摘要
目的探讨血清可溶性B7同源体4(sB7-H4)评估急性胰腺炎(AP)患者病情及疾病转归的临床价值。方法选取2020年2月至2022年9月河南科技大学第一附属医院收治的82例AP患者为研究对象。根据病情严重程度分为重症组(SAP组)、中度组(MSAP组)、轻症组(MAP组);根据转归情况分为好转组(31例)、迁延组(38例)、死亡组(13例)。采用双抗体夹心酶联免疫吸附法检测血清sB7-H4水平。采用受试者工作特征(ROC)曲线评估血清sB7-H4对AP病情严重程度及疾病转归的预测价值,采用多因素logistic回归分析探讨AP患者预后的相关因素。结果SAP组血清降钙素原(PCT)、C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、急性生理与慢性健康评分Ⅱ(APACHE-Ⅱ)评分均高于MSAP、MAP组,MSAP组PCT、CRP、TNF-α、APACHE-Ⅱ评分高于MAP组(P<0.05)。SAP组血清sB7-H4水平高于MSAP组和MAP组,MSAP组血清sB7-H4水平高于MAP组(P<0.05)。好转组血清sB7-H4水平、APACHE-Ⅱ评分低于迁延组和死亡组,且迁延组血清sB7-H4水平、APACHE-Ⅱ评分低于死亡组(P<0.05)。SAP组、MSAP组、MAP组患者APACHE-Ⅱ评分均与血清sB7-H4呈正相关(r=0.514、0.469、0.524,P<0.05)。血清sB7-H4水平与PCT、CRP、TNF-α呈正相关(r=0.464、0.634、0.514,P<0.05)。血清sB7-H4诊断AP患者重症和死亡的曲线下面积分别为0.817(0.754~0.880)、0.897(0.815~0.979)。严重程度、CRP、APACHE-Ⅱ评分、血清sB7-H4高表达均为AP患者死亡的危险因素(P<0.05)。结论AP患者血清可溶性B7-H4水平与病情严重程度和疾病转归有关,血清sB7-H4高表达为急性胰腺炎患者预后的危险因素,其可作为临床诊治AP的生物标志物,为早期诊断、临床治疗、预后评估提供参考依据。
Objective To explore the clinical value of serum soluble B7 homolog 4(sB7-H4)in evaluating the condition and disease outcome of patients with acute pancreatitis(AP).Methods A total of 82 AP patients admitted to the First Affiliated Hospital of Henan University of Science and Technology from February 2020 to September 2022 were selected as the research objects.According to the severity of the disease,they were divided into severe group(SAP group),moderate group(MSAP group),and mild group(MAP group).According to the outcome,they were divided into improvement group(31 cases),protracted group(38 cases),and death group(13 cases).The level of serum sB7-H4 was detected by double antibody sandwich enzyme-linked immunosorbent assay.The receiver operating characteristic(ROC)curve was used to assess the predictive value of serum sB7-H4 for the severity of AP and the outcome of the disease.The prognostic factors of AP patients were explored by multivariate logistic regression analysis.Results Serum procalcitonin(PCT),C-reactive protein(CRP),tumor necrosis factorα(TNF-α),and acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ)scores in SAP group were higher than those in MSAP and MAP groups,and PCT,CRP,TNF-α,APACHE-Ⅱscore in MSAP group was higher than that of the MAP group(P<0.05).The serum sB7-H4 level of SAP group was higher than that of MSAP group and MAP group,and the serum sB7-H4 level of MSAP group was higher than that of MAP group(P<0.05).The serum sB7-H4 level and APACHE-Ⅱscore in the improvement group were lower than those in the prolonged group and the death group,and the serum sB7-H4 level and APACHE-Ⅱscore in the prolonged group were lower than those in the death group(P<0.05).The APACHE-Ⅱscores of patients in SAP group,MSAP group and MAP group were positively correlated with serum sB7-H4(r=0.514,0.469,0.524,P<0.05).Serum sB7-H4 levels were positively correlated with PCT,CRP and TNF-α(r=0.464,0.634,0.514,P<0.05).The area under the curve of serum sB7-H4 for diagnosis of severe illness and death in AP patients was 0.817(0.754-0.880)and 0.897(0.815-0.979).Severity,CRP,APACHE-Ⅱscore,high expression of serum sB7-H4 were risk factors for death in AP patients(P<0.05).Conclusion Serum soluble B7-H4 level in AP patients is related to the severity of the disease and the outcome of the disease.The high expression of serum sB7-H4 is a risk factor for the prognosis of patients with acute pancreatitis,and it can be used as a biomarker for clinical diagnosis and treatment of AP,providing a reference for early diagnosis,clinical treatment and prognosis evaluation.
作者
张莉
张杨
郭虹
ZHANG Li;ZHANG Yang;GUO Hong(Department of Intensive Medicine(Internal Medicine),the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China;Department of Gastroenterology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)
出处
《河南医学研究》
2025年第1期14-18,共5页
Henan Medical Research
