血清可溶性生长刺激表达基因2蛋白在预测急性胰腺炎严重程度及预后中的临床意义

Clinical value of serum inflammatory marker ST2 in predicting the severity and prognosis of acute pancreatitis

目的:探讨血清炎症标志物可溶性生长刺激表达基因2蛋白(sST2)与急性胰腺炎(AP)严重程度及预后的关系。方法:选取2018年1月—2020年11月在首都医科大学附属北京世纪坛医院诊治的203例AP患者(AP组),根据改良的Marshall评分进行器官功能衰竭评估,按AP严重程度分为轻度AP(MAP组)、中度AP(MSAP组)和重度AP(SAP组)。另选取100例我院健康体检者作为对照组。采用酶联免疫吸附法检测入院时、入院48 h后和缓解期(出院前24 h)血清sST2水平。结果:与对照组相比,AP患者血清干扰素(IFN-γ)、白细胞介素-2(IL-2)、IL-4、IL-13、IL-33、sST2水平均升高,差异有统计学意义(P<0.05)。然而只有血清sST2水平与疾病严重程度呈正相关(P<0.05)。入院时血清sST2水平预测SAP的受试者工作特征曲线下面积为0.940(95%CI:0.904~0.976)。血清sST2水平和急性生理与慢性健康评分Ⅱ(APACHEⅡ)、全身炎症反应综合征评分呈正相关(P<0.001)。经单因素和多因素logistic回归分析,入院时血清sST2>526.0 pg/mL是预测患者院内死亡的独立危险因素(P<0.05)。对于幸存的AP患者,与入院时相比,入院48 h、缓解期时血清sST2水平逐渐降低(P<0.001)。结论:血清sST2有可能成为AP诊断和监测疾病严重程度的候选生物标志物,同时也是患者院内死亡的独立预测因子。

Objective:To investigate the relationship between serum inflammatory marker soluble growth stimulation expression gene 2 protein(sST2)and severity and prognosis of acute pancreatitis(AP).Methods:A total of 203 patients with AP treated in our hospital from January 2018 to November 2020 were selected.According to the improved Marshall score,they were divided into mild AP(MAP)group,moderate AP(MSAP)group and severe AP(SAP)group.A healthy control group of 100 patients were selected from local hospital staff.Serum sST2 levels were detected by enzyme-linked immunosorbent assay at admission,48 hours after admission and in remission(24 hours before discharge).Results:Compared with healthy control group,serum levels of interferon-γ,interleukin-2(IL-2),IL-4,IL-13,IL-33 and sST2 were increased in AP patients(P<0.05).However,only serum sST2 levels were positively correlated with disease severity(P<0.05).The area under the receiver operating characteristic curve for predicting SAP by serum sST2 level at admission was 0.940(95%CI:0.904-0.976).There was positive correlation between serum sST2 level and acute physiology and chronic health scoreⅡ,systemic inflammatory response syndrome score(P<0.001).Univariate and multivariate logistic regression analysis showed that admission serum ST2>526.0 pg/mL was an independent risk factor for predicting in-hospital death(P<0.05).For the surviving AP patients,the level of serum sST2 decreased gradually at 48 hours of admission and remission compared with that at admission(P<0.001).Conclusion:sST2 may be a candidate biomarker for AP diagnosis and monitoring of disease severity,and it is also an independent predictor of in-hospital death.