血清HSP-70、IL-35水平对消化性溃疡患者并发上消化道出血的预测价值

The Predictive Value of Serum HSP-70 and IL-35 Levels for Upper Gastrointestinal Bleeding in Patients with Peptic Ulcer

目的 探究血清热休克蛋白-70(HSP-70)、白细胞介素-35(IL-35)水平对消化性溃疡(PU)患者并发上消化道出血(UGIB)的预测价值。方法 选取2021年6月至2023年3月在本院就诊的PU患者137例为研究组,根据是否并发UGIB分为并发UGIB组45例和未并发UGIB组92例,选取同期健康体检者60例为对照组。采用酶联免疫吸附法检测血清HSP-70、IL-35水平,收集PU患者一般资料和实验室指标血尿素氮、血红蛋白、血小板计数、凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(Fib)。采用Spearman相关系数分析PU患者血清HSP-70、IL-35与其他指标相关性;采用多因素Logistic回归分析PU患者并发UGIB的影响因素;采用受试者工作特征(ROC)曲线分析血清HSP-70、IL-35对PU患者并发UGIB的预测价值。结果 与对照组相比,研究组血清HSP-70水平显著升高,IL-35水平显著降低(P<0.05)。并发UGIB组使用NSAIDs、溃疡最大直径≥20mm、溃疡分期为活动期、Hp感染所占比例及HSP-70、APTT、PT、TT显著高于未并发UGIB组,IL-35、血红蛋白、Fib水平显著低于未并发UGIB组(P<0.05)。PU患者血清HSP-70、IL-35与使用NSAIDs、溃疡分期、Hp感染、血红蛋白、APTT、PT具有相关性(P<0.05)。使用NSAIDs、Hp感染、HSP-70、IL-35是PU患者并发UGIB的影响因素(P<0.05)。血清HSP-70、IL-35及联合预测PU患者并发UGIB的AUC分别为0.818、0.804、0.905,其中联合预测AUC显著高于二者单独预测(ZHSP-70=1.782,ZIL-35=2.069,P<0.05)。结论 PU并发UGIB患者血清HSP-70水平升高,IL-35降低,对PU并发UGIB具有一定的预测价值。

Objective To explore the predictive value of serum levels of heat shock protein 70(HSP-70)and interleukin 35(IL-35)in patients with peptic ulcer(PU)complicated with upper gastrointestinal bleeding(UGIB).Methods A total of 137 PU patients who visited our hospital from June,2021 to March,2023 were selected as the study group.According to whether there were concurrent UGIB,these patients were separated into two study groups:45 cases in the concurrent UGIB group and 92 cases in the non-concurrent UGIB group,while 60 healthy individuals who underwent physical examination were regarded as the control group.Enzyme-linked immunosorbent assay was applied to detect serum levels of HSP-70 and IL-35 in all study subjects.The general data and laboratory indexes of PU patients were collected,including blood urea nitrogen,hemoglobin,platelet count,activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT)and fibrinogen(Fib).Spearman correlation coefficient was calculated to analyze the correlation between serum HSP-70,IL-35 and other indicators in PU patients;Multivariate logistic regression was applied to analyze the influencing factors of concurrent UGIB in PU patients;Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum HSP-70 and IL-35 in PU patients with UGIB.Results Compared with the control group,levels of HSP-70,APTT,PT,TT in the study group were significantly increased,while IL-35,hemoglobin,Fib levels were significantly reduced(P<0.05).The proportions of use of NSAIDs,maximum ulcer diameter≥20mm,active ulcer staging,Hp infection,and the serum HSP-70 level in the concurrent UGIB group were significantly higher than those in the non-concurrent UGIB group,and the serum IL-35 level was significantly lower than that in the non-concurrent UGIB group(P<0.05).Serum HSP-70 and IL-35 levels in PU patients were correlated with use of NSAIDs,ulcer staging,Hp infection,hemoglobin,APTT,and PT(P<0.05).The use of NSAIDs,Hp infection,HSP-70,and IL-35 were influencing factors for the occurrence of UGIB in PU patients(P<0.05).AUCs of serum HSP-70,IL-35,and the combined prediction of UGIB in PU patients were 0.818,0.804,and 0.905,respectively,while the AUC of combined prediction was significantly higher than the individual prediction of either marker(Z HSP-70=1.782,Z IL-35=2.069,P<0.05).Conclusion Patients with PU complicated with UGIB have higher serum HSP-70 level and lower IL-35 level,which has certain predictive value for PU complicated with UGIB.