急性胰腺炎患者血清sCD40早期检测的临床意义

背景:CD40是免疫应答中的共刺激分子,通过与其配体CD40L结合,参与介导免疫调节信号。研究显示在多种疾病状态下,外周血和体液可溶性CD40(sCD40)水平异常增高。目的:检测急性胰腺炎(AP)患者的入院早期血清sCD40水平并探讨其临床意义。方法:随机选取72例住院AP患者(MAP 44例,SAP 28例),以ELISA法检测入院24h内血清sCD40水平,21例健康体检者作为对照。以ROC曲线评价早期血清sCD40对AP以及AP相关急性肺损伤(ALI)的诊断效能。结果:AP组入院24 h内血清sCD40水平显著高于对照组(P0.01),其中SAP组又高于MAP组,并与入院24 h内血清CRP水平呈显著正相关(r=0.413,P=0.000)。血清sCD40诊断AP的ROC曲线下面积(AUC)为0.806,最佳诊断界值为≥29.45 pg/mL;预测AP相关ALI的AUC为0.808,诊断效能明显高于APACHEⅡ评分(AUC=0.733)、Ranson评分(AUC=0.648)和血清CRP(AUC=0.625),最佳诊断界值为≥47.96 pg/mL。结论:早期检测血清sCD40有助于早期识别AP、判断病情严重程度以及预测AP相关ALI的发生。

Clinical Significance of Early Detection of Serum sCD40 in Patients with Acute Pancreatitis

Background： CD40 is a co-stimulatory molecule in immune response, and plays an important role in the mediation of immunoregulatory signals via binding to its ligand CD40L. Previous studies revealed that soluble CIM0 （sCIM0） was extraordinarily up-regulated in peripheral blood and body fluid in various diseased status. Aims： To explore the serum level of sCD40 in patients with acute pancreatitis （AP） at early stage of admission and its clinical significance. Methods： A total of seventy-two inpatients with AP （44 cases of MAP and 28 cases of SAP） were randomly selected and the serum level of sCIM0 was measured by ELISA within 24 hours after admission. Twenty-one healthy subjects receiving routine medical examination were served as controls. The diagnostic performance of early stage serum sCIM0 for identifying AP and predicting AP-associated acute lung injury （ALI） was evaluated by ROC curve. Results： Serum sCIM0 level within 24 hours after admission was significantly higher in AP patients than in healthy controls （ P 〈 0.01 ） , and that in SAP was higher than that in MAP with no significance. A significant positive correlation was found between serum sCIM0 and serum CRP in AP patients within 24 hours after admission （ r = 0. 413, P = 0. 000）. Area under the ROC curve （AUC） by serum sCD40 for identifying AP was 0. 806 and the cutoff value was i〉29.45 pg/mL. AUC by serum sCD40 for predicting AP- associated ALI was 0. 808, which was higher than that of APACHE lI score （ AUC = 0. 733 ）, RansoM score （ AUC = 0. 648） and serum CRP （ AUC = 0.625） ; the cutoff value was /〉47.96 pg/mL. Conclusions ： Detection of serum sCD40 at early stage may be beneficial for early identifying AP, assessing disease severity and predicting AP-associated ALI.