重症急性胰腺炎继发感染的影响因素及PTEN mRNA和IL-8与ICAM-1的诊断价值

Influencing factors and the diagnostic value of PTEN mRNA,IL-8 and ICAM-1 in secondary infection from severe acute pancreatitis

目的探究重症急性胰腺炎继发感染的影响因素及血清磷酸酶及张力蛋白同源基因(PTEN)mRNA、白细胞介素(IL)-8、细胞间黏附分子-1(ICAM-1)水平的诊断价值。方法回顾性选取四川省成都市简阳市人民医院2019年6月-2022年12月收治的426例重症急性胰腺炎患者,根据是否继发感染分为感染组(181例)和非感染组(245例)。统计重症急性胰腺炎患者继发感染的现况;通过单因素及多因素分析法分析重症急性胰腺炎患者继发感染的危险因素;比较感染组和非感染组患者血清PTEN mRNA、IL-8、ICAM-1水平;采用受试者工作特征(ROC)曲线分析血清PTEN mRNA、IL-8、ICAM-1水平单一及联合检测对重症急性胰腺炎患者继发感染的诊断价值。结果多因素Logistic分析结果显示,禁食时间>3 d、有机械通气、急性生理与慢性健康评分(APACHEⅡ)高是重症急性胰腺炎患者继发感染的危险因素(P<0.05);感染组血清PTEN mRNA水平低于非感染组,而血清IL-8、ICAM-1水平均高于非感染组(P<0.05);血清PTEN mRNA、IL-8、ICAM-1水平联合检测诊断重症急性胰腺炎患者继发感染的AUC值高于单一检测(P<0.05),且联合检测的敏感度为86.19%,特异度为92.24%,诊断价值均较高。结论重症急性胰腺炎患者继发感染发生率较高,影响因素有禁食时间、有机械通气、APACHEⅡ评分;重症急性胰腺炎继发感染患者中PTEN水平呈低表达,IL-8、ICAM-1水平呈高表达,三者联合检测对重症急性胰腺炎患者继发感染的诊断价值高,临床可据此予以早期针对性防治措施从而降低重症急性胰腺炎患者继发感染的发生风险。

OBJECTIVE To investigate the influencing factors and the diagnostic value of serum levels of phosphatase and tensin homologous gene(PTEN)mRNA,interleukin(IL)-8 and intercellular adhesion molecule-1(ICAM-1)in secondary infection from severe acute pancreatitis.METHODS A total of 426 patients with severe acute pancreatitis admitted to Jianyang City People′s Hospital from Jun 2019 to Dec 2022 were retrospectively enrolled in the study.According to whether secondary infection occurred or not,they were divided into the infected group(181 cases)and the non-infected group(245 cases).The current status of secondary infection in patients with severe acute pancreatitis was counted.The risk factors for secondary infection in patients with severe acute pancreatitis were analyzed by univariate and multivariate analysis.Serum levels of PTEN mRNA,IL-8 and ICAM-1 were compared between the infected group and the non-infected group.The value of single and combined detection of serum PTEN mRNA,IL-8,ICAM-1 in the diagnosis of secondary infection from patients with severe acute pancreatitis was analyzed by receiver operating characteristic(ROC)curve.RESULTS Multivariate logistic analysis showed that fasting time>3 d,presence of mechanical ventilation,and high acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score were risk factors for secondary infection in patients with severe acute pancreatitis(P<0.05).The serum PTEN mRNA level in the infected group was lower than that in the non-infected group,and the serum IL-8 and ICAM-1 levels were higher than those in the non-infected group(P<0.05).The AUC value of serum PTEN mRNA,IL-8 and ICAM-1 combined detection in the diagnosis of secondary infection in patients with severe acute pancreatitis was higher than that of the individual detection(P<0.05),and the sensitivity and specificity of combined detection were 86.19% and 92.24%,respectively,with higher diagnostic value.CONCLUSION The incidence of secondary infection was higher in patients with severe acute pancreatitis,and the influencing factors were fasting time,mechanical ventilation and APACHEⅡ score.The level of PTEN in patients with secondary infection from severe acute pancreatitis is low,and the levels of IL-8 and ICAM-1 are high.The combined detection of these indexes have high diagnostic value for the secondary infection in patients with severe acute pancreatitis,and can be used for early targeted prevention and treatment in clinical practice,reducing the risk of secondary infection from patients with severe acute pancreatitis.