血清连蛋白、闭锁连接蛋白-1、肿瘤坏死因子-α与急性胰腺炎严重程度的相关性

Correlation analysis of serum zonulin,ZO-1,TNF-αwith severity of acute pancreatitis

目的分析急性胰腺炎(AP)患者外周血中连蛋白(zonulin)、闭锁连接蛋白-1(ZO-1)、肿瘤坏死因子-α(TNF-α)与AP严重程度的相关性,以及预测中重度AP的价值。方法回顾性分析2020年6月至2022年1月期间安徽医科大学第二附属医院收治的115例AP患者的临床资料,分为轻度组69例、中重度组46例。检测所有患者入院后第1、3、7天的血清zonulin、ZO-1、TNF-α水平,比较两组间检验结果,将第1天的zonulin、ZO-1、TNF-α与急性生理与慢性健康状况(APACHEⅡ)评分进行相关性分析,分析各指标预测中重度AP的价值。结果中重度组AP患者的C反应蛋白(CRP)水平高于轻度组,差异有统计学意义(均P<0.05)。中重度组AP患者的zonulin、ZO-1、TNF-α水平在入院后第1、3、7天呈上升趋势,中重度组AP患者入院后第1、3、7天的zonulin、ZO-1、TNF-α水平均高于同时间点的轻度组,差异均有统计学意义(均P<0.05)。AP患者入院第1天时的APACHEⅡ评分与zonulin、ZO-1、TNF-α水平均呈正相关(r=0.736、0.552、0.621,均P<0.05)。zonulin预测中重度AP的曲线下面积(AUC)最高,为0.892,最佳阈值为2.075 pg/ml,zonulin灵敏度最高,为0.804,ZO-1的特异度最高,为0.926。以zonulin≥2.075 pg/ml、ZO-1≥399.4 ng/ml、TNF-α≥40.88 pg/ml为阈值,将三种指标联合,平行试验得到的灵敏度及特异度分别为0.976及0.710;系列试验得到的灵敏度及特异度分别为0.326及0.999。结论AP患者血清zonulin、ZO-1、TNF-α值与AP的病情严重程度具有相关性,zonulin、ZO-1、TNF-α对于中重度AP的预测具有一定的临床价值。

Objective To analyze the correlation between the severity of acute pancreatitis(AP)and the levels of zonulin,zonula occludens protein-1(ZO-1),tumor necrosis factor-α(TNF-α)in the peripheral blood of patients with acute pancreatitis(AP),and the value of predicting moderate and severe AP.Methods The clinical data of 115 AP patients admitted to the Second Affiliated Hospital of Anhui Medical University from June 2020 to January 2022 were retrospectively analyzed.They were divided into mild group(69 cases)and moderate severe group(46 cases).The blood levels of zonulin,ZO-1,and TNF-αwere measured for all patients on the 1st,3rd,and 7th day after admission,and the results of the two group tests were compared.The correlation between zonulin,ZO-1,TNF-αand Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores on the 1st day was and the value of various indicators for predicting moderate to severe AP were analyzed.Results The C-reactive protein(CRP)levels of AP patients in the moderate to severe group were higher than those in the mild group,and the difference was statistically significant(all P<0.05).The levels of zonulin,ZO-1,and TNF-αin AP patients in the moderate to severe group showed an upward trend on the 1st,3rd,and 7th days after admission.The levels of zonulin,ZO-1,and TNF-αin AP patients in the moderate to severe group were higher than those in the mild group at the same time point,and the differences were statistically significant(all P<0.05).The APACHEⅡscore of AP patients on the first day of admission was positively correlated with the levels of zonulin,ZO-1,and TNF-α(r=0.736,0.552,0.621,all P<0.05).Zonulin had the highest area under the curve(AUC)for predicting moderate to severe AP,at 0.892,with an optimal threshold of 2.075 pg/ml.Zonulin had the highest sensitivity,at 0.804,and ZO-1 had the highest specificity,at 0.926.Using zonulin≥2.075 pg/ml,ZO-1≥399.4 ng/ml,and TNF-α≥40.88 pg/ml as thresholds;the sensitivity and specificity obtained from parallel experiments were 0.976 and 0.710,respectively;The sensitivity and specificity obtained from the series of experiments were 0.326 and 0.999,respectively.Conclusions There is a correlation between the serum levels of zonulin,ZO-1,and TNF-αin AP patients and the severity of AP.Zonulin,ZO-1,and TNF-αhave certain clinical value in predicting moderate to severe AP.