重症胆源性胰腺炎早期内镜治疗的临床对照研究

目的探讨重症胆源性胰腺炎早期内镜治疗的临床价值。方法采用前瞻性随机对照研究,纳入佛山市第一人民医院2011年9月-2014年11月收治的确诊为重症胆源性胰腺炎患者共100例,所有病例均在发病72 h内接受治疗,其中非手术治疗组采用常规对症内科治疗,包括胃肠减压、灌肠、肠内营养、腹腔穿刺引流等方法;内镜治疗组则在非手术治疗组的基础上进行内镜下治疗。观察两组患者1周内的APACHE-Ⅱ和Balthazar CT评分,同时记录并发症和死亡率。结果入院治疗后第3天开始,内镜治疗组的APACHE-Ⅱ评分低于非手术治疗组,两组相比差异有统计学意义(P0.05);入院后第7天内镜治疗组Balthazar评分低于非手术治疗组,两组相比差异有统计学意义(P0.05),内镜治疗组并发症和死亡率低于非手术治疗组,差异有统计学意义(P0.05)。结论早期内镜治疗与非手术治疗相比可以降低重症胆源性胰腺炎的并发症及死亡率,是治疗急性胆源性合并胆管梗阻的有效方法之一。     

早期应用柴芩承气汤治疗老年重症急性胰腺炎随机对照研究

目的探讨早期运用柴芩承气汤治疗老年性重症急性胰腺炎（ESAP）的临床疗效。方法将80例ESAP患者,按1：1比例随机分为早期治疗组（n=40例,入院时服用柴芩承气汤）和晚期治疗组（n=40例,72h后再加柴芩承气汤）,对比分析两组并发症的疗效。结果总病死率36.25%;入院时Ranson评分、CT评分及APACHEⅡ评分两组间无统计学差异（P〉0.05）;早期治疗组ARDS、肾功能衰竭、休克、心衰、肝功能衰竭、感染发生率明显低于晚期治疗组（P〈0.05）,同时中转ICU率、手术率、病死率及住院时间也明显低于晚期治疗组（P〈0.05）。结论早期使用柴芩承气汤能明显降低ESAP患者的并发症,从而减少中转ICU率、手术率、病死率及住院时间。     

早期肠内营养支持治疗对重症急性胰腺炎自然病程的影响

目的探讨早期肠内营养（EEN）支持对重症急性胰腺炎（SAP）治疗的影响。方法将60例SAP患者随机分为2组,实验组在常规治疗基础上实施EEN持续至经口进食。观察治疗后血/尿淀粉酶、血常规、肝肾功能、血浆内毒素变化;比较治疗前后APACHEⅡ评分、Balthazar CT评分、住院费用及天数。结果 2组治疗后血/尿淀粉酶、血常规、肝肾功能等均无明显变化;实验组治疗后内毒素水平较治疗前及对照组治疗后降低（P〈0.05或〈0.01）。入院1周后2组APACHEⅡ评分无统计学差异,实验组Balthazar CT评分、住院天数及费用均高于对照组（P均〈0.01）。结论 EEN支持治疗能明显降低SAP患者感染、并发症的发生,缩短患者病程,减少住院费用。     

酒精相关性重症急性胰腺炎的临床探讨

目的探讨酒精相关性重症急性胰腺炎(ARSAP)的临床特点.方法 2001 ～ 2004年我院共收治重症急性胰腺炎(SAP)721例,符合纳入标准并剔除排除标准者347例,分成ARSAP组(77例)和对照组(270例),对比分析其年龄、性别、入院时Ranson评分、CT评分、APACHEⅡ评分、血糖、血清三酰甘油、并发症及后期感染率和病死率.结果两组年龄无统计学差异(P ＞ 0.05),ARSAP组男性的构成比明显高于对照组(P ＜ 0.01),入院时两组Ranson评分、CT评分及血糖无统计学差异(P ＞ 0.05),但ARSAP组APACHEⅡ评分和血清三酰甘油水平明显高于对照组(P ＜ 0.05),ARSAP组ARDS和上消化道出血的发生率与对照组无统计学差异(P ＞ 0.05),急性肾功能衰竭、肝功能不全、休克、心功能衰竭、脑病、感染的发生率及病死率明显高于对照组(P ＜ 0.05).结论 ARSAP患者以男性为主,并发症多,病死率高;治疗的关键是,早期诊断,及时体液复苏,促进酒精的排泄,改善微循环以及对症支持治疗;做好卫生知识宣传,改变酗酒的不良嗜好,是预防ARSAP的有效措施.     

