNF-αin serum were detected by enzyme linked immunosorbent assay(ELISA).The receiver operating characteristic(ROC)curve was used to analyze the value of serum sFlt-1,VEGFA and TNF-αlevel in the prognosis of patients with AP.Results:On the first day of onset,the levels of serum sFlt-1,VEGFA and TNF-αin patients with AP were higher than those in normal control group(P<0.05),and the above three items in patients with severe AP were higher than those in patients with mild AP(P<0.05);the levels of serum sFlt-1,VEGFA and TNF-αdecreased gradually in mild AP patients and severe AP patients on the 3 rd,5 th and 7 th day of treatment.The levels of sFlt-1,TNF-αand VEGFA in AP patients with poor prognosis were significantly higher than those in patients with good prognosis(P<0.05).The ROC curve showed that the area under the curve(AUC)of serum sFlt-1,TNF-αand VEGFA at admission in predicting poor prognosis of AP patients was 0.728(0.634-0.810),0.753(0.660-0.831)and 0.736(0.642-0.816),respectively.The AUC of the combined prediction of serum sFlt-1,TNF-αand VEGFA was 0.868(0.789-0.926),and the combined prediction effect was significantly better than that of each prediction effect(P<0.05).Conclusion:The high expression of sFlt-1,VEGFA and TNF-αin the serum of patients with AP is related to the severity of the disease.The levels of the above indicators gradually decrease after treatment,and the combined detection of the three indicators has a certain predictive value for the poor prognosis of patients.