肿瘤坏死因子-α和血清胱抑素C水平与急性梗阻性化脓性胆管炎病情严重程度的相关性

Correlation between tumor necrosis factor-αand serum cystatin C levels and the severity of acute obstructive suppurative cholangitis

目的探讨急性梗阻性化脓性胆管炎患者血清肿瘤坏死因子-α和血清胱抑素C水平变化及其与患者病情严重程度的关系。方法选取2019年6月至2023年6月南阳医学高等专科学校第一附属医院收治的144例急性梗阻性化脓性胆管炎患者的临床血清样本作为研究对象(观察组)。选取30例健康者作为对照(对照组)。依据患者病情严重程度,将患者分为单纯急性梗阻性化脓性胆管炎组(单一组)、急性梗阻性化脓性胆管炎合并脓毒症组(合并脓毒症组)和急性梗阻性化脓性胆管炎休克组(合并休克组),分别检测患者入院时和入院后2 d患者血清肿瘤坏死因子-α和血清胱抑素C水平,并制作受试者工作曲线,分析血清肿瘤坏死因子-α和胱抑素C水平对诊断急性梗阻性化脓性胆管炎的价值。组间计量数据比较采用单因素方差分析。结果观察组患者血清肿瘤坏死因子-α和血清胱抑素C水平[(58.84±25.84)、(0.93±0.11)pg/ml]明显高于对照组健康者[(9.21±1.59)、(1.53±0.26)pg/ml],差异有统计学意义(t=10.600、12.310,P<0.05)。单一组患者血清肿瘤坏死因子-α和血清胱抑素C水平[(33.97±9.77)、(1.24±0.11)pg/ml]明显低于合并脓毒症组患者[(58.56±14.98)、(1.54±0.11)pg/ml],差异有统计学意义(t=9.528、7.574,P<0.05)。合并休克组患者血清肿瘤坏死因子-α和血清胱抑素C水平[(84.70±18.63)、(1.81±0.18)pg/ml]高于合并脓毒症组患者[(58.56±14.98)、(1.54±0.11)pg/ml],差异有统计学意义(t=13.680、9.012,P<0.05)。单一组患者急性生理学与慢性健康状况评分[(10.06±2.54)分]明显低于合并脓毒症组患者[(15.52±2.16)分],差异有统计学意义(t=11.340,P<0.05)。合并休克组患者急性生理学与慢性健康状况评分[(22.98±4.34)分]高于合并脓毒症组患者[(15.52±2.16)分],差异有统计学意义(t=10.650,P<0.05)。血清肿瘤坏死因子-α和血清胱抑素C水平与急性生理学与慢性健康状况评分(APACHEⅡ)呈正相关(r=0.814、0.719,P<0.05)。血清肿瘤坏死因子-α的阈值27.58 pg/ml,诊断急性梗阻性化脓性胆管炎的灵敏度为80.25%,特异性为65.59%,曲线下面积为0.74。血清胱抑素C的阈值1.61 pg/ml,诊断急性梗阻性化脓性胆管炎的灵敏度为75.65%,特异性为76.98%,曲线下面积为0.68。血清肿瘤坏死因子-α和血清胱抑素C水平联合诊断灵敏度为92.36%,特异性为85.69%,曲线下面积为0.89。结论血清肿瘤坏死因子α和胱抑素C水平与急性梗阻性化脓性胆管炎患者病情严重程度呈正相关。

Objective To explore the changes of serum tumor necrosis factor-αand serum cystatin C levels in patients with acute obstructive suppurative cholangitis(AOSC)and their relationship with the severity of the disease.MethodsClinical serum samples from 144 patients with AOSC admitted to our hospital from June 2019 to June 2023 were selected as the research objects(observation group).A total of 30 healthy people were selected as the control group.According to the severity of the disease,the patients were divided into simple AOSC subgroup(single subgroup),AOSC combined with sepsis group(AOSC+sepsis group)and AOSC combined with shock group(AOSC+shock group).The levels of serum tumor necrosis factor-αand serum cystatin C were detected on admission and 2 days after admission,and the receiver operating characteristic curve was made to analyze the value of serum tumor necrosis factor-αand serum cystatin C levels in the diagnosis of AOSC.The comparison of quantitative data between groups was performed using one-way analysis of variance.ResultsThe levels of serum tumor necrosis factor-αand serum cystatin C in the observation group[(58.84±25.84),(0.93±0.11)pg/ml]were significantly higher than those in the control group[(9.21±1.59),(1.53±0.26)pg/ml,t=10.600,12.310,P<0.05].The serum tumor necrosis factor-αand serum cystatin C levels in the single subgroup[(33.97±9.77),(1.24±0.11)pg/ml]were significantly lower than those in the AOSC+sepsis suboup[(58.56±14.98),(1.54±0.11)pg/ml,t=9.528,7.574,P<0.05].The serum tumor necrosis factor-αand serum cystatin C levels in the AOSC+shock subgroup[(84.70±18.63),(1.81±0.18)pg/ml]were higher than those in the AOSC+sepsis subgroup[(58.56±14.98),(1.54±0.11)pg/ml,t=13.680,9.012,P<0.05].The acute physiology and chronic health evaluationⅡscore in the single subgroup[(10.06±2.54)points]was significantly lower than that in the AOSC+sepsis subgroup[(15.52±2.16)points,t=11.340,P<0.05].The acute physiology and chronic health evaluationⅡscore in the AOSC+shock subgroup[(22.98±4.34)points]was higher than that in the AOSC+sepsis group[(15.52±2.16)points,t=10.650,P<0.05].The serum tumor necrosis factor-αand serum cystatin C levels were positively correlated with the acute physiology and chronic health evaluationⅡscore(r=0.814,0.719,P<0.05).The threshold value of serum tumor necrosis factor-αwas 27.58 pg/ml,and the sensitivity was 80.25%,the specificity was 65.59%,and the area under the curve was 0.74.The threshold value of serum cystatin C was 1.61 pg/ml,and the sensitivity was 75.65%,the specificity was 76.98%,and the area under the curve was 0.68.The combined diagnostic sensitivity of serum tumor necrosis factor-αand serum cystatin C levels was 92.36%,the specificity was 85.69%,and the area under the curve was 0.89.ConclusionSerum tumor necrosis factor-αand cystatin C levels are positively correlated with the severity of AOSC.