IL-17及IL-12p70与高脂血症性急性胰腺炎患者的病情及预后的关系

doi:10.11958/20220540

摘要/Abstract

摘要：

目的探讨白细胞介素（IL）-17、IL-12p70与高脂血症性急性胰腺炎患者病情严重程度及预后的关系。方法选取60例高脂血症性急性胰腺炎患者,根据病情严重程度分为轻度组（19例）、中度组（27例）和重度组（14例）,比较3组患者血清IL-17、IL-12p70水平,分析血清IL-17、IL-12p70水平与病情严重程度的关系。随访28 d,统计患者预后情况,分析高脂血症性急性胰腺炎患者死亡的影响因素。采用受试者工作特征（ROC）曲线分析血清IL-17、IL-12p70水平对高脂血症性急性胰腺炎患者死亡的预测价值。结果轻、中、重度组患者血清IL-17、IL-12p70水平依次增高（均P<0.05）。相关性分析显示血清IL-17、IL-12p70与病情严重程度均呈正相关（r_s分别为0.429、0.384,均P<0.01）。单因素分析显示,死亡患者的性别,合并糖尿病、高血压、冠心病比例及年龄、血清降钙素原（PCT）、空腹血糖（Glu）、总胆固醇（TC）、血淀粉酶（AMY）水平与生存患者比较差异均无统计学意义（P>0.05）,死亡患者的重度比例及血清C反应蛋白（CRP）、三酰甘油（TG）、IL-17、IL-12p70水平均高于生存患者（P<0.05）。多因素分析显示IL-17和IL-12p70水平升高是影响高脂血症性急性胰腺炎患者死亡的独立危险因素（P<0.05）。ROC分析显示,血清IL-17、IL-12p70水平预测高脂血症性急性胰腺炎患者死亡的最佳截断值分别为331.17 ng/L和24.60 ng/L,敏感度分别为85.71%和78.57%,特异度分别为71.74%和76.09%,曲线下面积（AUC）分别为0.798和0.783,两者联合的敏感度、特异度和AUC分别为92.86%、63.04%和0.823。结论血清IL-17、IL-12p70水平与高脂血症性急性胰腺炎病情严重程度及预后有关,检测其水平对预测患者死亡具有一定的临床价值。

关键词: 白细胞介素17, 白细胞介素12, 胰腺炎, 预后, 白细胞介素12p70, 高脂血症性急性胰腺炎

Abstract:

Objective To explore the relationship between interleukin 17 (IL-17), interleukin 12p70 (IL-12p70) and the severity and prognosis of hyperlipidemic acute pancreatitis. Methods A total of 60 patients with hyperlipidemic acute pancreatitis admitted to the Department of Critical Care Medicine, Fuyang People's Hospital were selected and divided into the mild group (19 cases), the moderate group (27 cases) and the severe group (14 cases) according to the severity of the disease. Serum levels of IL-17 and IL-12p70 were compared between the three groups. The relationship between serum levels of IL-17 and IL-12p70 and the severity of the disease was analyzed. Patients were followed up for 28 days, and the prognosis was analyzed. The influencing factors of death in patients with hyperlipidemic acute pancreatitis were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum IL-17 and IL-12p70 levels for death in patients with hyperlipidemic acute pancreatitis. Results Serum levels of IL-17 and IL-12p70 were increased sequentially in the mild group, the moderate group and the severe group (all P<0.05). Correlation analysis showed that serum levels of IL-17 and IL-12p70 were positively correlated with disease severity (r_s=0.429, 0.384, both P<0.01). Univariate analysis showed that there were no significant differences in gender, proportion of patients with diabetes, hypertension, coronary heart disease and age, serum procalcitonin (PCT), fasting blood glucose (Glu), total cholesterol (TC) and blood amylase (AMY) levels between the dead patients and the surviving patients (P>0.05). The severe proportion and serum C-reactive protein (CRP), triacylglycerol (TG), IL-17 and IL-12p70 levels were significantly higher in the dead patients than those of the surviving patients (P<0.05). Multivariate analysis showed that the elevated levels of IL-17 and IL-12p70 were independent risk factors for death in patients with hyperlipidemic acute pancreatitis (P<0.05). ROC analysis showed that the best cut-off values of serum IL-17 and IL-12p70 levels for predicting death in patients with hyperlipidemic acute pancreatitis were 331.17 ng/L and 24.60 ng/L, the sensitivity was 85.71% and 78.57%, the specificity was 71.74% and 76.09%, and the area under the curve (AUC) was 0.798 and 0.783, respectively. The combined sensitivity, specificity and AUC were 92.86%, 63.04% and 0.823, respectively. Conclusion Serum IL-17 and IL-12p70 levels are related to the severity and prognosis of hyperlipidemic acute pancreatitis, and clinical detection of their levels has a certain predictive value in predicting the death of patients.

