急性胰腺炎合并肺部感染患者免疫状态及炎症指标诊断价值

目的探究急性胰腺炎合并肺部感染患者免疫状态改变及C-反应蛋白(CRP)、降钙素原(PCT)、急性生理和慢性健康评分(APACHEⅡ)指标诊断的价值。方法选取成都医学院第二附属医院消化内科2017年1月-2019年12月收治的急性胰腺炎(AP)患者共438例作为研究对象,根据其严重程度及相关标准将其分为轻度急性胰腺炎组(MAP,n=304)、中度重症急性胰腺炎组(MSAP,n=103)和重度急性胰腺炎组(SAP,n=31)。对其肺部感染情况及病原学特点进行分析,观察感染患者CD4⁺T细胞,CD4⁺/CD8⁺比值、免疫球蛋白(IgA、IgG、IgM)水平变化,采用受试者工作特征(ROC)曲线分析CRP、PCT及APACHEⅡ评分诊断患者肺部感染的价值。结果304例MAP组感染66例,感染率为21.71%,103例MSAP组感染60例,感染率为58.25%,31例SAP组感染23例,感染率74.19%,三组患者感染率比较差异具有统计学意义(χ²=107.155,P<0.001);149例感染患者临床标本共检出病原菌159株,其中革兰阴性菌89株占55.98%,革兰阳性菌株63株占39.62%;与未感染患者比较,三组中感染患者CD4⁺、CD4⁺/CD8⁺、IgA、IgM、IgG水平均下降,CRP、PCT、APACHEⅡ均升高,比较差异具有统计学意义(P<0.05);CRP、PCT、APACHEⅡ诊断AP患者发生肺部感染的AUC分别为0.764、0.801、0.732,三指标联用时诊断价值最高。结论中度及重度胰腺炎患者肺部感染发生率明显增加,伴随着明显的细胞免疫功能下降,CRP、PCT及APACHEⅡ联合对其具有较高的诊断价值。

Immune status of patients with acute pancreatitis patients complicated with pulmonary infection and diagnostic value of inflammatory indexes

OBJECTIVE To explore the changes of immune status of the acute pancreatitis(AP)patients complicated with pulmonary infection and analyze the diagnostic value of C-reactive protein(CRP),procalcitonin(PCT)and acute physiology and chronic health(APACHEⅡ)score.METHODS A total of 438 patients with AP who were treated in gastroenterology department of the Second Affiliated Hospital of Chengdu Medical College from Jan.2017 to Dec.2019 were recruited as the study subjects and divided into the mild AP group with 304 cases(the MAP group),the moderate and severe AP group with 103 cases(the MSAP group),and the severe AP group with 31 cases(the SAP group).The incidence of pulmonary infection and etiological characteristics were analyzed,the changes of CD4⁺T cell,CD4⁺/CD8⁺ratio and immunoglobulins(IgA,IgG,IgM)of the patients with infection were observed,and the value of CRP,PCT and APACHEⅡscore in diagnosis of pulmonary infection was analyzed by means of receiver operating characteristic(ROC)curve.RESULTS Totally 66 of 304 patients had infection in the MAP group,with the infection rate 21.71%;totally 60 of 103 patients had infection in the MSAP group,with the infection rate 58.25%;totally 23 of 31 patients had infection in the SAP group,with the infection rate 74.19%;there was significant difference in the infection rate among the three groups of patients(χ²=107.155,P<0.001).A total of 159 strains of pathogens were isolated from clinical specimens of 143 patients with infection,89(55.98%)of which were gram-negative bacteria,and 39.62%were gram-positive bacteria.The levels of CD4⁺,CD4⁺/CD8⁺,IgA,IgM and IgG of the patients with infection were significantly lower than those of the patiens without infection,while the levels of CRP,PCT and APACHEⅡof the patients with infection were significantly higher than those of the patients without infection(P<0.05).The AUC of CRP,PCT and APACHEⅡwere respectively 0.764,0.801 and 0.732 in diagnosis of pulmonary infection in the AP patients,and the diagnostic value of the joint detection of the three indexes was the highest.CONCLUSION The incidence of pulmonary infection is significantly increased in the patients with moderate and severe acute pancreatitis,the cellular immune function significantly declines,and the joint detection of CRP,PCT and APACHEⅡhas high diagnostic value.