急性胰腺炎患者血TRAF6和NF-κB水平变化对胰外并发症急性肺损伤的预测价值

Predictive value of changes of blood TRAF6 and NF-κB levels in patients with acute pancreatitis for extrapancreatic complication acute lung injury

目的:探讨急性胰腺炎(acute pancreatitis,AP)患者血肿瘤坏死因子受体相关因子6(tumor necrosis factor receptor related factor 6,TRAF6)、核转录因子-κB(nuclear factor kappa B,NF-κB)水平变化对胰外并发症急性肺损伤(acute lung injury,ALI)的预测价值。方法:选取2021年8月—2023年3月在我院诊治的AP患者269例为研究组,选取同期健康体检者269例为对照组。两组均检测血清TRAF6、NF-κB水平。研究组根据《中国急性胰腺炎诊治指南(2021)》相关标准分为轻症AP(mild AP,MAP)和重症AP(severe SAP,SAP),并采用急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health status scoring systemⅡ,APACHEⅡ)评估患者病情程度,分析TRAF6、NF-κB与APACHEⅡ评分的相关性。统计研究组ALI发生率,对比不同发生时间的ALI患者TRAF6、NF-κB水平。分析继发ALI的影响因素。绘制受试者工作曲线(receiver operating curve,ROC)评估TRAF6、NF-κB预测ALI的价值。结果:研究组治疗前、治疗24 h血清TRAF6、NF-κB水平高于对照组(P<0.05)。研究组治疗24 h血清TRAF6、NF-κB水平低于治疗前(P<0.05)。MAP患者、SAP患者治疗24 h血清TRAF6、NF-κB水平及APACHEⅡ评分低于治疗前(P<0.05)。治疗前、治疗24 h SAP患者血清TRAF6、NF-κB水平及APACHEⅡ评分高于MAP患者(P<0.05)。治疗前TRAF6、NF-κB与APACHEⅡ评分呈正相关(P<0.05)。研究组269例患者中34例发生ALI,发生率为12.65%。≤24 h出现ALI患者的治疗前、治疗24 h TRAF6、NF-κB均高于>24 h出现ALI患者的水平(P<0.05)。调整混杂因素后治疗前TRAF6、NF-κB水平升高仍会增加AP患者ALI发生风险(P<0.05)。TRAF6、NF-κB联合评估AP患者发生ALI的AUC值大于单独评估值(P<0.05)。结论:AP患者血清TRAF6、NF-κB水平与病情程度呈正相关,且对预测ALI具有较高价值,且二者水平越高,继发ALI的时间越早。

Objective To investigate the predictive value of changes of blood tumor necrosis factor receptor related factor 6(TRAF6)and nuclear factor kappa B(NF-κB)levels in patients with acute pancreatitis(AP)for acute lung injury(ALI)caused by extrapancreatic complications.Methods A total of 269 AP patients diagnosed and treated in our hospital from August 2021 to March 2023 were selected as the study group,and 269 healthy subjects during the same period were selected as the control group.Serum TRAF6 and NF-κB levels were detected in both groups.The study group was divided into mild AP(MAP)and severe SAP(SAP)according to the Chinese Guidelines for Diagnosis and Treatment of Acute Pancreatitis(2021).The acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)was used to evaluate the severity of the disease,and the correlation of TRAF6,NF-κB and APACHEⅡscore was analyzed.The incidence of ALI in the study group was analyzed.The levels of TRAF6 and NF-κB in ALI patients with different onset time were compared.The influencing factors of secondary ALI were analyzed.Receiver operating curve(ROC)was plotted to evaluate the value of TRAF6 and NF-κB in predicting ALI.Results Serum TRAF6 and NF-κB levels in the study group were higher than those in the control group before treatment and within 24 h after treatment(P<0.05).The levels of serum TRAF6 and NF-κB in the study group at 24 h after treatment were lower than before treatment(P<0.05).Serum TRAF6,NF-κB levels and APACHEⅡscores in MAP and SAP patients were lower than before treatment at 24 h(P<0.05).Serum TRAF6,NF-κB levels and APACHEⅡscores in SAP patients were higher than those in MAP patients before treatment and 24 h after treatment(P<0.05).TRAF6,NF-κB were positively correlated with APACHEⅡscores(P<0.05).There was a positive correlation between TRAF6,NF-κB and APACHEⅡscores before treatment(P<0.05).ALI occurred in 34 of 269 patients in the study group(12.65%).The levels of TRAF6 and NF-κB in patients complicated with ALI within 24 h before treatment and 24 h after treatment were higher than those in patients with ALI>24 h(P<0.05).After adjusting for confounding factors,the elevated expression of TRAF6 and NF-κB before treatment still increased the risk of ALI occurrence in AP patients(P<0.05).The AUC value of ALI in AP patients assessed by combination of TRAF6 and NF-κB was higher than that assessed by each alone(P<0.05).Conclusion Serum levels of TRAF6 and NF-κB in AP patients are positively correlated with the severity of the disease,and they have great value in predicting ALI.The higher the level of both,the earlier the time of secondary ALI.