血清Hcy、TNF-α及sIL-2R水平与急性胰腺炎患者病情严重程度及预后的关系

Relationship between serum Hcy,TNF⁃αand sIL⁃2R levels and the severity and prognosis of acute pancreatitis patients

目的 分析血清同型半胱氨酸(HCY)、肿瘤坏死因子-α(TNF-α)及可溶性白细胞介素2受体(sIL-2R)水平与急性胰腺炎(AP)患者病情严重程度及预后的关系。方法 选取2020年3月至2022年3月黑龙江省铁力市人民医院收治的107例AP患者设为观察组。根据病情严重程度分为轻症组(轻症急性胰腺炎)86例及重症组(重症急性胰腺炎)21例。另选取本院同期健康体检者52名为对照组。比较不同人群、观察组不同病情程度血清Hcy、TNF-α、sIL-2R水平及BISAP评分,采用Pearson相关性分析血清Hcy、TNF-α、sIL-2R水平与BISAP评分的关系。比较重症组不同预后情况一般资料及血清Hcy、TNF-α、sIL-2R水平。采用二元Logistic回归分析重症组患者预后不良的危险因素。结果观察组血清Hcy、TNF-α、sIL-2R水平高于对照组,差异具有统计学意义(P<0.05);观察组中重症组Hcy、TNF-α、sIL-2R水平及BISAP评分均显著高于轻症组,差异有统计学意义(P<0.05)。经Pearson直线相关性分析得:Hcy、TNF-α、sIL-2R水平与BISAP评分呈正相关(P<0.05)。预后良好组16例,预后不良组5例。两组性别、年龄、发病至入院时间、甘油三酯、白细胞计数、血小板计数比较差异无统计学意义(P>0.05)。两组血肌酐、C反应蛋白、尿素氮、BISAP评分、Hcy、TNF-α、sIL-2R水平比较差异具有统计学意义(P<0.05)。以是否预后不良为因变量,将单因素分析中具有统计学意义的变量纳入二元Logistic回归模型进一步分析,结果显示血肌酐>133μmol/L、C反应蛋白>10 mg/L、尿素氮>7.1 mmol/L、BISAP评分>3分、Hcy≥15μmol/L、TNF-α>8.1 pg/mL、sIL-2R>296 U/mL是影响AP患者预后不良的危险因素(P<0.05)。结论 血清Hcy、TNF-α及sIL-2R与急性胰腺炎患者病情严重程度及预后关系密切相关,通过检测上述指标可尽早评估患者病情进展及预后,三指标可为指导临床制定干预措施提供依据。

Objective To analyze the relationship between serum homocysteine(HCY),tumor necrosis factor-α(TNF-α)and soluble interleukin-2 receptor(SIL2R)levels and the severity and prognosis of acute pancreatitis(AP)patients.Methods 107 AP patients admitted to Tieli People's Hospital of Heilongjiang Province from March 2020 to March 2022 were selected as observation group.According to the severity of the disease,they were classified into the mild group of 86 cases(mild acute pancreatitis)and the severe group of 21 cases(severe acute pancreatitis).In addition,52 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group.The serum levels of Hcy,TNF-α,sIL-2R and BISAP score were compared among different populations and observation groups with different disease degrees.Pearson correlation was used to analyze the relationship between serum levels of Hcy,TNF-α,sIL-2R and BISAP score.The general information of different prognosis and serum levels of Hcy,TNF-αand sIL-2R in the severe group were compared.The risk factors of poor prognosis were analyzed by binary Logistic regression.Results Serum Hcy,TNF-α,sIL-2R levels in the observation group were higher than those in the control group,the difference was statistically significant(P<0.05).The levels of Hcy,TNF-α,sIL-2R and BISAP scores in the severe group were significantly higher than those in the mild group,and the difference was statistically significant(P<0.05).Pearson linear correlation analysis showed that the levels of Hcy,TNF-αand sIL-2R were positively correlated with BISAP score(P<0.05).There were 61 cases in the good prognosis group and 5 cases in the poor prognosis group.There were no significant differences in gender,age,time from onset to admission,triglyceride,white blood cell count,and platelet count between the two groups(P>0.05).There were statistically significant differences in serum creatinine,C-reactive protein,urea nitrogen,BISAP score,Hcy,TNF-αand sIL-2R levels between the two groups(P<0.05).The results showed that serum creatinine>133μmol/L,C-reactive protein>10 mg/L,urea nitrogen>7.1 mmol/L,BISAP score>3,Hcy≥15μmol/L,TNF-α>8.1 pg/mL,sIL-2R>296 U/mL were the risk factors affecting the prognosis of AP patients(P<0.05).Conclusion Serum Hcy,TNF-αand sIL-2R are closely related to the severity and prognosis of patients with acute pancreatitis,and the detection of these indicators can evaluate the progression and prognosis of patients as early as possible,and the three indicators can provide evidence for clinical intervention.