血浆置换在治疗重症高脂血症性急性胰腺炎中的应用

目的评估血浆置换治疗重症高脂血脂性急性胰腺炎的临床疗效。方法 75例重症高脂血脂性急性胰腺炎患者分为血浆置换治疗组(35例)和对照组(40例),观察血浆置换治疗的安全性、两组患者的甘油三酯(TG),炎症因子、呼吸功能、肠道功能、Balthazar CT评分、住院时间和病死率等。结果治疗组的腹痛缓解时间、机械通气时间、住院时间少于对照组(P0.05),治疗组治疗第2天和第7天TG和CRP、WBC均较对照组降低(P0.05),氧合指数高于对照组(P0.05)。治疗组第7天Balthazar CT评分低于对照组(P0.05)。没有严重副反应发生。结论血浆置换对重症高脂血症性急性胰腺炎有良好的临床疗效和安全性。     

酒精相关性重症急性胰腺炎的临床探讨

目的 探讨酒精相关性重症急性胰腺炎（ARSAP）的临床特点。方法 2001～2004年我院共收治重症急性胰腺炎（SAP）721例，符合纳入标准并剔除排除标准者347例，分成ARSAP组（77例）和对照组（270例），对比分析其年龄、性别、入院时Ranson评分、CT评分、APACHEⅡ评分、血糖、血清三酰甘油、并发症及后期感染率和病死率。结果 两组年龄无统计学差异（P〉0．05），ARSAP组男性的构成比明显高于对照组（P〈0．01），入院时两组Ranson评分、CT评分及血糖无统计学差异（P〉0．05），但ARSAP组APACHEⅡ评分和血清三酰甘油水平明显高于对照组（P〈0．05），ARSAP组ARDS和上消化道出血的发生率与对照组无统计学差异（P〉0．05），急性肾功能衰竭、肝功能不全、休克、心功能衰竭、脑病、感染的发生率及病死率明显高于对照组（P〈0．05）。结论 ARSAP患者以男性为主，并发症多，病死率高；治疗的关键是，早期诊断，及时体液复苏，促进酒精的排泄，改善微循环以及对症支持治疗；做好卫生知识宣传，改变酗酒的不良嗜好，是预防ARSAP的有效措施。     

急性重症胰腺炎早期肠内、外营养联和治疗的临床观察

目的评价全胃肠外营养（TPN）和肠内营养（EN）联合应用对重症急性胰腺炎（SAP）的治疗效果，明确TPN和EN在重症急性胰腺炎中的作用。方法将我科确诊为重症急性胰腺炎的患者21例随机分为TPN组（10例）及TPN＋EN组（11例）。重症急性胰腺炎严重度评估依据：Ranson标准、APACHEⅡ评分、Balthazar CT积分。结果两组患者入院时年龄、性别及重症急性胰腺炎严重度评分等方面差异均无显著性。TPN＋EN治疗组能较TPN组更快缓解患者症状，降低疾病严重程度、MOF的发生率及死亡率，减少重症监护时间和住院时间。结论重症急性胰腺炎肠内营养和全胃肠外营养联合治疗能有效改善胰腺炎的自然病程，且能降低各种并发症的发生率和死亡率，减少患者的住院费用。     

