急性胰腺炎患者血清三结构域35和肿瘤坏死因子受体相关因子3表达水平及其临床意义

The expression levels and clinical significance of serum tripartite motif containing 35 and tumor necrosis factor receptor associated factor 3 in patients with acute pancreatitis

目的探究急性胰腺炎(AP)患者血清三结构域35(TRIM35)和肿瘤坏死因子受体相关因子3(TRAF3)表达水平及其与病情程度和预后的相关性。方法采用前瞻性研究的方法,选取青海红十字医院2020年7月至2022年9月AP患者93例(观察组),其中轻症急性胰腺炎(MAP)40例,中重症急性胰腺炎(MSAP)29例,重症急性胰腺炎(SAP)24例;另选取同期健康体检者40例作为健康对照组。采用实时荧光定量聚合酶链反应(RT-qPCR)法检测血清TRIM35和TRAF3水平。随访入院28 d后的生存状况。相关性分析采用Pearson法;采用多因素Logistic回归分析血清TRIM35和TRAF3与AP患者预后的关系;采用受试者工作特征(ROC)曲线分析血清TRIM35和TRAF3对AP患者预后的评估价值。结果观察组血清TRIM35和TRAF3水平明显高于健康对照组(3.76±1.36比1.02±0.19和5.37±2.18比1.04±0.16),差异有统计学意义(P<0.01)。MSAP和SAP患者血清TRIM35和TRAF3水平明显高于MAP患者(4.11±1.73和4.96±1.47比2.79±1.04、5.43±2.15和7.01±2.85比4.35±1.79),SAP患者明显高于MSAP患者,差异有统计学意义(P<0.05)。随访结果显示,死亡11例,存活82例。死亡患者血清TRIM35和TRAF3明显高于存活患者(4.94±1.01比3.60±1.67和7.08±1.43比5.14±2.57),差异有统计学意义(P<0.05)。Pearson相关分析结果显示,AP患者血清TRIM35水平与血清TRAF3水平呈正相关(r=0.483,P<0.01)。多因素Logistic回归分析结果显示,血清TRIM35和TRAF3水平是影响AP患者预后的独立危险因素(OR=1.86和1.37,95%CI 1.12~3.09和1.02~1.82,P<0.05)。ROC曲线分析结果显示,血清TRIM35联合TRAF3水平评估AP患者预后的曲线下面积明显大于血清TRIM35和TRAF3单独评估(0.85比0.81和0.81,Z=0.03和0.04,P<0.05),血清TRIM35和TRAF3水平的最佳截断值为4.90和6.11。结论AP患者血清TRIM35和TRAF3水平明显升高,且与病情程度有关,血清TRIM35和TRAF3水平是影响AP患者预后的独立影响因素,两者联合检测评估AP患者的预后更有价值。

Objective To explore the expression levels of serum triple domain 35(TRIM35)and tumor necrosis factor receptor associated factor 3(TRAF3)in patients with acute pancreatitis(AP)and their correlation with the severity and prognosis of the disease.Methods Using a prospective research method,93 patients with AP(observation group)were selected from July 2020 to September 2022 in Qinghai Red Cross Hospital,including 40 cases of mild acute pancreatitis(MAP),29 cases of moderate to severe acute pancreatitis(MSAP)and 24 cases of severe acute pancreatitis(SAP).During the same period,40 healthy individuals who underwent physical examinations were selected as healthy control group.The serum TRIM35 and TRAF3 levels were detected by real time fluorescence quantitative polymerase chain reaction(RT-qPCR).The survival status after 28 d of admission was followed up.The correlation was analyzed by Pearson method.Multivariate Logistic regression analysis was used to analyze the relationship between serum TRIM35 and TRAF3 levels and the prognosis in patients with AP.The efficacy of serum TRIM35 and TRAF3 in predicting the prognosis in patients with AP was evaluated by the receiver operating characteristics(ROC)curve.Results The serum TRIM35 and TRAF3 levels in observation group were significantly higher than those in healthy control group(3.76±1.36 vs.1.02±0.19 and 5.37±2.18 vs.1.04±0.16),and there were statistical differences(P<0.01).The serum TRIM35 and TRAF3 levels in patients with MSAP and SAP were significantly higher than those in patients with MAP(4.11±1.73 and 4.96±1.47 vs.2.79±1.04,5.43±2.15 and 7.01±2.85 vs.4.35±1.79),the indexes in patients with SAP were significantly higher than those in patients with MSAP,and there were statistical differences(P<0.05).The follow-up results showed that 11 cases died and 82 cases survived.The serum TRIM35 and TRAF3 levels in death patients were significantly higher than those in surviving patients(4.94±1.01 vs.3.60±1.67 and 7.08±1.43 vs.5.14±2.57),and there were statistical differences(P<0.05).Pearson correlation analysis result showed that serum TRIM35 level was positive correlation with serum TRAF3 level in patients with AP(r=0.483,P<0.01).Multivariate Logistic regression analysis result showed that serum TRIM35 and TRAF3 levels were the independent risk factors of prognosis in patients with AP(OR=1.86 and 1.37,95%CI 1.12 to 3.09 and 1.02 to 1.82,P<0.05).ROC curve analysis result showed that the area under the curve of serum TRIM35 combined with TRAF3 levels for evaluating the prognosis in patients with AP was significantly larger than serum TRIM35 and TRAF3 alone(0.85 vs.0.81 and 0.81,Z=0.03 and 0.04,P<0.05).The optimal cutoff values of serum TRIM35 and TRAF3 levels were 4.90 and 6.11.Conclusions The serum TRIM35 and TRAF3 levels in patients with AP are significantly elevated,and are related to the severity of the condition.The serum TRIM35 and TRAF3 levels are independent risk of prognosis in patients with AP,and their combined detection is more valuable in evaluating the prognosis in patients with AP.