急性胰腺炎患者血清成纤维细胞生长因子-21水平及其对患者死亡风险的预测价值

目的 探讨急性胰腺炎患者血清成纤维细胞生长因子-21（FGF-21）水平与病情严重程度的相关性，分析FGF-21对重症患者死亡风险的预测价值。方法 选取2017年2月—2019年7月成都市第六人民医院收治的急性胰腺炎患者160例作为急性胰腺炎组，根据病情严重程度进一步分为轻症组64例、中度重症组61例、重症组35例。另取同期在该院进行体检的健康志愿者110例作为正常对照组。对比急性胰腺炎组、正常对照组血清FGF-21水平的差异；对比不同病情急性胰腺炎患者及重症组不同预后患者的淀粉酶、C反应蛋白（CRP）、降钙素原（PCT）水平及急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分差异。采用Pearson法分析血清FGF-21与急性胰腺炎病情的相关性。采用受试者工作特征（ROC）曲线分析FGF-21对重症组患者死亡风险的预测价值。结果 急性胰腺炎组患者血清FGF-21水平高于正常对照组（P <0.05），轻症组、中度重症组、重症组血清淀粉酶、CRP、PCT水平及APACHE Ⅱ评分依次升高（P <0.05）。急性胰腺炎患者血清FGF-21水平与淀粉酶、CRP、PCT水平及APACHE Ⅱ评分均呈正相关（r =0.673、0.701、0.599和0.637，均P <0.05）。重症患者中，存活组血清FGF-21、淀粉酶、CRP、PCT水平及APACHE Ⅱ评分低于死亡组（P <0.05）。FGF-21预测重症患者90 d内死亡的最佳截点为9.35pg/ml，敏感性为83.33%（95% CI：0.794，0.897）、特异性为56.52%（95% CI：0.538，0.614）。结论 急性胰腺炎患者血清FGF-21明显升高，其在评估急性胰腺炎病情、预测重症患者死亡风险方面具有辅助作用。

The level of serum FGF-21 in patients with acute pancreatitis and its predictive value for the risk of death

Objective To investigate the correlation between the serum level of fibroblast growth factor-21 (FGF-21) and disease severity in acute pancreatitis patients, and to analyze the predictive value of FGF-21 for the risk of death in critical patients.Methods The 160 cases of acute pancreatitis patients admitted to our hospital from February 2017 to July 2019 were included as the acute pancreatitis group, and were further divided into mild group (n = 64), moderately severe group (n = 61), and severe group (n = 35) according to the severity of their conditions. Another 110 healthy volunteers who underwent the physical examination in our hospital during the same period were selected as the normal control group. The level of serum FGF-21 was compared between the acute pancreatitis group and the normal control group. The levels of amylase, C-reactive protein (CRP), and procalcitonin (PCT), and the score of Acute Physiology and Chronic Health Evaluation (APACHE II) were compared among acute pancreatitis patients with different conditions and patients with different survival outcomes in the severe group. The Pearson correlation method was applied to evaluate the relationship between serum FGF-21 and the condition of acute pancreatitis patients. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of FGF-21 for the death risk of patients in the severe group.Results The serum level of FGF-21 was higher in the acute pancreatitis group than that in the normal control group (P < 0.05). The serum levels of amylase, CRP and PCT, as well as the score of APACHE II increased as the condition of acute pancreatitis aggravated (P < 0.05). The serum FGF-21 level was positively correlated with the serum levels of amylase, CRP, and PCT, and the score of APACHE II in acute pancreatitis patients (r = 0.673, 0.701, 0.599 and 0.637; all P < 0.05). Among the severe group, the serum levels of FGF-21, amylase, CRP and PCT, and the score of APACHE II were even lower in those who survived compared with those who died (P < 0.05). The optimal cut-off point of the level of FGF-21 for predicting the death of severe patients within 90 days was 9.35 pg/ml, with a sensitivity of 83.33% (95% CI: 0.794, 0.897) and a specificity of 56.52% (95% CI: 0.538, 0.614).Conclusions The serum level of FGF-21 is highly elevated in acute pancreatitis patients, and plays roles in assessing the condition of the patients and predicting the risk of death in severe patients.