sCD14-ST、PTX-3对重症急性胰腺炎合并胰周坏死感染的预测价值

doi:10.11958/20220967

摘要/Abstract

摘要：

目的探讨血清可溶性白细胞分化抗原14亚型（sCD14-ST）、正五聚蛋白-3（PTX-3）预测重症急性胰腺炎（SAP）合并胰周坏死感染的价值。方法 112例SAP患者根据胰周坏死感染情况分为感染组（54例）和未感染组（58例）。对感染组的患者进行病原菌的培养。采用酶联免疫吸附试验检测血清sCD14-ST、PTX-3、降钙素原（PCT）以及C反应蛋白（CRP）的表达情况。结果感染组患者共检出61株病原菌，其中革兰阴性菌45株（73.77%），革兰阳性菌14株（22.95%），真菌2株（3.28%）。感染组血清sCD14-ST、PTX-3、PCT、CRP水平高于未感染组（P<0.05）。SAP患者血清sCD14-ST与PTX-3、PCT、CRP均呈正相关（P<0.05）。血清PTX-3与sCD14-ST、PCT、CRP均呈正相关（P<0.05）。sCD14-ST、PTX-3、PCT、CRP升高均是SAP患者发生胰周坏死感染的危险因素（P<0.05）。sCD14-ST、PTX-3、PCT、CRP预测SAP患者发生胰周坏死感染的曲线下面积分别为0.854（95%CI：0.784~0.925）、0.851（95%CI：0.780~0.923）、0.837（95%CI：0.756~0.919）、0.749（95%CI：0.654~0.844）。结论 SAP合并胰周坏死感染患者的血清sCD14-ST、PTX-3水平异常升高，且其表达水平与患者的感染风险密切相关，两者对SAP合并胰周坏死感染的预测价值较高。

关键词: 胰腺炎，急性坏死性, 细菌感染和真菌病, 预后, 可溶性白细胞分化抗原14亚型, 正五聚蛋白-3

Abstract:

Objective To explore the predictive value of serum soluble leukocyte differentiation antigen subtype 14 (sCD14 st) and pentamerin-3 (PTX-3) in severe acute pancreatitis (SAP) complicated with peripancreatic necrosis infection. Methods A total of 112 SAP patients were selected and divided into the infection group (54 cases) and the non-infection group. Cultures of pathogenic bacteria were performed in patients of the infection group. Enzyme-linked immunosorbent assay was used to detect serum levels of sCD14 st, PTX-3, procalcitonin (PCT) and C-reactive protein (CRP). Results A total of 61 strains of pathogenic bacteria were detected in the infection group, including 45 strains of Gram-negative bacteria (73.77%), 14 strains of Gram-positive bacteria (22.95%) and 2 strains of fungi (3.28%). The serum levels of sCD14-ST, PTX-3, PCT and CRP were significantly higher in the infected group than those in the non-infected group (P<0.05). Serum sCD14-ST was positively correlated with PTX-3, PCT and CRP in SAP patients (P<0.05). Serum PTX-3 was positively correlated with sCD14-ST, PCT and CRP (P<0.05). The high levels of sCD14-ST, PTX-3, PCT and CRP were the risk factors of peripancreatic necrosis infection in SAP patients (P<0.05). The areas under the curve of sCD14-ST, PTX-3, PCT and CRP predicting peripancreatic necrosis infection in SAP patients were 0.854 (95%CI: 0.784-0.925), 0.851 (95%CI: 0.780-0.923), 0.837 (95%CI: 0.756-0.919) and 0.749 (95%CI: 0.654-0.844) respectively. Conclusion The serum levels of sCD14-ST and PTX-3 are abnormally elevated in SAP patients with peripancreatic necrosis infection, and their expression levels are closely related to the risk of infection. Both of them have high predictive value for SAP patients with peripancreatic necrosis infection.

