BISAP评分联合促炎/抗炎细胞因子检测对重症急性胰腺炎预后的评估价值

目的：探讨急性胰腺炎严重程度床边指数( BISAP)评分联合促炎/抗炎细胞因子检测对重症急性胰腺炎( SAP)预后的评估价值。方法选择2012年1月—2014年12月解放军323医院消化内科收治的SAP患者160例,均予常规治疗。于患者入院24 h内进行BISAP评分,检测血清白介素( IL)-6、IL-8、IL-10水平,记录患者预后指标,包括死亡、MODS、感染、局部并发症。依据预后不同分组,比较BISAP评分及血清IL-6、IL-8、IL-10差异,分别以BISAP评分及血清IL-6、IL-8、IL-10的中位值为界值,比较组间结局差异；分析BISAP评分与血清IL-6、IL-8、IL-10的相关性以及BISAP评分对SAP预后的预测能力。结果依局部并发症、感染、MODS、死亡不同预后分组,BISAP评分及血清IL-6、IL-8水平均依次增高、血清IL-10水平依次降低(F=3.72~5.39, P<0．05)。 BISAP评分≥3分、IL-6≥65μg/L、IL-8≥180μg/L、IL-10<40μg/L 的患者死亡、MODS 及感染的发生率均高于 BISAP 评分<3分、IL-6<65μg/L、IL-8<180μg/L、IL-10≥40μg/L患者(χ2=3.99~7.78, P<0．05,P<0．01)。 Pearson直线相关分析显示,死亡患者BISAP评分与血清IL-6、IL-8水平均呈显著正相关(r=0.60、0.49, P<0．05),而与血清IL-10水平呈显著负相关(r=-0.52, P<0．05)。 MODS、感染患者也具有一致的相关性。 ROC曲线显示,BISAP评分对死亡、MODS具有良好的预测能力(Z=3.29、5.17, P<0．05)。结论 BISAP评分联合促炎/抗炎细胞因子检测对SAP预后具有较好的评估价值,BISAP评分≥3分、IL-6≥65μg/L、IL-8≥180μg/L、IL-10<40μg/L提示患者病情危重、预后不佳,原因可能与促炎/抗炎细胞因子失衡、促炎细胞因子占据优势而增加了炎性损伤有关。

Evaluation Value of BISAP Score Combined with Inflammatory/Anti-inflammatory Cytokines in Detection of Prognosis of Patients with Severe Acute Pancreatitis

Objective To investigate the evaluation value of bedside index for severity in acute pancreatitis ( BISAP) score combined with inflammatory/anti-inflammatory cytokines in detection of prognosis of severe acute pancre-atitis ( SAP) in order to provide reference for SAP clinical treatment. Methods A total of 160 SAP patients during Janu-ary 2012 and December 2014 were recruited in this study, and all underwent conventional treatment. BISAP score, serum interleukin-6 (IL-6), IL-8 and IL-10 levels were detected within 24 h upon admission, and prognostic indicators such as death, multiple organ dysfunction syndrome (MODS), infection and local complications were recorded. Patients were di-vided into different groups by different prognoses, and then the values of BISAP score, serum IL-6, IL-8 and IL-10 levels were compared. Median values of the above indicators were used as border values respectively, and the differences were compared between the groups. Correlations between BISAP score and serum IL-6, IL-8 and IL-10 levels were analyzed, and the prediction value of BISAP score on SAP prognosis was also analyzed. Results Groups were divided by local complications, infection, MODS and death, BISAP score and serum IL-6 and IL-8 levels were increased in turn, while serum IL-10 levels were decreased in turn (F=3. 72-5. 39, P<0. 05). Incidence rates of death, MODS and infection in patients with BISAP score over or equal 3 scores, IL-6 level over or equal 65 μg/L, IL-8 level over or equal 180 μg/L and IL-10 level less than 40μg/L were all higher than those of patients with BISAP score less than 3 scores, IL-6 level less than 65 μg/L, IL-8 level less than 180 μg/L and IL-10 large or equal 40 μg/L (χ2 =3. 99-7. 78, P<0. 05, P<0. 01 ) . Pearson linear correlation analysis showed that BISAP score had positive correlation with serum IL-6 and IL-8 lev-els in death cases (r=0. 60, 0. 49, P<0. 05), yet had negative correlation with serum IL-10 level in death patients (r= -0. 52, P<0. 05), and congruous correlations were found in MODS and infection patients. The ROC curves showed that BISAP score had good predictive ability for death and MODS (Z=3. 29, 5. 17, P<0. 05). Conclusion BISAP score combined with inflammatory/anti-inflammatory cytokines detection has good evaluation value on SAP prognosis , and BISAP score over or equal 3 scores, IL-6 level over or equal 65 μg/L, IL-8 level over or equal 180 μg/L and IL-10 level less than 40μg/L hint critical condition or poor prognosis of patients, and the causes may be related to increasing in-flammatory injury induced by inflammatory/anti-inflammatory cytokine imbalance and dominant inflammatory cytokine.