本文選題：重癥急性胰腺炎 + 炎性因子��； 參考：《中國(guó)全科醫(yī)學(xué)》2017年25期

【摘要】：目的探討不同炎性因子對(duì)重癥急性胰腺炎(SAP)的預(yù)測(cè)價(jià)值。方法本研究采用前瞻性觀察性研究方法。選取于2014年6月—2016年10月收住蘭州大學(xué)第二醫(yī)院外科重癥監(jiān)護(hù)病房(SICU)的并發(fā)器官功能障礙的急性胰腺炎(AP)患者40例。入科48 h根據(jù)患者是否持續(xù)存在器官功能障礙,將患者分為中重癥急性胰腺炎(MSAP)組27例和SAP組13例。比較兩組患者入科時(shí)的腫瘤壞死因子α(TNF-α)、白介素1(IL-1)、白介素6(IL-6)、白介素8(IL-8)及白介素10(IL-10)水平,采用Spearman秩相關(guān)分析、Logistic回歸分析篩選出能夠預(yù)測(cè)SAP的炎性因子,繪制受試者工作特征(ROC)曲線并尋找其最佳截?cái)帱c(diǎn),比較其對(duì)SAP的預(yù)測(cè)價(jià)值。結(jié)果兩組患者入住SICU時(shí),TNF-α、IL-6水平比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);IL-1、IL-8、IL-10水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。Spearman秩相關(guān)分析顯示,SAP與TNF-α、IL-6呈正相關(guān)(rs值分別為0.539、0.557,P0.05);與IL-1、IL-8、IL-10無相關(guān)性(rs值分別為0.303、0.284、-0.257,P0.05)。Logistic回歸分析結(jié)果顯示,TNF-α、IL-6是SAP發(fā)生的影響因素[OR(95%CI)分別為1.143(1.011,1.293)、1.084(1.014,1.158),P0.05]。TNF-α、IL-6預(yù)測(cè)SAP的ROC曲線下面積(AUC)分別為0.832(0.700,0.964)、0.843(0.684,1.000),均較好地預(yù)測(cè)了SAP的發(fā)生(P0.05)。TNF-α、IL-6的截?cái)帱c(diǎn)分別為141.7 pg/L、143.3pg/L時(shí)預(yù)測(cè)SAP的靈敏度和特異度較高。結(jié)論收住ICU的AP患者早期檢測(cè)血漿中TNF-α與IL-6的水平,與其他炎性因子相比,可早期預(yù)測(cè)SAP的發(fā)生,為盡早采取措施保護(hù)器官功能提供了理論依據(jù)。
[Abstract]:Objective to investigate the predictive value of different inflammatory factors in severe acute pancreatitis (SAP). Methods A prospective observational study was used in this study. From June 2014 to October 2016, 40 patients with acute pancreatitis complicated with organ dysfunction in surgical intensive care unit (SICU) of second Hospital of Lanzhou University were selected. According to the persistent organ dysfunction, patients were divided into moderate and severe acute pancreatitis group (n = 27) and SAP group (n = 13). The levels of TNF- 偽, IL-1, IL-6, IL-8 and IL-10 were compared between the two groups. The inflammatory factors which could predict SAP were screened by Spearman rank correlation analysis and logistic regression analysis. The operating characteristics of the subjects were drawn and the optimal truncation point was found, and the predictive value of the curve to SAP was compared. Results the levels of TNF- 偽 IL-6 were significantly different between the two groups when they were admitted to SICU, and the levels of IL-8 and IL-8 were significantly different between the two groups. There was no significant difference in P0.05U. Spearman rank correlation analysis between SAP and TNF- 偽 IL-6. The positive correlation between SAP and TNF- 偽 IL-6 was 0.539 / 0. 557 (P0.05) and there was no correlation with IL-1IL-8 / IL-10. The results of logistic regression analysis showed that TNF- 偽 IL-6 was the influential factor of SAP [OR995 CI]. TNF- 偽 IL-6 was a predictor of ROC in SAP (P < 0.05, P < 0. 05, P < 0. 05), but not correlated with IL-8 / IL-10 (P = 0. 3030.284- 0. 257P0.05. logistic regression analysis showed that TNF- 偽 IL-6 was an influential factor in the occurrence of SAP. [ORN95CIR = 1. 1431.011 / 1.29384 / 1.014141.158p] .TNF- 偽 was used to predict the ROC of SAP. The area under the curve was 0.832 ~ 0.700 ~ 0.964g / L, respectively. The sensitivity and specificity of SAP prediction were higher when the cut-off point of SAP was 141.7 PG / L ~ (143.3) PG / L, respectively, and the area under the curve was 0.832 ~ 0.700 ~ 0.964p ~ (-1) ~ (-1) ~ (-1) ~ 0.684 ~ (-1) ~ (-1) ~ (-1), respectively. The results showed that the sensitivity and specificity of prediction of SAP were higher when the cut-off point of SAP was 141.7 PG / L ~ (-1), respectively. Conclusion the early detection of plasma levels of TNF- 偽 and IL-6 in AP patients with ICU can predict the occurrence of SAP early compared with other inflammatory factors and provide a theoretical basis for early protection of organ function.
【作者單位】： 蘭州大學(xué)第二醫(yī)院重癥醫(yī)學(xué)一科;
【基金】：甘肅省蘭州市城關(guān)區(qū)科技計(jì)劃項(xiàng)目(2015-3-7)
【分類號(hào)】：R576

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