本文選題：胰腺炎 + 降鈣素原��； 參考：《中南大學(xué)》2013年博士論文

【摘要】：目的：通過(guò)檢測(cè)血清降鈣素原(procalcitonin, PCT)及可溶性髓樣細(xì)胞觸發(fā)受體-1(soluble triggering receptor expressed on myeloid cells-1, sTREM-1)的水平,并監(jiān)測(cè)其動(dòng)態(tài)變化,探討上述兩個(gè)炎癥標(biāo)記物在急性胰腺炎(acute pancreatitis, AP)嚴(yán)重程度早期評(píng)估中的臨床意義,確定PCT診斷重癥急性胰腺炎(severe acute pancreatitis, SAP)的最佳界值參數(shù),并初步分析兩指標(biāo)的相關(guān)性,比較各預(yù)測(cè)方法對(duì)SAP的診斷效能。 方法：收集2012年8月至12月在湘雅醫(yī)院住院的確診AP患者34例,分為輕癥急性胰腺炎(mild acute pancreatitis, MAP)組(16例)和SAP組(18例),同時(shí)隨機(jī)選取20例體檢健康者作為對(duì)照組。分別測(cè)定AP患者在入院后第1天、4天、7天的血清PCT及sTREM-1濃度,并進(jìn)行急性生理學(xué)及慢性健康狀況評(píng)分(acute phsiology and chronic health evalution score Ⅱ, APACHE Ⅱ)、CT嚴(yán)重度指數(shù)(computed tomography severity index, CTSI)評(píng)分及床旁急性胰腺炎嚴(yán)重度(bedside index for severity in acute pancreatitis, BISAP)評(píng)分,健康個(gè)體采血3ml檢測(cè)血清PCT及sTREM-1濃度。各組間進(jìn)行比較分析。 結(jié)果： (1)入院7天內(nèi),SAP組血清PCT濃度明顯高于同期MAP組(P0.001)；在診斷界值取1.56ng/ml時(shí),PCT診斷SAP的敏感性為88.9%、特異性為100%。 (2)SAP患者入院后第1天的血清sTREM-1濃度高于MAP組(P0.005)和正常對(duì)照組(P0.001),MAP組高于正常對(duì)照組(P0.001)；SAP組與MAP組血清sTREM-1濃度在入院7天內(nèi)的同一時(shí)間節(jié)點(diǎn)均有顯著差異(P0.05)；sTREM-1濃度與APACHE II評(píng)分、CTSI評(píng)分及BISAP評(píng)分均呈正相關(guān)(P0.05)；以0.41ng/ml為界時(shí)sTREM-1診斷SAP的敏感性為66.7%、特異性為93.8%。 (3)非參數(shù)等級(jí)相關(guān)分析顯示,AP患者血清PCT和sTREM-1表達(dá)水平呈正相關(guān)(相關(guān)系數(shù)r=0.471,P0.01)。 (4)繪制受試者工作特征曲線,計(jì)算曲線下面積(area under the curve, AUC)可見,與APACHE II(AUC=0.882)、sTREM-1(AUC=0.839)相比,降鈣素原(AUC=0.96)對(duì)SAP的診斷效能最大。 結(jié)論： (1)血清PCT是早期預(yù)測(cè)SAP的理想指標(biāo),診斷界值為1.56ng/ml時(shí)其對(duì)SAP的診斷效能最大。 (2)血清sTREM-1與AP嚴(yán)重程度相關(guān),可作為AP病情早期預(yù)測(cè)的參考指標(biāo)。 (3)血清PCT和sTREM-1參與了AP的炎癥反應(yīng)過(guò)程,在AP發(fā)病過(guò)程中呈正相關(guān)。
[Abstract]:Objective: to detect the levels of procalcitonin (PCT) and soluble myeloid cell trigger receptor -1soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in serum and their dynamic changes. To investigate the clinical significance of the above two inflammatory markers in the early assessment of acute pancreatitis (AP) severity, to determine the optimal threshold parameters for the diagnosis of severe acute pancreatitis, SAP) by PCT, and to preliminarily analyze the correlation between the two indexes. The diagnostic effectiveness of each prediction method for SAP was compared. Methods: Thirty-four patients with AP in Xiangya Hospital from August to December 2012 were divided into mild acute pancreatitis (acute pancreatitis, MAP) group (n = 16) and SAP group (n = 18). 20 healthy persons were randomly selected as control group. Serum PCT and sTREM-1 levels were measured in patients with AP on day 1 and day 4 and day 7 after admission, respectively. Acute phsiology and chronic health evalution score 鈪，

本文編號(hào)：1822649