| 李湘成,郭感恩,赵 洁,邓健超,莫 辉.血清PCT、NETs、MFG-E8、TLR 9与重症急性胰腺炎患者肠黏膜屏障功能的相关性分析及对预后的影响[J].,2023,(5):963-968 |
| 血清PCT、NETs、MFG-E8、TLR 9与重症急性胰腺炎患者肠黏膜屏障功能的相关性分析及对预后的影响 |
| Correlation Analysis of Serum PCT, NETs, MFG-E8, TLR9 and Intestinal Mucosal Barrier Function in Patients with Severe Acute Pancreatitis and its Impact on Prognosis |
| 投稿时间：2022-05-27 修订日期：2022-06-23 |
| DOI：10.13241/j.cnki.pmb.2023.05.033 |
| 中文关键词: PCT NETs MFG-E8 TLR 9 重症急性胰腺炎 肠黏膜屏障功能 预后 |
| 英文关键词: PCT NETs MFG-E8 TLR 9 Severe acute pancreatitis Intestinal mucosal barrier function Prognosis |
| 基金项目:湖南省科技创新计划项目（S2017SFYLJS0371） |
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| 中文摘要: |
| 摘要 目的：分析血清降钙素原（PCT）、中性粒细胞胞外诱捕网（NETs）、乳脂球表皮生长因子8（MFG-E8）、Toll样受体9（TLR 9）与重症急性胰腺炎（SAP）患者肠黏膜屏障功能的相关性，并观察其对预后的影响。方法：回顾性分析本院2019年3月至2022年1月期间收治的174例SAP患者的临床资料（SAP组），另收集并分析同期来本院进行健康体检的90例志愿者临床资料（对照组），对比对照组、SAP组的血清PCT、NETs、MFG-E8、TLR 9和血清内毒素（LPS）、D-乳酸、二胺氧化酶（DAO）水平，分析PCT、NETs、MFG-E8、TLR 9与肠黏膜屏障功能指标的相关性。174例患者入院28 d内死亡39例，生存135例，根据28 d内预后不同分为死亡（n=39）和生存组（n=135）。单因素和多因素Logistic回归分析预后的影响因素。结果：SAP组的血清PCT、NETs、TLR 9水平高于对照组，MFG-E8水平低于对照组（P<0.05）。SAP组的血清LPS、D-乳酸、DAO水平高于对照组（P<0.05）。Pearson相关性分析结果证实：LPS、D-乳酸、DAO与PCT、NETs、TLR 9呈正相关，与MFG-E8呈负相关（P<0.05）。单因素分析显示：SAP患者的预后与年龄、糖尿病、高血脂、D-二聚体（D-D）、血淀粉酶、急性生理功能和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、急性胰腺炎严重程度床边指数（BISAP）评分、LPS、D-乳酸、DAO、PCT、NETs、MFG-E8、TLR 9、减少饮酒、低脂饮食有关（P<0.05）。多因素Logistic回归分析结果显示：BISAP评分偏高、APACHE Ⅱ评分偏高、LPS偏高、PCT偏高、血淀粉酶偏高、D-乳酸偏高、DAO偏高、NETs偏高、MFG-E8偏低、TLR 9偏高均是SAP患者预后的危险因素，而减少饮酒、低脂饮食则是SAP患者预后的保护因素（P<0.05）。结论：SAP患者体内血清PCT、NETs、MFG-E8、TLR 9水平异常变化，且与肠黏膜屏障功能相关，同时血淀粉酶、APACHEⅡ评分、BISAP评分、LPS、PCT、D-乳酸、DAO、NETs、MFG-E8、TLR 9是SAP患者预后的危险因素，而减少饮酒、低脂饮食则是SAP患者预后的保护因素，临床应注意早期评估，以改善患者预后。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the correlation between serum procalcitonin (PCT), neutrophil extracellular trapping nets (NETs), milk fat globule-epidermal growth factor 8 (MFG-E8), toll like receptor 9 (TLR 9) and intestinal mucosal barrier function in patients with severe acute pancreatitis (SAP), and to observe their effects on the prognosis. Methods: The clinical data of 174 patients with SAP (SAP group) who were treated in our hospital from March 2019 to January 2022 were retrospectively analyzed. In addition, the clinical data of 90 volunteers (control group) who came to our hospital for physical examination in the same period were collected and analyzed. The levels of serum PCT, NETs, MFG-E8, TLR 9, endotoxin (LPS), D-lactic acid and diamine oxidase (DAO) in the control group and SAP group were compared, and the correlation between PCT, NETs, MFG-E8, TLR 9 and intestinal mucosal barrier function indexes was analyzed. Among the 174 patients, 39 patients died within 28 days after admission and 135 patients survived. According to prognosis within 28 d, they were divided into death group (n=39) and survival group (n=135). Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of prognosis. Results: The levels of serum PCT, NETs and TLR 9 in SAP group were higher than those in the control group, and the MFG-E8 level was lower than that in the control group (P<0.05). The levels of serum LPS, D-lactic acid and DAO in the SAP group were higher than those in the control group(P<0.05). Pearson correlation analysis confirmed that LPS, D-lactic acid and DAO were positively correlated with PCT, NETs and TLR 9, and negatively correlated with MFG-E8(P<0.05). Univariate analysis showed that: the prognosis of patients with SAP was related to age, diabetes mellitus, blood amylase, acute physiological function and chronic health score System Ⅱ (APACHE Ⅱ) score, acute pancreatitis severity bedside index (BISAP) score, LPS, D-lactic acid, DAO, PCT, NETs, MFG-E8, TLR 9, reducing alcohol consumption, low fat diet (P<0.05). Multivariate Logistic regression analysis showed that: high BISAP score, high APACHE Ⅱ score, high LPS, high PCT, high blood amylase, high D-lactic acid, high DAO, high NETs, low MFG-E8 and high TLR 9 were risk factors for the prognosis of patients with SAP. Reducing alcohol consumption and low fat diet were the protective factors for the prognosis of patients with SAP(P<0.05). Conclusion: The levels of serum PCT, NETs, MFG-E8 and TLR 9 in patients with SAP are abnormal and correlated with intestinal mucosal barrier function. Meanwhile, blood amylase, APACHEⅡ score, BISAP score, LPS, PCT, D-lactic acid, DAO, NETs, MFG-E8 and TLR 9 are risk factors for the prognosis of patients with SAP, while reducing alcohol consumption and low fat diet are protective factors for the prognosis of patients with SAP. Early clinical evaluation should be paid attention to to improve the prognosis of patients. |
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