可溶性白细胞分化抗原CD14亚型、Toll样受体4诊断急性胰腺炎并发肾损伤的临床价值

The clinical value of preseptin and Toll Like Receptor 4 in the diagnosis of acute pancreatitis complicated with renal injury

目的分析可溶性白细胞分化抗原CD14亚型(Presepsin)、Toll样受体4(TLR4)在急性胰腺炎(AP)病人中的水平及评估肾损伤发生风险的价值。方法2020年6月~2021年12月我院AP病人132例为AP组,同期健康体检者66例为对照组。AP组与对照组均检测血清Presepsin、TLR4水平,采用Spearman相关系数分析AP组血清Presepsin、TLR4水平与病情程度的相关性。分析AP组发生肾损伤的影响因素及Presepsin、TLR4水平对肾损伤发生风险的交互作用。采用受试者工作特征(ROC)曲线分析血清Presepsin、TLR4预测AP组发生肾损伤的价值并进行决策曲线、临床影响曲线验证。结果AP组血清Presepsin、TLR4水平高于对照组(P<0.05);AP组血清Presepsin、TLR4水平与病情程度均呈正相关关系(r_(1)=0.794,P_(1)<0.001;r_(2)=0.835,P_(2)<0.001);血清Presepsin、TLR4水平是AP病人发生肾损伤的影响因素(P<0.05);血清Presepsin、TLR4对AP病人发生肾损伤存在协同作用,协同效应为二者单独存在产生效应之和的1.095倍(SI=1.095);血清Presepsin>1021.88 ng/L、TLR4>31.85 ng/ml时AP病人发生肾损伤风险较高,联合检测的AUC值为0.851;在阈值0.12~0.78范围内,Presepsin、TLR4联合评估AP病人发生肾损伤净受益率优于单独检测,在各阈值概率下,被联合检测方案划分为高风险的人数与真阳性例数在阈值概率为0.51时,两者基本达到一致。结论AP发生后血清Presepsin、TLR4水平随病情程度加重而异常升高,血清Presepsin、TLR4高水平表达是AP病人发生肾损伤的独立危险因素,且二者对肾损伤发生存在协同作用,通过联合检测其水平评估肾损伤发生风险具有较高价值。

Objective Aim To analyze the levels of soluble leukocyte differentiation antigen CD14 subtype(Presepsin)and Toll-like receptor 4(TLR4)in patients with acute pancreatitis(AP)and their value in assessing the risk of renal injury.Methods A total of 132 patients with AP in our hospital from June 2020 to December 2021 were selected,and 66 healthy subjects were selected during the same period.The serum Presepsin and TLR4 levels were detected in both AP patients and healthy subjects.Spearman correlation coefficient was used to analyze the correlation between serum Presepsin and TLR4 levels and disease severity in AP patients.The influencing factors of renal injury in AP patients and the interaction of Presepsin and TLR4 levels on the risk of renal injury were analyzed.Receiver operating characteristic(ROC)curve was used to analyze the value of serum Presepsin and TLR4 in predicting renal injury in AP patients,and the decision curve and clinical impact curve were used to verify.Results The serum Presepsin and TLR4 levels in AP patients were higher than those in healthy people(P<0.05).The serum Presepsin and TLR4 levels in AP patients were positively correlated with the severity of the disease(r_(1)=0.794,P_(1)<0.001;r_(2)=0.835,P_(2)<0.001).Serum Presepsin and TLR4 levels were the influencing factors of renal injury in AP patients(P<0.05).Serum Presepsin and TLR4 had a synergistic effect on renal injury in AP patients,and the synergistic effect was 1.095 times the sum of the effects of the two alone(SI=1.095).When serum Presepsin>1021.88 ng/L and TLR4>31.85 ng/ml,AP patients had a higher risk of renal injury,and the AUC value of combined detection was 0.851.Within the threshold range of 0.12 to 0.78,the combined assessment of Presepsin and TLR4 for the net benefit rate of renal injury in patients with AP was superior to the independent detection.At each threshold probability,the number of people classified as high risk by the joint detection scheme and the number of true positive cases were basically consistent when the threshold probability was 0.51.Conclusion After the occurrence of AP,the levels of serum Presepsin and TLR4 increase abnormally with the severity of the disease.The high levels of serum Presepsin and TLR4 are independent risk factors for renal injury in AP patients,and the two have a synergistic effect on the occurrence of renal injury.Horizontal assessment of the risk of renal injury has high value and it can provide early warning in clinical practice.