Key words: pancreatitis, acute necrotizing, bacterial infections and mycoses, prognosis, soluble leukocyte differentiation antigen 14 isoform, pentraxin-3

中图分类号:

R657.5+1

图/表 4

参考文献 18

[1]	GLIEM N, AMMER-HERRMENAU C, ELLENRIEDER V, et al. Management of severe acute pancreatitis:An update[J]. Digestion, 2021, 102(4):503-507. doi:10.1159/000506830.
[2]	GARG P K, SINGH V P. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156(7):2008-2023. doi:10.1053/j.gastro.2018.12.041.
[3]	LI W, OU L, FU Y, et al. Risk factors for concomitant infectious pancreatic necrosis in patients with severe acute pancreatitis:A systematic review and Meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2022, 46(5):101901. doi:10.1016/j.clinre.2022. 101901.
[4]	ZHU X, LI K, ZHENG J, et al. Usage of procalcitonin and sCD14-ST as diagnostic markers for postoperative spinal infection[J]. J Orthop Traumatol, 2022, 23(1):25. doi:10.1186/s10195-022-00644-9.
[5]	ZHOU W, RAO H, DING Q, et al. Soluble CD14 subtype in peripheral blood is a biomarker for early diagnosis of sepsis[J]. Lab Med, 2020, 51(6):614-619. doi:10.1093/labmed/lmaa015.
[6]	VYAS V, PAULA LONGHI M. Pentraxin 3:A novel target in the obesity-inflammation cascade[J]. Cardiovasc Res, 2019, 115(13):1811-1812. doi:10.1093/cvr/cvz146.
[7]	STAUBLI S M, SCHAFER J, ROSENTHAL R, et al. The role of CRP and Pentraxin 3 in the prediction of systemic inflammatory response syndrome and death in acute pancreatitis[J]. Sci Rep, 2019, 9(1):18340. doi:10.1038/s41598-019-54910-8.
[8]	张怡, 谭辉, 刘宁, 等. 血清sPD-L1联合Balthazar CT分级对急性胰腺炎患者后期胰周坏死感染的预测能效[J]. 河北医学, 2021, 27(8):1325-1329.
	ZHANG Y, TAN H, LIU N, et al. Predictive energy efficiency of serum SPD-L1 combined with balthazar CT grading in patients with acute pancreatitis in the late stage of peripancreatic necrosis infection[J]. Hebei Med, 2021, 27(8):1325-1329. doi:10.3969/j.issn.1006-6233.2021.08.020.
[9]	MEDEROS M A, REBER H A, GIRGIS M D. Acute pancreatitis:A review[J]. JAMA, 2021, 325(4):382-390. doi:10.1001/jama.2020.20317.
[10]	李幼生. 抗生素在重症急性胰腺炎治疗中的合理应用:争议与进展[J]. 中华医学杂志, 2021, 101(30):2346-2348.
	LI Y S. Rational use of antibiotics in severe acute pancreatitis:controversy and progress[J]. Natl Med J China, 2021, 101(30):2346-2348. doi:10.3760/cma.j.cn112137-20210307-00580.
[11]	谢蕾, 刘航, 申洋, 等. 重症急性胰腺炎并发感染的危险因素及对机体免疫水平的影响[J]. 中华胰腺病杂志, 2020, 20(4):283-287.
	XIE L, LIU H, SHEN Y, et al. Risk factors for severe acute pancreatitis complicated with infection and the effects on immune level[J]. Chin J Pancreatol, 2020, 20(4):283-287. doi:10.3760/cma.j.cn115667-20190826-00076.
[12]	GAD G I, SHINKAR D M, KAMEL EL-DIN M M, et al. The utility of soluble CD14 subtype in early diagnosis of culture-proven early-onset neonatal sepsis and prediction of outcome[J]. Am J Perinatol, 2020, 37(5):497-502. doi:10.1055/s-0039-1683863.
[13]	TAKEUCHI M, YOKOSE T, KAWAKUBO H, et al. The perioperative presepsin as an accurate diagnostic marker of postoperative infectious complications after esophagectomy:A prospective cohort study[J]. Esophagus, 2020, 17(4):399-407. doi:10.1007/s10388-020-00736-7.
[14]	VAN MALDEGHEM I, NUSMAN C M, VISSER D H. Soluble CD14 subtype (sCD14-ST) as biomarker in neonatal early-onset sepsis and late-onset sepsis:A systematic review and meta-analysis[J]. BMC Immunol, 2019, 20(1):17. doi:10.1186/s12865-019-0298-8.
[15]	LIN T Y, GUO H, CHEN X. Unraveling mechanisms of pentraxin 3 secretion in adipocytes during inflammation[J]. J Mol Endocrinol, 2021, 67(3):55-69. doi:10.1530/JME-21-0026.
[16]	SEKINE Y, KOTANI K, OKA D, et al. Presepsin as a predictor of septic shock in patients with urinary tract infection[J]. BMC Urol, 2021, 21(1):144. doi:10.1186/s12894-021-00906-4.
[17]	赵德浩, 蒋梁, 赵军. PTX-3在开颅术后颅内感染中的诊断价值研究[J]. 重庆医学, 2020, 49(16):2755-2757.
	ZHAO D H, JIANG L, ZHAO J. Study on the diagnosis value of PTX-3 for intracranial infection after craniotomy[J]. Chongqing Med, 2020, 49(16):2755-2757. doi:10.3969/j.issn.1671-8348.2020.16.034.
[18]	BAUMERT M, SURMIAK P, SZYMKOWIAK M, et al. The assessment of pentraxin 3:A novel biomarker in early detection of infection in newborns[J]. Biomed Res Int, 2021, 30(6):6638622. doi:10.1155/2021/6638622.