早期个体化全胃肠外营养支持治疗重症急性胰腺炎疗效分析

目的探讨早期全胃肠外营养（TPN）支持治疗重症急性胰腺炎（SAP）的临床价值。方法治疗组23例，以TPN支持治疗；对照组26例，以常规液体治疗。两组其他治疗相同。回顾性分析两组患者的病死率、并发症的发生率、住院时间、APACHEⅡ评分、血清总蛋白、胃肠功能恢复时间、血淀粉酶恢复时间等指标的影响及疗效。结果治疗组并发症的发生率低于对照组，人院后10天治疗组患者血红蛋白、血清总蛋白明显高于对照组，治疗组住院时间、胃肠功能恢复时间、血淀粉酶恢复时间、APACHEⅡ评分明显低于对照组，两组差异有统计学意义。治疗组病死率较对照组（4．3％vs15．4％）明显降低，但两组差异无统计学意义。结论早期个体化TPN支持疗法在SAP综合治疗中起重要作用，疗效显著，能够改善营养，减少并发症的发生，改善预后，促进患者早日康复，缩短平均住院日。     

前列腺素E_1治疗急性胰腺炎的疗效及安全性研究

目的评价急性胰腺炎应用前列腺素E1治疗的临床效果及安全性。方法将包头医学院第二附属医院重症医学科收治的68例重症急性胰腺炎(SAP)患者纳入本研究,按照入院先后顺序将患者随机分为观察组和对照组,各34例。两组患者入院后给予综合治疗,对照组患者在综合治疗基础上给予生长抑素(SS),观察组患者在综合治疗基础上给予前列腺素E_1(PGE_1),对比两组临床疗效、血液生化指标、凝血指标、术后恢复情况、并发症发生率和病死率。结果观察组临床总有效率显著高于对照组(P0.05)。观察组血清淀粉酶及LDH下降幅度显著大于对照组(P0.05)。观察组治疗后第14天TT、APTT显著低于对照组(P0.05)。观察组患者入住ICU时间、症状缓解时间以及恢复进食时间显著短于对照组(P0.05)。两组不良反应发生率和病死率差异均无统计学意义(P0.05)。结论 PGE_1能明显改善SAP相关临床症状,降低血粘度,促进血清淀粉酶恢复正常,降低并发症发生率和病死率低。     

超早期手术对重症高血压脑出血患者的影响

目的探讨超早期手术对重症高血压脑出血患者的影响。方法选取2014年3月—2016年3月黄石市第五医院收治的重症高血压脑出血患者120例,采用随机数字表法分为对照组和观察组,每组60例。对照组患者采取保守治疗,观察组患者采取超早期手术。比较两组患者治疗前后神经功能缺损评分标准(ESS)评分、Barthel指数(BI)评分,致残率及并发症发生率。结果两组患者治疗前ESS评分、BI评分比较,差异无统计学意义(P>0.05);观察组患者治疗后ESS评分、BI评分高于对照组(P<0.05)。观察组患者致残率低于对照组(P<0.05)。观察组患者多器官功能衰竭综合征、肺部感染、应激性溃疡发生率低于对照组(P<0.05)。结论超早期手术可有效促进重症高血压脑出血患者神经功能恢复,有利于降低患者致残率和并发症发生率。     

Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis]

OBJECTIVE: To compare the efficacy of early total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). METHODS: A total of 22 consecutive patients with SAP were randomized to receive TPN (group I) or TEN (group II). SAP was defined applying APACHE II score, C-reactive protein (CRP) measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-a, IL-6), visceral proteins (pre-albumin, albumin), complications (systemic inflammatory response syndrome, multiorgan failure, infections), surgical interventions, length of hospital stay and mortality were evaluated. RESULTS: No significant differences were found between the two groups in the APACHE II score, in CRP, TNF-a and IL-6 concentrations or in pre-albumin and albumin levels over the first 10 days. Seven patients in group I and 4 in group II suffered severe complications. Three patients in group I required surgical intervention. Length of hospital stay was alike in the two groups. Two patients from group I died in the course of the hospitalization. CONCLUSIONS: SAP patients with TEN feeding showed a tendency towards a better outcome than patients receiving TPN.     

