基于外周血可溶性T细胞免疫球蛋白黏蛋白3构建重症急性胰腺炎预测模型

Construction of prediction model of severe acute pancreatitis based on serum soluble T cell immunogloblulin and mucin domain-containing protein 3

目的探讨基于可溶性T细胞免疫球蛋白黏蛋白3(sTIM3)构建的模型对急性胰腺炎(AP)患者进展为重症急性胰腺炎(SAP)的预测价值。方法采用回顾性队列研究方法,选择2020年6月1日至2022年6月30日常州市第一人民医院和常州市第二人民医院收治的AP患者作为观察主体。根据AP患者住院期间病情进展情况,将轻症AP(MAP)及中度重症AP(MSAP)患者列为非SAP组,SAP患者列为SAP组。收集患者基本资料,入院48 h内血液生物学指标、外周血sTIM3水平、急性胰腺炎严重程度床旁指数(BISAP)评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、修正CT严重指数(MCTSI)评分,以及预后指标。采用多因素Logistic回归分析筛选AP患者住院期间进展为SAP的独立危险因素,并基于多因素分析结果及最小赤池信息标准(AIC)筛选出的最佳参数,构建基于sTIM3的SAP预测模型;绘制受试者工作特征曲线(ROC曲线),分析模型的预测效能。结果最终纳入99例AP患者,其中非SAP组80例,SAP组19例。与非SAP组比较,SAP组患者体质量指数(BMI)、饮酒史比例、心率(HR)、呼吸频率(RR)、白细胞计数(WBC)、红细胞计数(RBC)、C-反应蛋白(CRP)、丙氨酸转氨酶(ALT)、血肌酐(SCr)、降钙素原(PCT)、白细胞介素-6(IL-6)、sTIM3、BISAP评分、APACHEⅡ评分、MCTSI评分均明显升高,脉搏血氧饱和度(SpO_(2))、直接胆红素(DBil)、IL-10均明显下降;且SAP组患者重症监护病房(ICU)住院时间及总住院时间均较非SAP组明显延长〔ICU住院时间(d):1.0(0,1.5)比0(0,0),总住院时间(d):17.11±9.39比8.40±3.08,均P<0.01〕。多因素Logistic回归分析显示,HR〔优势比(OR)=1.059,95%可信区间(95%CI)为1.010~1.110,P=0.017〕、DBil(OR=0.981,95%CI为0.950~0.997,P=0.043)、sTIM3(OR=1.002,95%CI为1.001~1.003,P=0.027)是AP患者住院期间进展为SAP的独立危险因素;构建基于sTIM3的SAP预测模型:Logit(P)=-14.602+0.187×BMI+0.057×HR+0.006×CRP-0.020×DBil+0.002×sTIM3;ROC曲线分析显示,单因素定量指标中以IL-6预测AP患者住院期间进展为SAP的效能最佳,但基于sTIM3模型的预测效能明显优于IL-6〔ROC曲线下面积(AUC)及95%CI:0.957(0.913~1.000)比0.902(0.845~0.958),P<0.05〕。结论基于sTIM3构建的模型对于AP患者住院期间进展为SAP有较好的预测价值。

Objective To investigate the predictive value of the model based on soluble T cell immunogloblulin and mucin domain-containing protein 3(sTIM3)for the progression of severe acute pancreatitis(SAP)in patients with acute pancreatitis(AP).Methods A retrospective cohort study was conducted.The AP patients admitted to Changzhou First People's Hospital and Changzhou Second People's Hospital from June 1,2020 to June 30,2022 were enrolled.Mild AP(MAP)and moderately severe AP(MSAP)patients were classified as non-SAP group,and SAP patients were classified as SAP group according to the progression of AP patients during hospitalization.The basic data,blood biological indicators,serum sTIM3 level,bedside index for severity in acute pancreatitis(BISAP),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,modified computed tomography severity index(MCTSI)score within 48 hours of admission,and prognosis indicators were collected.Multivariate Logistic regression analysis was conducted to analyze the risk factors of the progression of SAP in patients with AP during hospitalization.Based on the results of multivariate analysis and the best parameters selected based on the minimal Akaike information criterion(AIC),the SAP prediction model based on sTIM3 was constructed.The receive operator characteristic curve(ROC curve)was plotted to analyze the predictive efficacy of the model.Results A total of 99 AP patients were enrolled,80 patients in the non-SAP group and 19 patients in the SAP group.Compared with the non-SAP group,body mass index(BMI),drinking history ratio,heart rate(HR),respiration rate(RR),white blood cell count(WBC),red blood cell count(RBC),C-reactive protein(CRP),alanine aminotransferase(ALT),serum creatinine(SCr),procalcitonin(PCT),interleukin-6(IL-6),sTIM3,BISAP score,APACHEⅡ score and MCTSI score were significantly increased,and pulse oxygen saturation(SpO_(2)),direct bilirubin(DBil)and IL-10 were significantly decreased.The length of intensive care unit(ICU)stay and total length of hospital stay of patients in the SAP group were significantly longer than those in the non-SAP group[length of ICU stay(days):1.0(0,1.5)vs.0(0,0),total length of hospital stay(days):17.11±9.39 vs.8.40±3.08,both P<0.01].Multivariate Logistic regression analysis showed that HR[odds ratio(OR)=1.059,95% confidence interval(95%CI)was 1.010-1.110,P=0.017],DBil(OR=0.981,95%CI was 0.950-0.997,P=0.043),and sTIM3(OR=1.002,95%CI was 1.001-1.003,P=0.027)were independent risk factors for predicting the progression of SAP in patients with AP,and the SAP prediction model based on sTIM3 was constructed:Logit(P)=-14.602+0.187×BMI+0.057×HR+0.006×CRP-0.020×DBil+0.002×sTIM3.ROC curve analysis showed that among the aforementioned single factor quantitative indicators,IL-6 was the most effective in predicting the progression of AP patients to SAP during hospitalization,but the predictive performance of prediction model based on the sTIM3 was significantly better than IL-6[area under the ROC curve(AUC)and 95%CI:0.957(0.913-1.000)vs.0.902(0.845-0.958),P<0.05].Conclusion The model based on serum sTIM3 demonstrated good predictive value for the progression of SAP in patients with AP.