外周血ICAM-1、LPS、sPD-L1对老年重症急性胰腺炎继发感染性胰腺坏死的预测价值

Predictive value of serum ICAM-1, LPS, and sPD-L1 for infectious pancreatic necrosis secondary to severe acute pancreatitis in elderly patients

目的 探究外周血细胞间黏附分子-1(ICAM-1)、脂肪酶(LPS)、可溶性程序死亡配体1(sPD-L1)对老年重症急性胰腺炎(SAP)继发感染性胰腺坏死(IPN)的预测价值。方法 选取我院2019年1月至2021年7月收治的45例老年SAP病人作为研究对象,根据住院4周内是否继发IPN分为IPN组(17例)与对照组(28例)。比较2组临床资料、外周血ICAM-1、LPS、sPD-L1水平,分析各外周血指标与Ranson评分、APACHEⅡ评分的相关性;采用相关分析和Logistic回归、ROC曲线分析外周血ICAM-1、LPS、sPD-L1与SAP继发IPN的关系及其预测SAP继发IPN的价值。结果 IPN组Ranson评分、APACHEⅡ评分,外周血ICAM-1、LPS、sPD-L1水平均高于对照组(P<0.05);Pearson相关性分析显示,外周血ICAM-1、LPS、sPD-L1水平与Ranson评分、APACHEⅡ评分呈正相关(P<0.05);Logistic回归分析显示,外周血ICAM-1、LPS、sPD-L1水平与SAP继发IPN独立相关(P<0.05);ROC曲线分析显示,外周血ICAM-1、LPS、sPD-L1单独预测SAP继发IPN的AUC分别为0.800、0.712、0.687,联合预测SAP继发IPN的AUC为0.876,95%CI为0.764~0.988,敏感度为76.47%,特异度为89.29%,明显高于三者单独预测价值。结论 外周血ICAM-1、LPS、sPD-L1与SAP病情严重程度显著相关,联合检测可作为预测SAP继发IPN的潜在途径,为临床及时制定防治措施提供依据。

Objective To investigate the predictive value of serum intercellular adhesion molecule-1(ICAM-1), lipase(LPS), and soluble programmed death ligand 1(sPD-L1) for infectious pancreatic necrosis(IPN) secondary to severe acute pancreatitis(SAP) in the elderly. Methods Forty-five elderly patients with SAP admitted to our hospital from January 2019 to July 2021 were selected and divided into observation group(17 cases) and control group(28 cases) according to whether they presented with secondary IPN within 4 weeks of hospitalization. The clinical data, serum levels of ICAM-1, LPS, and sPD-L1 of the two groups were compared, and the correlation between each peripheral blood index and Ranson score, Acute Physiological and Chronic Health Evaluation Ⅱ(APACHEⅡ) score was analyzed, and the relationship between serum ICAM-1, LPS, and sPD-L1 and secondary IPN of SAP was analyzed. The value of each peripheral blood index to predict IPN secondary to SAP was evaluated. Results In the observation group, Ranson score, APACHEⅡscore, serum levels of ICAM-1, LPS, and sPD-L1 were higher than those in the control group(P<0.05);Pearson correlation analysis showed that the serum levels of ICAM-1, LPS, and sPD-L1 were positively correlated with Ranson score and APACHEⅡ score(P<0.05);Logistic regression analysis showed that serum ICAM-1, LPS, and sPD-L1 were independently correlated with IPN secondary to SAP(P<0.05);Receiver operator characteristic curve analysis showed that the area under the curve(AUC) of serum ICAM-1, LPS, and sPD-L1 to predict IPN secondary to SAP was 0.800, 0.712, and 0.687, respectively. And the AUC of combination of serum ICAM-1, LPS, and sPD-L1 to predict IPN secondary to SAP was 0.876(95% CI: 0.764-0.988), with sensitivity of 76.47% and specificity of 89.29%, which was significantly higher than that of the three index alone. Conclusions Serum levels of ICAM-1, LPS, and sPD-L1 are significantly correlated with the severity of SAP, and the combined detection of the three indexes can be a potential way to predict secondary IPN.