急性胰腺炎患者血清CXC趋化因子配体10和CC类趋化因子22水平与疾病严重程度关系及临床诊断价值研究

Relationship between serum CXCL10,CCL22 levels and disease severity in patients with acute pancreatitis and their clinical diagnostic value

目的:分析急性胰腺炎患者血清CXC趋化因子配体10(CXCL10)和CC类趋化因子22(CCL22)水平与疾病严重程度的关系及临床诊断价值。方法:选取急性胰腺炎患者102例,分为轻症组(轻症急性胰腺炎患者,47例)、中度重症组(中度重症急性胰腺炎患者,31例)和重症组(重症急性胰腺炎患者,24例)。选择52例体检健康者为健康组。采用全自动生化分析仪检测受试者肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]、肾功能指标[肌酐(Scr)、血尿素氮(BUN)]以及淀粉酶(AMY)水平。采用酶联免疫吸附法检测血清中CXCL10、CCL22水平。采用急性胰腺炎严重程度床边指数(BISAP)评分评估急性胰腺炎患者疾病严重程度。采用Logistic回归分析中度重症和重症急性胰腺炎发生的影响因素。采用Pearson法分析急性胰腺炎患者血清CXCL10、CCL22水平及BISAP评分间的相关性。采用受试者工作特征(ROC)曲线评价血清CXCL10、CCL22水平诊断中度重症和重症急性胰腺炎的价值。结果:与健康组比较,轻症组ALT、Scr、BUN、AMY水平升高,中度重症组和重症组ALT、AST、Scr、BUN、AMY水平升高(均P<0.05)。与轻症组比较,中度重症组BUN水平升高,重症组ALT、AST、Scr、BUN水平升高(均P<0.05)。与中度重症组比较,重症组BUN水平升高(P<0.05)。四组血清CXCL10、CCL22水平及BISAP评分依次升高(均P<0.05)。急性胰腺炎患者血清CXCL10和CCL22水平呈正相关(P<0.05);血清CXCL10、CCL22水平与BISAP评分呈正相关(均P<0.05)。血清CXCL10、CCL22、BISAP评分是中度重症和重症急性胰腺炎发生的独立危险因素(均P<0.05)。血清CXCL10、CCL22对中度重症和重症急性胰腺炎均有一定诊断价值,且两项联合诊断价值更高(均P<0.05)。结论:急性胰腺炎患者血清CXCL10、CCL22水平呈高表达,且随疾病严重程度的加重而升高,两者联合诊断中度重症和重症急性胰腺炎的价值较高。

Objective:To analyze the relationship between serum CXC chemokine ligand 10(CXCL10),CC class chemokine 22(CCL22)levels and disease severity in patients with acute pancreatitis and their clinical diagnostic value.Methods:A total of 102 patients with acute pancreatitis were enrolled and divided into mild group(47 patients with mild acute pancreatitis),moderately severe group(31 patients with moderate severe acute pancreatitis)and severe group(24 patients with severe acute pancreatitis).Fifty-two healthy people were selected as the healthy group.The levels of liver function indexes(ALT and AST),renal function indexes(Scr and BUN)and amylase(AMY)were measured by automatic biochemical analyzer.The levels of CXCL10 and CCL22 in serum were detected by enzyme-linked immunosorbent assay.Disease severity of patients with acute pancreatitis were evaluated by BISAP score.Logistic regression was used to analyze the influencing factors of moderately severe pancreatitis and severe acute pancreatitis.Pearson method was used to analyze the correlation between serum CXCL10,CCL22 levels and BISAP score in patients with acute pancreatitis.The value of serum CXCL10 and CCL22 levels in the diagnosis of moderate severe acute pancreatitis and severe acute pancreatitis was evaluated by ROC curve.Results:Compared with healthy group,the levels of ALT,Scr,BUN and AMY were increased in mild group,and the levels of ALT,AST,Scr,BUN and AMY in moderately severe group and severe group were increased(all P<0.05).Compared with mild group,BUN level in moderately severe group were increased,and the levels of ALT,AST,Scr and BUN in severe group were increased(all P<0.05).Compared with moderately severe group,BUN level in the severe group was increased(P<0.05).Serum CXCL10,CCL22 levels and BISAP score in healthy group,mild group,moderately severe group and severe group were increased successively(all P<0.05).The serum levels of CXCL10 and CCL22 in patients with acute pancreatitis were positively correlated(P<0.05).Serum CXCL10 and CCL22 levels were positively correlated with BISAP scores(all P<0.05).Serum CXCL10,CCL22 and BISAP score were independent risk factors for moderately severe acute pancreatitis and severe acute pancreatitis(all P<0.05).Serum CXCL10 and CCL22 had certain diagnostic value for moderately severe acute pancreatitis and severe acute pancreatitis,and the combination of the two had higher diagnostic value(all P<0.05).Conclusion:Serum levels of CXCL10 and CCL22 are highly expressed in patients with acute pancreatitis,and increase with the severity of the disease.The combination of CXCL10 and CCL22 has a high value in the diagnosis of moderately severe acute pancreatitis and severe acute pancreatitis.