Key words: interleukin-17, interleukin-12, pancreatitis, prognosis, interleukin 12p70, hyperlipidemia acute pancreatitis

中图分类号:

R576

图/表 5

参考文献 20

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组别	n	IL-17	IL-12p70
轻度组	19	235.72±43.05	17.31±3.28
中度组	27	314.69±55.37^a	21.54±3.75^a
重度组	14	386.27±69.82^ab	26.33±4.46^ab
F		30.057^＊＊	22.937^＊＊

组别	n	IL-17	IL-12p70
轻度组	19	235.72±43.05	17.31±3.28
中度组	27	314.69±55.37^a	21.54±3.75^a
重度组	14	386.27±69.82^ab	26.33±4.46^ab
F		30.057^＊＊	22.937^＊＊

组别		n		男性			年龄（岁）		合并糖尿病				合并高血压
死亡组		16		12（75.0）			46.38±7.76		10（62.5）				7（43.8）
生存组		44		29（65.9）			44.72±6.15		25（56.8）				16（36.4）
χ²或t				0.448			0.861		0.156				0.271
组别			合并冠心病					严重程度
组别			合并冠心病					轻度			中度				重度
死亡组			8（50.0）					1（6.2）			8（50.0）				7（43.8）
生存组			19（43.2）					18（40.9）			19（43.2）				7（15.9）
χ²或t			0.220								8.470^＊
组别	CRP（mg/L）					TG（mmol/L）				PCT（µg/L）		Glu（mmol/L）
死亡组	134.29±22.71					29.86±5.09				4.35±0.83		10.34±1.70
生存组	118.56±19.33					25.14±4.23				4.18±0.74		9.65±1.62
χ²或t	2.660^＊					2.852^＊＊				0.762		1.440
组别		TC （mmol/L）			AMY （U/L）				IL-17 （ng/L）					IL-12p70 （ng/L）
死亡组		11.28±2.06			406.58±57.22				371.49±68.64					25.92±4.31
生存组		10.79±1.69			428.93±62.47				294.52±51.07					20.16±3.75
χ²或t		0.936			1.252				33.721^＊＊					5.056^＊＊

组别		n		男性			年龄（岁）		合并糖尿病				合并高血压
死亡组		16		12（75.0）			46.38±7.76		10（62.5）				7（43.8）
生存组		44		29（65.9）			44.72±6.15		25（56.8）				16（36.4）
χ²或t				0.448			0.861		0.156				0.271
组别			合并冠心病					严重程度
组别			合并冠心病					轻度			中度				重度
死亡组			8（50.0）					1（6.2）			8（50.0）				7（43.8）
生存组			19（43.2）					18（40.9）			19（43.2）				7（15.9）
χ²或t			0.220								8.470^＊
组别	CRP（mg/L）					TG（mmol/L）				PCT（µg/L）		Glu（mmol/L）
死亡组	134.29±22.71					29.86±5.09				4.35±0.83		10.34±1.70
生存组	118.56±19.33					25.14±4.23				4.18±0.74		9.65±1.62
χ²或t	2.660^＊					2.852^＊＊				0.762		1.440
组别		TC （mmol/L）			AMY （U/L）				IL-17 （ng/L）					IL-12p70 （ng/L）
死亡组		11.28±2.06			406.58±57.22				371.49±68.64					25.92±4.31
生存组		10.79±1.69			428.93±62.47				294.52±51.07					20.16±3.75
χ²或t		0.936			1.252				33.721^＊＊					5.056^＊＊

影响因素	β	SE	Wald χ²	P	OR（95%CI）
IL-17	1.385	0.417	11.031	<0.001	3.995（1.764~9.046）
IL-12p70	1.406	0.438	10.304	<0.001	4.080（1.729~9.626）
常数项	-22.017	5.826	14.282	<0.001	<0.001