百草枯中毒普萘洛尔的解毒治疗有效性研究湖北省新华医院重症医学科郭俊

【】目的：探讨普萘洛尔对百草枯(paraqua,PQ)中毒的解毒治疗的临床效果。方法：回顾性分析2008年9月～2015年2月期间,我院收治的100例百草枯中毒患者,其中50例患者给予常规治疗,作为对照组,50例患者在给予常规治疗基础上,早期应用普萘洛尔治疗,作为治疗组。然后将对照组患者与治疗组患者的治疗效果进行比较。结果：治疗组患者的总有效率优于对照组,组间有显著差异(P＜0.01)。其中,在轻中度中毒患者中,治疗组患者的总有效率优于对照组,组间有显著差异(P＜0.01)；在重度中毒患者中,治疗组患者的总有效率与对照组间差异无统计学意义(P>0.05)。比较治疗组患者不同病情的治疗总有效率,轻中度中毒患者的治疗有效率明显高于重度中毒患者,组间有显著差异(P＜0.01)。比较治疗组并发症的发生率及死亡率明显低于对照组,组间均有显著差异(P＜0.01)。其中,在轻中度中毒患者中,治疗组患者的并发症发生率及死亡率明显低于对照组患者,组间有显著差异(P＜0.01)；在重度中毒患者中,两组患者的并发症发生率及死亡率无统计学差异(P>0.05)。比较治疗组不同病情患者的并发症发生率及死亡率,轻中度中毒患者的并发症发生率及死亡率明显低于对照组患者,组间有显著差异(P＜0.01)。结论：在常规治疗基础上,早期给予患者普萘洛尔治疗,能够提高轻中度中毒患者的治疗效果,降低轻中度中毒患者死亡率,但对于重度中毒患者并无特殊疗效。应继续研究百草枯中毒的特异性拮抗剂来降低死亡率。     

急性胰腺炎患者血清高迁移率族蛋白B1水平的变化及意义

目的 检测急性胰腺炎(AP)患者血清高迁移率族蛋白B1(high mobility group box-1protein,HMGB1)的水平变化,探讨HMGB1在AP发生发展中的作用.方法 以33例重症急性胰腺炎(SAP)、38例轻症急性胰腺炎(MAP)以及28例健康体检者为研究对象,在发病72 h内收集血标本,采用ELISA法检测血清HMGB1水平,分析其与患者性别,年龄,病因,发病时间,Ranson评分,Balthazar CT评分,血清C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、肌酐、总胆红素等指标,局部和(或)全身并发症的关系.结果 健康对照组、MAP组、SAP组血清HMGB1水平分别为(1.82±0.64)μg/L、(6.13±5.80)μg/L、(11.48±6.94)μg/L,SAP组显著高于MAP组,MAP组又显著高于健康对照组(P值均<0.05).在发病24 h内患者血清HMGB1水平开始增高,48 h内达峰值,后开始下降,至72 h仍维持在高于正常值水平.血清HMGB1水平与患者性别、年龄、病因无关;与Ranson评分、Balthazar CT评分、CRP、LDH、血肌酐值呈正相关关系.有局部和(或)全身并发症患者血清HMGB1水平高于无并发症者,但差异不显著.结论 HMGB1是一种晚期炎症介质,与AP病情的严重程度相关,并可能参与了SAP时肾功能不全的发生.     

Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis

Background: The advent of specific therapeutic or preventive treatments for severe acute pancreatitis creates a need to determine the risk of complications for each individual. Scoring systems used in acute pancreatitis identify groups of patients at risk of complications, but the pancreatitis-specific scores require 48 h of hospital admission to give full information. The APACHE-II score is useful within 24 h, but ignores simple clinical features, such as obesity, known to predict severity. The aim of this study was to evaluate a combination of the APACHE-II score with an obesity score in patients with acute pancreatitis, to predict severity using information available during the first 24 h of hospital admission. Methods: Data were collected prospectively from 186 consecutive patients with acute pancreatitis, to allow calculation of the APACHE-II score and body mass index (BMI). BMI was categorised as normal (score = 0), overweight (BMI 26–30: score = 1), or obese (BMI > 30: score = 2). A logistic regression model was used to identify factors significantly associated with complications (Atlanta criteria; 104 complications in 60 patients). Results: Age, BMI and the acute physiology score independently predicted complications. Addition of the score for obesity to the APACHE-II score gave a composite score (APACHE-O) with greater predictive accuracy. At cut-off of > 8, APACHE-O had sensitivity 82%, specificity 86%, positive predictive value 74%, negative predictive value 91% and overall accuracy 85%. Conclusions: This study confirms that age, obesity and APACHE-II measured in the first 24 h of hospital admission can predict complications in acute pancreatitis. Combination of the APACHE-II and obesity scores by simple addition improved categorical prediction of severity (mild or severe) in patients with acute pancreatitis.     

小剂量低分子肝素对急性胰腺炎的影响

目的 探讨小剂量低分子肝素抗凝治疗对急性胰腺炎(AP)患者的影响.方法 收集2002年至2008年住院治疗的98例AP患者,按数字表法随机分为抗凝治疗组(40例)和常规治疗对照组(58例).治疗组包括重症急性胰腺炎(SAP)15例和轻症急性胰腺炎(MAP)25例;对照组包括SAP19例和MAP 39例.对照组常规治疗,治疗组在常规治疗的基础上给予低分子肝素3 000 U皮下注射,每12 h一次,持续2周.观察各组患者治疗前后APACHEⅡ评分、并发症发生率、病死率和平均住院天数,以及治疗组的出凝血指标变化.结果 治疗组中SAP患者治疗后7 d的APACHEⅡ评分、并发症发生率、病死率和住院天数分别为9.9±4.9、20%、13.3%和(20.6±10.4)d;对照组SAP患者分别为12.2±4.8、42.1%、47.4%和(28.2±12.5)d,两组差异均有统计学意义(P<0.05).而治疗组和对照组的MAP患者之间上述指标的差异均无统计学意义.治疗组应用低分子肝素前后出凝血指标变化也无统计学意义.结论 小剂量低分子肝素能降低sAP患者并发症发生率和病死率,缩短住院时间,不引起出血并发症,建议早期应用.     

Clinical characteristics and management of patients with early acute severe pancreatitis： Experience from a medical center in China

AIM: To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP). METHODS: Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixty-nine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAP. The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared. RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31+/-0.68 vs 3.68+/-0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs 7.5%, P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE II score, Balthazar CT class, MODS and hypoxemia. CONCLUSION: ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.     

Randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis

BACKGROUND: Based on equivocal clinical data, intravenous antioxidant therapy has been used for the treatment of severe acute pancreatitis. To date there is no randomised comparison of this therapy in severe acute pancreatitis. METHODS: We conducted a randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in patients with predicted severe acute pancreatitis. Forty-three patients were enrolled from three hospitals in the Manchester (UK) area over the period June 2001 to November 2004. Randomisation stratified for APACHE-II score and hospital site, and delivered groups that were similar at baseline. RESULTS: Relative serum levels of antioxidants rose while markers of oxidative stress fell in the active treatment group during the course of the trial. However, at 7 days, there was no statistically significant difference in the primary end point, organ dysfunction (antioxidant vs placebo: 32% vs 17%, p = 0.33) or any secondary end point of organ dysfunction or patient outcome. CONCLUSIONS: This study provides no evidence to justify continued use of n-acetylcysteine, selenium, vitamin C based antioxidant therapy in severe acute pancreatitis. In the context of any future trial design, careful consideration must be given to the risks raised by the greater trend towards adverse outcome in patients in the treatment arm of this study.     

