急性胰腺炎免疫因子动态变化与病情的相关性

Correlation between dynamic changes in immune factors and disease severity in acute pancreatitis

目的分析急性胰腺炎患者血清免疫因子水平动态变化与病情及预后的相关性。方法将2020年1月至2022年12月于新疆维吾尔自治区人民医院胰腺外科就诊的急性胰腺炎患者纳入研究,根据治疗后患者是否出现胰腺和(或)胰周感染性坏死、器官衰竭及死亡将患者分为预后良好组及预后不良组,比较两组患者的年龄、性别等一般资料,比较两组患者病情严重情况、免疫因子水平及其动态变化,采用多因素logistics回归对上述影响因素进行分析,并对免疫因子动态变化情况与疾病严重程度的相关性进行分析,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估影响因素对急性胰腺炎患者预后的预测价值。结果预后不良组患者的年龄显著高于预后良好组(t=3.662,P=0.000),而两组患者的性别、BMI等一般资料及治疗前两组患者病情相关指标差异无统计学意义(均P>0.05)。两组治疗3 d后各指标较前显著升高,预后不良组显著高于对照组,且变异率显著高于对照组(均P<0.05);多因素logistic分析示高IL-8变异率、MCP-1变异率、PCT变异率及BISAP变异率为预后的独立危险因素(OR=1.003、1.009、1.022、1.002,均P<0.05);Pearson相关性分析结果示,IL-8变异率、MCP-1变异率及PCT变异率与病情变化呈显著正相关(ρ=0.615、0.591、0.627,均P<0.05);ROC曲线示IL-8变异率、MCP-1变异率、PCT变异率及BISAP变异率四项联合患者预后的AUC为0.916,显著高于IL-8变异率、MCP-1变异率、PCT变异率及BISAP变异率的单一诊断(均P<0.05),此时诊断的特异度为100.0%,敏感度为82.6%。结论急性胰腺炎患者治疗早期免疫因子水平变化情况与患者病情显著相关,并可预测患者预后,具有一定预测价值。

Objective To analyze the correlation between dynamic changes in serum immune factors and disease severity and prognosis in patients with acute pancreatitis.Methods This study included patients with acute pancreatitis who were treated at the Pancreatic Surgery Department of Xinjiang Uygur Autonomous Region People′s Hospital from January 2020 to December 2022.Patients were divided into a good prognosis group and a poor prognosis group based on whether they developed pancreatic and/or peripancreatic infectious necrosis,organ failure,or death after treatment.We compared the general data such as age and sex between the two groups and analyzed the severity of the disease,immune factor levels,and their dynamic changes.Multivariate logistic regression was used to analyze these factors,and the correlation between dynamic changes in immune factors and disease severity was examined.Receiver operating characteristic(ROC)curves were drawn to evaluate the predictive value of these factors for prognosis.Results The age of patients in the poor prognosis group was significantly higher than that in the good prognosis group(t=3.662,P=0.000).There were no significant differences in gender,BMI,or disease-related indicators before treatment between the two groups(all P>0.05).Three days after treatment,all indicators significantly increased,with the poor prognosis group showing significantly higher levels and variability than the good prognosis group(all P<0.05).Multivariate logistic analysis indicated that high variability in IL-8,MCP-1,PCT,and BISAP were independent risk factors for poor prognosis(OR=1.003,1.009,1.022,1.002;all P<0.05).Pearson correlation analysis showed that the variability in IL-8,MCP-1,and PCT was positively correlated with changes in disease severity(ρ=0.615,0.591,0.627;all P<0.05).The ROC curve analysis showed that the combined AUC of IL-8,MCP-1,PCT,and BISAP variability for predicting patient prognosis was 0.916,significantly higher than the individual diagnoses of these factors(all P<0.05),with a specificity of 100.0%and sensitivity of 82.6%.Conclusion Changes in immune factor levels early in the treatment of acute pancreatitis are significantly correlated with disease severity and can predict patient prognosis,demonstrating considerable predictive value.