急性胰腺炎患者外周血TLR4、IL-1β、NLR水平与疾病进展和预后的关系

doi:10.11958/20231354

摘要/Abstract

摘要：

目的研究急性胰腺炎（AP）患者外周血Toll样受体4（TLR4）、白细胞介素（IL）-1β、中性粒细胞/淋巴细胞比值（NLR）与疾病进展、预后的关系。方法 250例AP患者按病情分为轻症组（121例）、中重症组（89例）、重症组（40例），依据治疗5 d后预后情况分为预后不良组（33例）、预后良好组（217例）。对比不同时间点、不同病情及不同预后AP患者外周血TLR4、IL-1β、NLR水平，采用Pearson相关分析外周血TLR4、IL-1β、NLR与Ranson评分、淀粉酶的相关性，绘制受试者工作特征（ROC）曲线分析各指标诊断重症AP的价值，多因素Logistic回归分析预后危险因素。结果 AP患者入院24 h TLR4、IL-1β、NLR水平较入院48 h、72 h高（P<0.05）；随病情加重，AP患者入院24 h TLR4、IL-1β水平升高，重症组NLR水平高于中重症组和轻症组（P<0.05）；AP患者入院24 h TLR4、IL-1β、NLR水平与入院48 h Ranson评分及入院24 h淀粉酶水平均呈正相关（P<0.05）；入院24 h TLR4、IL-1β、NLR联合预测重症AP的ROC曲线下面积、敏感度、特异度分别为0.895、84.53%、81.69%；预后不良组入院24 h TLR4、IL-1β、NLR水平高于预后良好组（P<0.05），且多因素Logistic回归分析显示入院24 h TLR4、IL-1β、NLR升高为AP患者预后不良的独立危险因素（P<0.05）。结论 AP患者外周血TLR4、IL-1β、NLR水平与疾病进展、预后有密切关联，可作为重要监测指标。

关键词: 胰腺炎, Toll样受体4, 白细胞介素4, 预后, 中性粒细胞/淋巴细胞比值

Abstract:

Objective To study the relationship between peripheral blood Toll like receptor 4 (TLR4), interleukin-1β (IL-1β) and neutrophil-to-lymphocyte ratio (NLR) and the progression and prognosis of acute pancreatitis (AP). Methods A total of 250 patients with AP were divided into the mild group (121 cases), the moderately severe group (89 cases) and the severe group (40 cases) according to the disease severity. Patients were divided into the poor prognosis group (33 cases) and the good prognosis group (217 cases) based on the prognosis after 5 days of treatment. Peripheral blood levels of TLR4, IL-1β and NLR were compared at different time points, different conditions and different prognosis in patients. The correlation of peripheral blood levels of TLR4, IL-1β and NLR, Ranson score and amylase were analyzed by Pearson correlation analysis. The value of each indicator in the diagnosis of severe AP was analyzed using ROC curve, and multivariate Logistic regression analysis was conducted to identify the prognostic risk factors. Results TLR4, IL-1β and NLR levels in AP patients were higher 24 h after admission than 48 h and 72 h after admission (P<0.05). Peripheral blood TLR4 and IL-1β levels in AP patients at 24 h after admission increased with the condition became worse. NLR level was higher in the severe group than that in the moderately group or the mild group (P<0.05). Peripheral blood TLR4, IL-1β and NLR levels in AP patients 24 h after admission were positively correlated with Ranson score at 48 h after admission and amylase level at 24 h after admission (P<0.05). The area under ROC curve, sensitivity and specificity of the combination of TLR4, IL-1β and NLR at 24 h after admission for predicting severe AP were 0.895, 84.53% and 81.69%. Peripheral blood TLR4, IL-1β and NLR levels 24 h after admission were higher in the poor prognosis group than those in the good prognosis group (P<0.05). Multivariate Logistic regression analysis showed that elevated TLR4, IL-1β and NLR at 24 h after admission were independent risk factors for poor prognosis of patients with AP (P<0.05). Conclusion Peripheral blood TLR4, IL-1β and NLR in patients with AP are closely related to disease progression and prognosis. Therefore, they can be taken as important monitoring indicators.

Key words: pancreatitis, Toll-like receptor 4, interleukin-4, prognosis, neutrophil-to-lymphocyte ratio

中图分类号:

R576

图/表 6

参考文献 18

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时间	TLR4	IL-1β/（ng/L）	NLR
入院24 h	0.63±0.09	19.69±2.53	9.09±1.16
入院48 h	0.45±0.05^a	18.56±5.02^a	8.30±1.81^a
入院72 h	0.39±0.08^ab	15.37±2.77^ab	7.11±0.79^ab
F	588.684^＊＊	157.564^＊＊	237.613^＊＊

时间	TLR4	IL-1β/（ng/L）	NLR
入院24 h	0.63±0.09	19.69±2.53	9.09±1.16
入院48 h	0.45±0.05^a	18.56±5.02^a	8.30±1.81^a
入院72 h	0.39±0.08^ab	15.37±2.77^ab	7.11±0.79^ab
F	588.684^＊＊	157.564^＊＊	237.613^＊＊

组别	n		入院48 h Ranson评分/分		入院24 h TLR4
轻症组	121		1.95±0.22		0.60±0.08
中重症组	89		3.02±0.15^a		0.65±0.07^a
重症组	40		4.58±0.78^ab		0.76±0.07^ab
F			853.356^＊＊		68.936^＊＊
组别		入院24 h IL-1β/（ng/L）		入院24 h NLR
轻症组		18.84±2.09		8.86±0.94
中重症组		19.94±1.67^a		9.05±0.83
重症组		23.01±2.42^ab		10.37±1.49^ab
F		64.597^＊＊		34.538^＊＊

组别	n		入院48 h Ranson评分/分		入院24 h TLR4
轻症组	121		1.95±0.22		0.60±0.08
中重症组	89		3.02±0.15^a		0.65±0.07^a
重症组	40		4.58±0.78^ab		0.76±0.07^ab
F			853.356^＊＊		68.936^＊＊
组别		入院24 h IL-1β/（ng/L）		入院24 h NLR
轻症组		18.84±2.09		8.86±0.94
中重症组		19.94±1.67^a		9.05±0.83
重症组		23.01±2.42^ab		10.37±1.49^ab
F		64.597^＊＊		34.538^＊＊

指标	AUC	AUC95%CI	P	敏感度/%	特异度/%
TLR4	0.808	0.745~0.871	<0.001	78.45	74.56
IL-1β	0.772	0.698~0.846	<0.001	76.22	75.68
NLR	0.701	0.601~0.800	<0.001	73.41	69.47
联合检测	0.895	0.852~0.938	<0.001	84.53	81.69