组别	n	性别（男/女）	年龄（岁）		病因				BMI （kg/m²）
组别	n	性别（男/女）	年龄（岁）		胆源性		非胆源性		BMI （kg/m²）
感染组	54	34/20	57.71±4.35		32（59.26）		22（40.74）		22.09±1.33
未感染组	58	30/28	55.94±5.76		25（43.10）		33（56.90）		22.12±1.47
χ²或t		1.442	1.825		2.921				0.113
组别	sCD14-ST（ng/L）			PTX-3（μg/L）		PCT（μg/L）		CRP（mg/L）
感染组	1 183.40±331.33			10.26±2.89		4.84±1.67		89.62±22.16
未感染组	804.95±186.39			6.59±2.26		2.91±1.06		70.97±16.24
χ²或t	7.831^＊＊			7.533^＊＊		7.351^＊＊		5.105^＊＊

组别	n	性别（男/女）	年龄（岁）		病因				BMI （kg/m²）
组别	n	性别（男/女）	年龄（岁）		胆源性		非胆源性		BMI （kg/m²）
感染组	54	34/20	57.71±4.35		32（59.26）		22（40.74）		22.09±1.33
未感染组	58	30/28	55.94±5.76		25（43.10）		33（56.90）		22.12±1.47
χ²或t		1.442	1.825		2.921				0.113
组别	sCD14-ST（ng/L）			PTX-3（μg/L）		PCT（μg/L）		CRP（mg/L）
感染组	1 183.40±331.33			10.26±2.89		4.84±1.67		89.62±22.16
未感染组	804.95±186.39			6.59±2.26		2.91±1.06		70.97±16.24
χ²或t	7.831^＊＊			7.533^＊＊		7.351^＊＊		5.105^＊＊

指标	β	SE	Wald χ²	P	OR	OR 95%CI
sCD14-ST	0.654	0.205	10.178	0.001	1.923	1.287~2.874
PTX-3	0.796	0.220	13.091	0.000	2.217	1.440~3.412
PCT	0.641	0.197	10.587	0.001	1.898	1.290~2.793
CRP	0.435	0.174	6.250	0.012	1.545	1.099~2.173
常数项	0.128	0.048	7.111	0.008	1.137	-

指标	β	SE	Wald χ²	P	OR	OR 95%CI
sCD14-ST	0.654	0.205	10.178	0.001	1.923	1.287~2.874
PTX-3	0.796	0.220	13.091	0.000	2.217	1.440~3.412
PCT	0.641	0.197	10.587	0.001	1.898	1.290~2.793
CRP	0.435	0.174	6.250	0.012	1.545	1.099~2.173
常数项	0.128	0.048	7.111	0.008	1.137	-

指标	AUC	AUC 95%CI	敏感度（%）	特异度（%）	约登指数
sCD14-ST	0.854	0.784~0.925	81.48	79.31	0.608
PTX-3	0.851	0.780~0.923	79.63	81.03	0.607
PCT	0.837	0.756~0.919	77.78	81.03	0.588
CRP	0.749	0.654~0.844	72.22	77.59	0.498