核因子-κB信号通路相关因子在急性上消化道出血患者中的表达及相互关系

Expression and correlation of NF-κB signaling pathway related factors in patients with acute upper gastrointestinal bleeding

目的 评估血清核因子-κB(nuclear factor-κB,NF-κB)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein,CRP)水平在急性上消化道出血(acute upper gastrointestinal bleeding,AUGIB)诊断及病情严重程度评估中的应用价值。方法 选择2020年1月至2022年6月北京中西医结合医院和解放军总医院第一医学中心消化内科收治的AUGIB患者175例作为AUGIB组,同期于两家医院门诊体检的健康者100例作为对照组。比较两组血清NF-κB、IL-6、TNF-α和CRP的表达水平,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各指标诊断AUGIB及评估其病情严重程度的临床价值。结果 与对照组比较,AUGIB组患者血清NF-κB、IL-6、TNF-α和CRP水平均明显升高(P<0.05)。血清NF-κB、IL-6、TNF-α和CRP诊断AUGIB的ROC曲线下面积(area under the curve,AUC)分别为0.867(95%CI 0.821~0.905)、0.758(95%CI 0.703~0.808)、0.783(95%CI 0.729~0.830)和0.837(95%CI 0.788~0.879)。AUGIB患者血清NF-κB水平与IL-6、TNF-α、CRP水平呈正相关(P<0.05),血清NF-κB、IL-6、TNF-α、CRP水平与Rockall评分均呈正相关(P<0.05)。血清NF-κB、IL-6、TNF-α和CRP识别中高危AUGIB的AUC分别为0.694(95%CI 0.620~0.762)、0.77(95%CI 0.700~0.830)、0.688(95%CI 0.614~0.756)和0.711(95%CI 0.638~0.777)。结论 血清NF-κB通路相关因子NF-κB、IL-6、TNF-α和CRP水平升高与AUGIB患者病情严重程度有关,对AUGIB的临床诊断和病情严重程度评估具有一定价值。

Objective The aim of this study was to assess the predictive value of serum NF-κB pathway-related factors nuclear factor(NF)-κB,interleukin(IL)-6,tumor necrosis factor(TNF)-αand C-reactive protein(CRP)levels on the diagnosis and extent of disease in patients with acute upper gastrointestinal bleeding(AUGIB).Method One hundred and seventy-five patients with AUGIB admitted to the Department of Gastroenterology of Beijing Hospital of Integrated Traditional Chinese and Western Medicine,and the First Medical Center of PLA General Hospital from January 2020 to June 2022 were selected as study subjects.One hundred healthy individuals who were physically examined at the outpatient clinic during the same period were randomly selected as the control group.The levels of NF-κB,IL-6,TNF-αand CRP were compared between the two groups.The specificity and sensitivity of each index for the differential diagnosis of the condition were assessed using the subject operating characteristic curve(ROC).Result Serum NF-κB,IL-6,TNF-αand CRP levels were all significantly higher in patients with AUGIB compared with controls(P<0.05).The AUC of serum NF-κB,IL-6,TNF-αand CRP levels diagnosed in AUGIB patients were 0.867(95%CI 0.821-0.905),0.758(95%CI 0.703-0.808),0.783(95%CI 0.729-0.830)and 0.837(95%CI 0.788-0.879).Serum NF-κB was significantly and positively correlated with IL-6,TNF-αand CRP levels in AUGIB patients(P<0.05).NF-κB,IL-6,TNF-αand CRP levels were significantly and positively correlated with Rockall score(P<0.05).The AUC of serum NF-κB levels identifying high-risk AUGIB patients were 0.694(95%CI 0.620-0.762),0.77(95%CI 0.700-0.830),0.688(95%CI 0.614-0.756)and 0.711(95%CI 0.638-0.777),respectively.Conclusion Elevated levels of serum NF-κB pathway-related factors NF-κB,IL-6,TNF-αand CRP were associated with the severity of disease in patients with AUGIB and are valuable for clinical diagnosis and identification of the severity of disease in AUGIB.