持续肾替代治疗对重症急性胰腺炎患者PCT、IL-17、IL-6、HMGB1水平的影响及其临床意义

Effect of continuous renal replacement therapy on levels of PCT, IL-17, IL-6 and HMGB1 in patients with severe acute pancreatitis and its clinical significance

摘要:

目的 分析持续肾替代治疗（CRRT）对重症急性胰腺炎（SAP）患者降钙素原（PCT）、白细胞介素17（IL-17）、白细胞介素6（IL-6）、高迁移率族蛋白B1（HMGB1）水平的影响及其临床意义。方法 将2018年10月—2020年10月武警四川省总队医院收治的182例SAP患者，分为对照组和观察组，每组91例。对照组予以常规疗法，观察组在对照组基础上联用CRRT治疗；比较两组疗效，治疗前及治疗72 h后两组PCT、IL-17、IL-6、HMGB1水平变化；统计全部患者的临床结局，比较存活组（148例）与死亡组（34例）的PCT、IL-17、IL-6、HMGB1水平；分析PCT、IL-17、IL-6、HMGB1单独及联合预测SAP死亡的价值。结果 治疗后，观察组总有效率高于对照组（P <0.05）。观察组治疗72 h后血清PCT、IL-17、IL-6、HMGB1水平较对照组下降更明显（P <0.05）。存活组PCT、IL-17、IL-6、HMGB1水平低于死亡组（P <0.05）。血清HMGB1单独检测敏感性最高，为97.06%（95% CI：0.847，0.999），依次高于联合检测、IL-6、PCT、IL-17单独检测的敏感性；联合检测的特异性最高，为92.57%（95% CI：0.871，0.962），依次高于PCT、IL-6、IL-17、HMGB1单独检测的特异性；联合检测的AUC最大，为0.983（95% CI：0.952，0.996），依次高于HMGB1、IL-6、PCT、IL-17单独检测的AUC（P <0.05）。结论 CRRT治疗SAP能显著改善机体炎症相关因子水平，疗效显著，联合检测血清PCT、IL-17、IL-6、HMGB1能作为预测SAP患者病情及不良预后的有效标志物。

Abstract:

Objective To analyze the effect of continuous renal replacement therapy (CRRT) on the levels of procalcitonin (PCT), interleukin (IL)-17, IL-6 and high mobility group protein B1 (HMGB1) in patients with severe acute pancreatitis (SAP) and to determine its clinical significance.Methods A total of 182 patients with SAP treated in our hospital from October 2018 to October 2020 were analyzed retrospectively. They were divided into the control group and the observation group, with 91 cases in each group. The control group was treated with the routine therapy, and the observation group was additionally treated with CRRT on the basis of the routine therapy. The curative effects of the two groups and the changes of PCT, IL-17, IL-6 and HMGB1 levels in the two groups before and 72 hours after the treatment were compared. The clinical outcomes of all patients were recorded, and the levels of PCT, IL-17, IL-6 and HMGB1 were compared between the survival group (n = 148) and the death group (n = 34). The values of PCT, IL-17, IL-6, HMGB1 and their combination in predicting the SAP death were analyzed.Results After the treatment, the overall effective rate of the observation group was higher than that of the control group (P < 0.05). The decreases in the levels of PCT, IL-17, IL-6 and HMGB1 at 72 hours after the treatment were greater in the observation group than those in the control group (P < 0.05). The levels of PCT, IL-17, IL-6 and HMGB1 in the survival group were lower than those in the death group (P < 0.05). The sensitivity of serum HMGB1 alone was the highest, which was 97.06% (95% CI: 84.7%, 99.9%), successively higher than that of the combined detection, IL-6, PCT, and IL-17 alone. The specificity of the combined detection was the highest, which was 92.57% (95% CI: 87.1%, 96.2%), successively higher than that of PCT, IL-6, IL-17, and HMGB1 alone. The area under the receiver operating characteristic (AUC) of the combined detection was the highest, which was 0.983 (95% CI: 0.952, 0.996), successively higher than that of HMGB1, IL-6, PCT, and IL-17 alone (P < 0.05).Conclusions CRRT can significantly regulate the levels of inflammation-associated factors and is effective in the treatment of SAP. The combined detection of serum PCT, IL-17, IL-6 and HMGB1 can be established as a valuable marker to predict the conditions and the poor prognosis of SAP patients.