TAM蛋白酪氨酸激酶受体及其配体评估急性胰腺炎严重程度的临床价值

Clinical value of TAM receptor tyrosine kinase and ligands in evaluating disease severity of acute pancreatitis

目的探讨Tyro3/Axl/Mertk(TAM)蛋白酪氨酸激酶受体及其配体预测AP严重程度的临床价值。方法前瞻性收集2020年2月至2022年7月间上海市第一人民医院消化内科收治的27例AP患者外周血标本及临床资料,根据2012年修订版急性胰腺炎亚特兰大分类指南将患者分为MAP组(13例)、MSAP组(10例)和SAP组(4例),另选10名健康体检者血清为正常对照组。记录患者的一般资料、生物化学分析指标及血细胞分析指标,采用ELISA法检测各组血清Gas6、蛋白S以及游离sAxl水平。采用线性回归方程分析血清Gas6、蛋白S、sAxl水平与各组患者白细胞计数、中性粒细胞百分比、淋巴细胞百分比、单核细胞百分比的相关性,评估Gas6、蛋白S及sAxl对预测AP患者病情严重程度的临床价值。结果与对照组比较,AP组血清Gas6水平[(31.3±13.0)ng/ml比(21.2±2.6)ng/ml]、蛋白S水平[(24.4±11.3)μg/ml比(17.7±3.4)μg/ml]、sAxl水平[(9.0±4.4)ng/ml比(6.6±1.3)ng/ml]均显著升高,且SAP组Gas6水平(54.1±13.7 ng/ml)显著高于MAP组(31.0±9.4 ng/ml)和MSAP组(25.2±8.9 ng/ml),差异均有统计学意义(P值均<0.05)。Gas6水平与AP患者血清白细胞计数(r=0.173)及中性粒细胞百分比(r=0.442)呈显著正相关,与淋巴细胞百分比(r=-0.363)呈显著负相关,差异均有统计学意义(P值均<0.05);蛋白S水平、sAXL水平与AP患者血清白细胞计数及中性粒细胞百分比呈正相关,与淋巴细胞百分比及单核细胞百分比呈负相关,但差异均无统计学意义。结论血清TAM蛋白酪氨酸激酶受体的配体Gas6水平随着AP严重程度分级升高而显著增加,对早期评估AP严重程度有较好的临床参考价值。

Objective To investigate the clinical value of Tyro3/Axl/Mertk(TAM)receptor tyrosine kinase and ligands in severity evaluation for acute pancreatitis(AP).Methods The peripheral blood and clinical data of 27 patients with AP admitted in the Department of Gastroenterology of Shanghai General Hospital from February 2020 to July 2022 were prospectively selected.The patients were divided in to mild AP group(MAP,n=13),moderately severe AP(MSAP,n=10)and severe AP group(SAP,n=4)according to the 2012-revised Atlanta classification for AP.Another 10 healthy normal subjects were selected as the control group.The general information,biochemical indicators and blood cell analysis of the patients were recorded,and the levels of serum Gas6,protein S and soluble Axl(sAxl)were measured by ELISA.Linear regression equations were used to analyze the correlation of serum Gas6,protein S and sAxl levels with the white blood cell(WBC)counts,neutrophil percentages,lymphocyte percentages,and monocyte percentages of each group,and to assess the clinical value of Gas6,protein S and sAxl in predicting the severity of AP patients.Results Compared with the control group,the serum Gas6 level[(31.3±13.0)ng/ml vs(21.2±2.6)ng/ml],protein S level[(24.4±11.3)μg/ml vs(17.7±3.4)μg/ml],and sAxl level[(9.0±4.4)ng/ml vs(6.6±1.3)ng/ml]were significantly higher in the AP group.The Gas6 level was significantly higher in the SAP group(54.1±13.7 ng/ml)than in the MAP group(31.0±9.4 ng/ml)and the MSAP group(25.2±8.9 ng/ml),and the differences were statistically significant(all P value<0.05).The Gas6 level was significantly positively correlated with the WBC count(r=0.1733)and neutrophils percentage(r=0.4424),and negatively correlated with lymphocyte percentage(r=-0.363),with statistically significant differences(all P value<0.05).The levels of protein S and sAXL were positively correlated WBC count and neutrophil percentage,and negatively correlated with monocyte percentage and lymphocyte percentage,but the differences were not statistically significant.Conclusions The serum levels of Gas6 increase significantly with the severity grading of AP,which may serve as a relatively good predictor for the early severity assessment of AP.