血清IL-18、LC3与S100A12联合检测对重症急性胰腺炎患者预后的预测价值

Predictive value of serum IL-18, MAP1-LC3, and S100A12 levels for prognosis in severe acute pancreatitis patients

摘要:

目的 探讨血清白细胞介素-18（IL-18）、微管相关蛋白1轻链3（MAP1-LC3）、S100钙结合蛋白A12（S100A12）水平对重症急性胰腺炎患者预后的预测价值。方法 选取2022年1月—2025年1月陕西省人民医院收治的118例重症急性胰腺炎患者纳入观察组，选取同期收治的98例非重症急性胰腺炎患者纳入对照组。比较观察组和对照组血清IL-18、MAP1-LC3、S100A12水平，以及急性胰腺炎严重程度床边指数（BISAP）评分、急性生理功能和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分。对观察组患者进行为期1个月的随访，根据随访结果将其分为生存组（84例）和死亡组（34例）。比较生存组和死亡组血清IL-18、MAP1-LC3、S100A12水平，以及BISAP评分、APACHE Ⅱ评分；采用Spearman法分析血清IL-18、MAP1-LC3、S100A12水平与重症急性胰腺炎患者预后的相关性；构建受试者工作特征（ROC）曲线评估血清IL-18、MAP1-LC3、S100A12联合检测对重症急性胰腺炎患者预后的预测价值。结果 观察组IL-18、MAP1-LC3、S100A12水平，以及BISAP评分和APACHE Ⅱ评分均高于对照组（P <0.05）；生存组IL-18、MAP1-LC3、S100A12水平，以及BISAP评分和APACHE Ⅱ评分均低于死亡组（P <0.05）；相关性分析显示，血清IL-18、MAP1-LC3、S100A12水平与重症急性胰腺炎患者不良预后结局均呈正相关（P <0.05）；ROC曲线分析结果显示，血清IL-18、MAP1-LC3、S100A12及联合检测预测重症急性胰腺炎患者预后的敏感性分别为82.4%（95% CI：0.655，0.932）、88.2%（95% CI：0.725，0.967）、73.5%（95% CI：0.556，0.871）、88.2%（95% CI：0.725，0.967），特异性分别为81.0%（95% CI：0.709，0.887）、89.3%（95% CI：0.806，0.950）、94.0%（95% CI：0.867，0.980）、97.6%（95% CI：0.917，0.997），曲线下面积分别为0.890（95% CI：0.827，0.952）、0.912（95% CI：0.852，0.972）、0.887（95% CI：0.816，0.957）、0.973（95% CI：0.946，1.000）。结论 血清IL-18、MAP1-LC3、S100A12水平与重症急性胰腺炎患者预后密切相关，联合检测可有效预测患者预后，具有较高的敏感性和特异性，是临床有价值的预后评估指标。

Abstract:

Objective To explore the predictive value of serum interleukin-18 (IL-18), microtubule-associated protein 1 light chain 3 (MAP1-LC3), and S100 calcium-binding protein A12 (S100A12) levels for prognosis in severe acute pancreatitis patients.Methods A total of 118 patients with ASP admitted between January 2022 and January 2025 were enrolled as the observation group, and 98 patients with non-severe acute pancreatitis treated during the same period were included as the control group. Serum IL-18, MAP1-LC3, and S100A12 levels were measured in both groups. Disease severity was assessed using the Bedside Index for Severity in Acute Pancreatitis (BISAP) score and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score. Patients in the observation group were followed up for 1 month and were classified into a survival subgroup (n = 84) and a death subgroup (n = 34) according to outcomes. Serum IL-18, MAP1-LC3, and S100A12 levels were compared between the two subgroups. Spearman correlation analysis was performed to evaluate the relationships between serum IL-18, MAP1-LC3, and S100A12 levels and prognosis in patients with severe acute pancreatitis. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of combined detection of serum IL-18, MAP1-LC3, and S100A12 levels for prognosis.Results Serum IL-18, MAP1-LC3, and S100A12 levels, as well as BISAP and APACHE Ⅱ scores, were significantly higher in the observation group than in the control group (P < 0.05). Serum IL-18, MAP1-LC3, and S100A12 levels were significantly lower in the survival subgroup than in the death subgroup (P < 0.05). Correlation analysis showed that serum IL-18, MAP1-LC3, and S100A12 levels were positively correlated with adverse prognosis in patients with severe acute pancreatitis (P < 0.05). ROC analysis showed that the sensitivities of serum IL-18, MAP1-LC3, S100A12, and their combined detection for predicting prognosis in patients with acute severe pancreatitis were 82.4% (95% CI: 0.655, 0.932), 88.2% (95% CI: 0.725, 0.967), 73.5% (95% CI: 0.556, 0.871), and 88.2% (95% CI: 0.725, 0.967), respectively. The specificities were 81.0% (95% CI: 0.709, 0.887), 89.3% (95% CI: 0.806, 0.950), 94.0% (95% CI: 0.867, 0.980), and 97.6% (95% CI: 0.917, 0.997), respectively. The areas under the ROC curve (AUCs) were 0.890 (95% CI: 0.827, 0.952), 0.912 (95% CI: 0.852, 0.972), 0.887 (95% CI: 0.816, 0.957), and 0.973 (95% CI: 0.946, 1.000), respectively.Conclusion Serum IL-18, MAP1-LC3, and S100A12 levels are closely associated with prognosis in patients with acute severe pancreatitis. Combined detection of these biomarkers provides high sensitivity and specificity for prognostic prediction and may serve as a valuable tool for clinical prognostic assessment.