重症急性胰腺炎继发肺部感染患者血清炎症细胞因子水平的变化及临床价值

目的探讨重症急性胰腺炎(Severe acute pancreatitis,SAP)继发肺部感染患者血清炎症细胞因子水平的变化并分析其临床意义。方法选取邢台市人民医院2017年4月-2018年12月收治的SAP继发肺部感染患者58例,根据临床肺部感染评分将其分为轻度组31例、中度组22例和重度组5例,同期选择单纯SAP患者63例为未感染组,检测全部患者血清中降钙素原(Procalcitonin,PCT)、可溶性髓样细胞触发受体-1(Soluble myeloid cells trigger receptor-1,sTREM-1)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)水平,评价各指标诊断SAP继发肺部感染的价值。结果感染组患者血清PCT、sTREM-1、TNF-α、IL-6水平均高于未感染组,差异具有统计学意义(P<0.001);重度组患者血清PCT、sTREM-1、TNF-α、IL-6水平均高于中度组和轻度组,中度组患者血清PCT、sTREM-1、TNF-α、IL-6水平均高于轻度组(P<0.05);单项指标检测中sTREM-1诊断SAP继发肺部感染的价值、敏感度和特异度最高,各项指标联合检测可明显提高单一指标检测诊断SAP继发肺部感染的价值、灵敏度及特异度(P<0.05)。结论血清炎症细胞因子PCT、sTREM-1、TNF-α、IL-6水平与SAP继发肺部感染的病情程度呈正相关,联合检测对疾病的早期诊断和治疗有一定的临床价值。

Variation levels of serum inflammatory cytokines in patients with severe acute pancreatitis secondary to pulmonary infection and its clinical value

OBJECTIVE To investigate the changes and clinical value of serum inflammatory cytokines in patients with severe acute pancreatitis with secondary pulmonary infection. METHODS Fifty-eight patients of severe acute pancreatitis with secondary pulmonary infection treated in Xingtai people’s Hospital from Apr. 2017 to Dec. 2018 were divided into the mild group(n=31), the moderate group(n=22) and the severe group(n=5). In the same period, 63 patients of severe acute pancreatitis without infection were selected as the uninfected group. The serum levels of procalcitonin(PCT), soluble myeloid triggered receptor-1(sTREM-1), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) were measured to be evaluated the value of each index in the diagnosis of pulmonary infection secondary to severe acute pancreatitis. RESULTS Levels of PCT, strom-1, TNF-α and IL-6 in the infected group were significantly higher than that in the uninfected group(p<0.001). The serum levels of PCT, sTREM-1, TNF-α and IL-6 in the severe group were significantly higher than that in the moderate group and mild group, and the levels of PCT, sTREM-1, TNF-α and IL-6 in the moderate group were significantly higher than that in the mild group(P<0.05). In the single index detection, the value, sensitivity and specificity of sTREM-1 level in the diagnosis of pulmonary infection secondary to severe acute pancreatitis were the highest. The combined detection of various indexes could significantly improve the value, sensitivity and specificity in the diagnosis of pulmonary infection secondary to severe acute pancreatitis than the single index(P<0.05). CONCLUSION Serum inflammatory cytokines PCT, sTREM-1, TNF-α, IL-6 levels were positively correlated with the severity of acute pancreatitis secondary to pulmonary infection. Combined indicator detection had certain clinical value for the early diagnosis and treatment of acute pancreatitis secondary to pulmonary infection.