Evaluation of prognostic factors in patients with acute pancreatitis.

BACKGROUND/AIMS: The severity of acute pancreatitis is variable and does not always correlate with structural and functional changes in the pancreas. More precise predictors of severity are necessary to enable intensive therapy to be targeted at patients with severe attacks, and to judge efficacy of treatment, to help in the early detection of complications, and to facilitate comparison of patients from different centers. METHODOLOGY: On admission, clinical criteria, biochemical and hematological parameters and multiple prognostic scores (Ranson, Imrie and APACHE-II scores) were collected from patients with acute pancreatitis. RESULTS: Two hundred and twenty-seven patients were seen during the study period. The overall mortality rate was 11.4%. A significantly higher mortality was found in patients with severe pancreatitis (25.8%) than in those with mild disease (1.5%, p=0.00001). Mortality was related to the presence of fever at admission (16.5% vs. 5.0%, p=0.006), and not to age, sex, etiological associations, or concomitant medical or surgical diseases. Of the biochemical and hematological parameters tested, ten factors (plasma glucose, BUN, serum creatinine, serum calcium, serum lactate dehydrogenase, serum albumin, red cell count, white cell count, hematocrit, and lymphocytes count) were found to be statistically significant, and four factors (serum potassium, alkaline phosphatase, total bilirubin, and hemoglobin) were marginally significant. In high-risk patients (Ranson and Imrie scores > or = 3, APACHE-II score > or = 10) mortality rates were higher (22.5%, 23.0%, and 22.5%, respectively) than in low-risk patients (2.4%, 2.3%, and 0.8%, respectively, p=0.00001). APACHE-II scores may be especially useful for monitoring the progress of patients with pancreatic necrosis and secondary pancreatic necrosis. CONCLUSIONS: Acute pancreatitis still represents a condition of variable severity. The adoption of multiparametric criteria proposed together with morphological evaluation consents the formulation of a discreetly reliable prognosis on the evolution of the disease a few days from onset, even though this still appears insufficient to plan a varied and timely therapeutic program.     

Early treatment of severe pancreatitis with imipenem: a prospective randomized clinical trial

OBJECTIVE: The main causes of death in severe pancreatitis are multiorgan failure and septic complications. Prophylactic treatment with effective antibiotics is therefore a tempting therapeutic option. However, there could be side effects such as selection of resistant microbes and fungi. The aim of the present study was to compare the rate of infectious complications, interventions, days in the intensive care unit (ICU), morbidity and mortality in patients with severe pancreatitis randomized to prophylactic therapy with imipenem compared with those receiving no treatment at all. MATERIAL AND METHODS: Seventy-three patients with severe pancreatitis were included in a prospective, randomized, clinical study in seven Norwegian hospitals. The number of patients was limited to 73 because of slow patient accrual. Severe pancreatitis was defined as a C-reactive protein (CRP) level of >120 mg/l after 24 h or CRP >200 48 h after the start of symptoms. The patients were randomized to either early antibiotic treatment (imipenem 0.5 g x 3 for 5-7 days) (imipenem group) (n=36) or no antibiotics (control group) (n=37). RESULTS: The groups were similar in age, cause of pancreatitis, duration of symptoms and APACHE II score. Patients in the imipenem group experienced lower rates of complications (12 versus 22 patients) (p=0.035) and infections (5 versus 16 patients) (p=0.009) than those in the control group. There was no difference in length of hospital stay (18 versus 22 days), need of intensive care (8 versus 7 patients), need of acute interventions (10 versus 13), nor for surgery (3 versus 3) or 30-day mortality rates (3 versus 4). CONCLUSIONS: The study, although underpowered, supports the use of early prophylactic treatment with imipenem in order to reduce the rate of septic complications in patients with severe pancreatitis.     

