血清α-MSH和MCP-1对急性胰腺炎严重程度早期评估及预后的预测价值

Predictive value of serum α-MSH and MCP-1 in early assessment and prognosis of acute pancreatitis severity

目的 研究血清α-黑色素细胞刺激素(α-MSH)和单核细胞趋化蛋白1(MCP-1)对急性胰腺炎(AP)严重程度早期评估及预后的预测价值。方法 选取2019年12月—2021年12月合肥市第二人民医院/安徽医科大学附属合肥医院急诊科诊治AP患者117例,入院时根据病情严重程度分为轻型胰腺炎(MAP)45例、中度重症胰腺炎(MSAP)38例、重症胰腺炎(SAP)34例,并根据28 d内病死情况分为病死组11例与生存组106例。检测并比较不同严重程度及不同预后AP患者血清α-MSH、MCP-1水平,Spearman分析血清α-MSH、MCP-1与AP严重程度的相关性,Logistic回归分析AP患者预后的影响因素,受试者工作特征曲线(ROC)分析血清α-MSH、MCP-1对AP患者预后的预测价值。结果 病死组入院当天胸腔积液占比、SAP占比高于生存组(χ~2/P=4.193/0.041、2.691/0.007);病死组血清α-MSH水平低于生存组,MCP-1水平高于生存组(t/P=12.072/<0.001、6.390/<0.001);血清α-MSH水平比较,MAP>MSAP>SAP(F/P=261.462/<0.001),而MCP-1水平比较,MAP<MSAP<SAP(F/P=128.199/<0.001)。经Spearman相关性分析,血清α-MSH水平与AP严重程度呈负相关(r=-0.415,P=0.021),MCP-1与AP严重程度呈正相关(r=0.520,P=0.017)。经Logistic回归分析显示,入院当天有胸腔积液、病情严重程度重及血清α-MSH低、MCP-1高是AP患者预后的危险因素[OR(95%CI)=4.768(2.075~10.959)、4.162 (1.811~9.565)、3.747(1.630~8.612)、4.289(1.866~9.857)]。血清α-MSH、MCP-1及二者联合预测AP患者预后的AUC分别为0.843、0.880、0.956,二者联合预测AP患者预后的效能优于单项预测(Z=2.495、1.981,P=0.029、0.047)。结论 血清α-MSH、MCP-1水平与AP严重程度密切相关,且对预后具有一定预测价值。

Objective To investigate the predictive value of serum α-melanocyte-stimulating hormone(α-MSH) and monocyte chemoattractant protein-1(MCP-1) in the early assessment and prognosis of acute pancreatitis(AP) severity.Methods From December 2019 to December 2021,117 patients with AP were diagnosed and treated in the Emergency Department of Hefei Second People’s Hospital/Hefei Hospital Affiliated to Anhui Medical University.They were divided into mild pancreatitis(MAP) 45 cases,moderate There were 38 cases of severe pancreatitis(MSAP) and 34 cases of severe pancreatitis(SAP),and they were divided into a death group of 11 cases and a survival group of 106 cases according to the death situation within 28 days.The levels of serum-α MSH and MCP-1 in AS patients with different severity and different prognosis were detected and compared,the correlation between serum α-MSH and MCP-1 and the severity was analyzed by Spearman,the influencing factors of the prognosis of AS patients,and receiver operating characteristic curve were analyzed by Logistic regression.(ROC) analysis of the predictive value of serum α-MSH and MCP-1 on the prognosis of AS patients.Results The proportion of pleural effusion and SAP on the day of admission in the death group were higher than those in the survival group(χ~2/P=4.193/0.041,2.691/0.007).Serum level of α-MSH in death group was lower than survial group,and MCP-1 was higher than survival group(t/P=12.072/MSAP>SAP,while MCP-1 levels were compared,MAP<MSAP<SAP(F/P=261.462/<0.001,128.199/<0.001).According to Spearman correlation analysis,serum α-MSH level was negatively correlated with AP severity(r=-0.415,P=0.021),and MCP-1 was positively correlated with AP severity(r=0.520,P=0.017).Logistic regression analysis showed that pleural effusion on the day of admission,more severe disease severity,low serum α-MSH,and high MCP-1 were risk factors for the prognosis of AP patients [OR(95%CI)=4.768(2.075-10.959),4.162(1.811-9.565),3.747(1.630-8.612),4.289(1.866-9.857)].The AUCs of serum α-MSH,MCP-1 and their combination in predicting the prognosis of AP patients were 0.843,0.880,and 0.956,and the combined effect of the two in predicting the prognosis of AP patients was better than single prediction(Z=2.495,1.981,P=0.029,0.047).Conclusion Serum α-MSH and MCP-1 levels are closely related to the severity of AP,and have certain predictive value for prognosis.