血清胃泌素、C反应蛋白和肿瘤坏死因子α与消化性溃疡出血程度的相关性分析

Correlation of serum gastrin,C-reactive protein and tumor necrosis factorαwith the degree of peptic ulcer bleeding

目的探讨血清胃泌素、C反应蛋白(CRP)和肿瘤坏死因子α(TNF-α)与消化性溃疡出血程度的相关性。方法回顾性分析浙江省医疗健康集团杭州医院2019年4月至2020年9月90例消化性溃疡出血患者(试验组)的临床资料,其中Blatchford评分低危15例,中危40例,高危35例;另外选取同期40例健康体检者作为对照组。采用酶联免疫吸附试验法检测血清CRP和TNF-α水平,放射免疫法检测血清胃泌素水平。采用Pearson法行CRP、TNF-α和胃泌素与Blatchford评分的相关性分析;采用多因素Logistic回归分析影响高危消化性溃疡出血的独立危险因素;采用受试者工作特征(ROC)曲线分析CRP、TNF-α和胃泌素预测高危消化性溃疡出血的价值。结果试验组CRP、TNF-α和胃泌素均明显高于对照组[(19.69 ± 3.41) mg/L比(2.28 ± 0.64) mg/L、(26.63 ± 4.24) ng/L比(1.35 ± 0.31) ng/L和(149.77 ± 21.41) μg/L比(72.65 ± 12.39) μg/L],差异有统计学意义(P<0.01)。中危和高危患者血红蛋白和血小板明显低于低危患者[(59.21 ± 4.63)和(28.94 ± 4.69) g/L比(89.68 ± 5.12) g/L、(162.14 ± 12.47)和(122.05 ± 10.39) × 109/L比(213.58 ± 16.98) × 109/L],高危患者明显低于中危患者,差异有统计学意义(P<0.05);中危和高危患者凝血酶原时间、CRP、TNF-α和胃泌素明显高于低危患者[(13.98 ± 1.29)和(16.97 ± 1.15)s比(11.00 ± 2.07)s、(18.87 ± 4.68)和(22.69 ± 2.96) mg/L比(15.45 ± 5.54) mg/L、(27.43 ± 5.05)和(31.02 ± 4.56) ng/L比(21.39 ± 8.54) ng/L、(140.89 ± 22.36)和(160.58 ± 25.52) μg/L比(121.39 ± 15.17) μg/L],高危患者明显高于中危患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血红蛋白、血小板、CRP、TNF-α和胃泌素为影响高危消化性溃疡出血的独立危险因素(OR = 0.224、0.321、3.687、3.058和4.051,95%CI 0.004~0.894、0.121~8.547、1.912~5.525、3.012~10.609和2.012~7.525,P<0.05或<0.01)。Pearson相关分析结果显示,CRP、TNF-α和胃泌素与Blatchford评分呈正相关(r = 0.501、0.526和0.542,P<0.01)。ROC曲线分析结果显示,CRP、TNF-α和胃泌素预测高危消化性溃疡出血的曲线下面积为0.890、0.825和0.901,最佳截断值为17.95 mg/L、22.16 ng/L和135.36 μg/L,灵敏度为97.14%、94.29%和82.86%,特异度为80.00%、66.67%和86.67%。结论 CRP、TNF-α和胃泌素与消化性溃疡出血程度具有一定的相关性,可以作为评估出血程度的指标。

Objective To investigate the correlation between serum gastrin,C-reactive protein(CRP),tumor necrosis factorα(TNF-α)and the degree of peptic ulcer bleeding.Methods The clinical data of 90 peptic ulcer bleeding patients(test group)from April 2019 to September 2020 in Hangzhou Hospital of Zhejiang Medical and Health Group were retrospectively analyzed,including 15 cases with low-risk,40 cases with intermediate-risk and 35 cases with high-risk of Blatchford score;40 physical examination volunteers were selected as the control group during the same period.The serum levels of CRP and TNF-αwere measured by enzyme-linked immunosorbent assay,and the serum level of gastrin was measured by radioimmunoassay.The correlation between CRP,TNF-α,gastrin and the Blatchford score was analyzed by Pearson method;the independent risk factors affecting high-risk peptic ulcer bleeding were analyzed by multivariate Logistic regression;the value of CRP,TNF-αand gastrin in predicting high-risk peptic ulcer bleeding was analyzed by the receiver operating characteristic(ROC)curve.Results The CRP,TNF-αand gastrin in test group were significantly higher than those in control group:(19.69±3.41)mg/L vs.(2.28±0.64)mg/L,(26.63±4.24)ng/L vs.(1.35±0.31)ng/L and(149.77±21.41)μg/L vs.(72.65±12.39)μg/L,and there were statistical differences(P<0.01).The hemoglobin and platelets in intermediate-risk and high-risk patients were significantly lower than those in low-risk patients:(59.21±4.63)and(28.94±4.69)g/L vs.(89.68±5.12)g/L,(162.14±12.47)and(122.05±10.39)×109/L vs.(213.58±16.98)×109/L,the indexes in high-risk patients were significantly lower than those in intermediate-risk patients,and there were statistical differences(P<0.05);the prothrombin time,CRP,TNF-αand gastrin in intermediate-risk and high-risk patients were significantly higher than those in low-risk patients:(13.98±1.29)and(16.97±1.15)s vs.(11.00±2.07)s,(18.87±4.68)and(22.69±2.96)mg/L vs.(15.45±5.54)mg/L,(27.43±5.05)and(31.02±4.56)ng/L vs.(21.39±8.54)ng/L,(140.89±22.36)and(160.58±25.52)μg/L vs.(121.39±15.17)μg/L,the indexes in high-risk patients were significantly higher than those in intermediate-risk patients,and there were statistical differences(P<0.05).Multivariate Logistic regression analysis result showed that hemoglobin,platelets,CRP,TNF-αand gastrin were independent risk factors for high-risk peptic ulcer bleeding(OR=0.224,0.321,3.687,3.058 and 4.051;95%CI 0.004 to 0.894,0.121 to 8.547,1.912 to 5.525,3.012 to 10.609 and 2.012 to 7.525;P<0.05 or<0.01).Pearson correlation analysis result showed that CRP,TNF-αand gastrin were positive correlation with the Blatchford score(r=0.501,0.526 and 0.542;P<0.01).ROC curve analysis result showed that the areas under the curve of CRP,TNF-αand gastrin for predicting high-risk peptic ulcer bleeding was 0.890,0.825 and 0.901,with optimal cut-off values of 17.95 mg/L,22.16 ng/L and 135.36μg/L,sensitivity of 97.14%,94.29%and 82.86%,and specificity of 80.00%,66.67%and 86.67%.Conclusions CRP,TNF-αand gastrin are correlated to the degree of peptic ulcer bleeding,and can be used as indexes to evaluate the bleeding degree of peptic ulcer.