血清促炎细胞因子水平与急性胰腺炎严重程度的相关性研究

目的 探究血清促炎细胞因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及高迁移率族蛋白B-1(HMGB1)水平在早期评估急性胰腺炎(AP)患者严重程度及预后的价值.方法 以33例重症急性胰腺炎(SAP)和38例轻症急性胰腺炎(MAP)患者为研究对象,另以51名健康体检者作为对照组.采用酶联免疫吸附试验(ELISA)检测血清IL-6、TNF-α及HMGB1水平,分析三者与患者Ranson评分、APACHEⅡ评分、Bahhazar CT评分、血清生化指标及预后的关系.结果 SAP组、MAP组、健康对照组血清IL-6水平分别为(553.72±175.76)pg/ml、(265.73±179.95)pg/ml和(16.43±3.32)pg/ml,三组间差异均有统计学意义(P均＜0.01).SAP组、MAP组、健康对照组血清TNF-α水平三组间差异均无统计学意义(P均＞0.05).SAP组、MAP组、健康对照组血清HMGB1水平分别为(11.48±6.94)μg/L、(6.13±5.80)μg/和(1.82±0.64)/μg/L,三组间HMGB1值差异均有统计学意义(P均＜0.05).患者血清HMGB1水平与IL-6,TNF-α的相关系数分别为0.896和0.724(P＜0.01).血清IL-6水平与Ranson评分、APACHE Ⅱ评分、Balthazar CT 评分均呈正相关;血清TNF-α水平与APACHEⅡ评分呈正相关;血清HMGB1水平与Ranson评分、Balthazar CT评分呈正相关.三者血清水平均与肌酐值呈正相关.病程中出现局部和(或)全身并发症者血清IL-6水平显著高于无并发症者.结论 血清IL-6、TNF-α、HMGB1水平与胰腺炎病情的严重程度显著相关,三者参与AP时急性肾功能不全的发生,血清IL-6水平升高与并发症发生显著相关.

Abstract：

Objective To explore the value of serum level of interleukin 6 (IL-6),tumor necrosis factor alpha (TNF-α) and high mobility group box-1 protein( HMGB1) in early assessment the severity and prognosis of acute pancreatitis (AP). Methods Thirty-three severe acute pancreatitis (SAP) patients and 38 mild acute pancreatitis (MAP) patients were selected as study objects;and 51healthy individuals were set as control group. Serum IL-6,TNF-α and HMGB1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA),the association of them and the scores of Ranson,APACHE Ⅱ . Balthazar CT,serum biochemical parameters and prognosis was analyzed.Results The serum IL-6 levels of SAP group,MAP group and healthy control group were (553. 72±175.76) pg/ml,(265. 73±179. 95) pg/ml and (16. 43±3. 32) pg/ml;and there were statistical significance of these three groups (all P＜0. 01). There was no significant difference of TNF-α in the three groups (all P＞0. 05). The serum HMGB1 levels of SAP group,MAP group and healthy control group were (11. 48±6. 94)μg/L,(6. 13±5. 80)μg/L and (1. 82±0. 64)μg/L respectively,and there were statistical significant of these three groups (all P＜0. 05). The correlation coefficient of serum HMGB1 with IL-6 and TNF-α were 0. 896 and 0. 724 (P＜0. 01) respectively. The IL-6 level was positively correlated with the scores of Ranson,APACHE Ⅱ and Balthazar CT. The TNF-αconcentration was positively correlated with APACHE Ⅱ score,and the HMGB1 concentration positively correlated with scores of Ranson and Balthazar CT. The levels of IL-6,TNF-α and HMGB1were all positively correlated with the serum creatinine concentration. The IL-6 levels of patients with local and/or systemic complications were significantly higher than those without complications.Conclusion The serum levels of IL-6,TNF-α and HMGB1 are significantly correlated with the severity of pancreatitis,all of them take part in the development of acute renal insufficiency. The high level of serum IL-6 significantly correlated with complications.