褪黑素浓度预测急性胰腺炎严重程度的临床意义。
Clinical significance of melatonin concentrations in predicting the severity of acute pancreatitis.
机构信息
Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2013 Jul 7;19(25):4066-71. doi: 10.3748/wjg.v19.i25.4066.
AIM
To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation II (APACHEII) and bedside index for severity in acute pancreatitis (BISAP) scoring systems.
METHODS
APACHEII and BISAP scores were calculated for 55 patients with acute physiology (AP) in the first 24 h of admission to the hospital. Additionally, morning (6:00 AM) serum melatonin concentrations were measured on the first day after admission. According to the diagnosis and treatment guidelines for acute pancreatitis in China, 42 patients suffered mild AP (MAP). The other 13 patients developed severe AP (SAP). A total of 45 healthy volunteers were used in this study as controls. The ability of melatonin and the APACHEII and BISAP scoring systems to predict SAP was evaluated using a receiver operating characteristic (ROC) curve. The optimal melatonin cutoff concentration for SAP patients, based on the ROC curve, was used to classify the patients into either a high concentration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEII and BISAP scoring systems, were compared between the two groups.
RESULTS
The MAP patients had increased melatonin levels compared to the SAP (38.34 ng/L vs 26.77 ng/L) (P = 0.021) and control patients (38.34 ng/L vs 30.73 ng/L) (P = 0.003). There was no significant difference inmelatoninconcentrations between the SAP group and the control group. The accuracy of determining SAP based on the melatonin level, the APACHEII score and the BISAP score was 0.758, 0.872, and 0.906, respectively, according to the ROC curve. A melatonin concentration ≤ 28.74 ng/L was associated with an increased risk of developing SAP. The incidence of high scores (≥ 3) using the BISAP system was significantly higher in patients with low melatonin concentration (≤ 28.74 ng/L) compared to patients with high melatonin concentration (> 28.74 ng/L) (42.9% vs 14.7%, P = 0.02). The incidence of high APACHEII scores (≥ 10) between the two groups was not significantly different.
CONCLUSION
The melatonin concentration is closely related to the severity of AP and the BISAP score. Therefore, we can evaluate the severity of disease by measuring the levels of serum melatonin.
目的
评估血浆褪黑素与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）和床边严重指数评分系统（BISAP）联合预测急性胰腺炎的价值。
方法
对 55 例入院 24 h 内发生急性生理学（AP）的患者进行 APACHEⅡ和 BISAP 评分，并在入院第 1 天晨（6：00 AM）测量血清褪黑素浓度。根据中国急性胰腺炎诊治指南，42 例患者患有轻度急性胰腺炎（MAP），其余 13 例患者患有重度急性胰腺炎（SAP）。共选择 45 名健康志愿者作为对照组。采用受试者工作特征（ROC）曲线评估褪黑素和 APACHEⅡ及 BISAP 评分系统预测 SAP 的能力。根据 ROC 曲线，确定预测 SAP 的最佳褪黑素截断浓度，将患者分为高浓度组（34 例）和低浓度组（21 例）。比较两组根据 APACHEⅡ和 BISAP 评分系统的高评分发生率的差异。
结果
MAP 患者的褪黑素水平高于 SAP（38.34ng/L 比 26.77ng/L）（P = 0.021）和对照组（38.34ng/L 比 30.73ng/L）（P = 0.003）。SAP 组与对照组之间褪黑素浓度无差异。根据 ROC 曲线，基于褪黑素水平、APACHEⅡ评分和 BISAP 评分判断 SAP 的准确率分别为 0.758、0.872 和 0.906。褪黑素浓度≤28.74ng/L 与 SAP 风险增加相关。BISAP 系统中低褪黑素浓度（≤28.74ng/L）患者高分（≥3）发生率明显高于高褪黑素浓度（>28.74ng/L）患者（42.9%比 14.7%，P = 0.02）。两组间高 APACHEⅡ评分（≥10）的发生率无显著差异。
结论
褪黑素浓度与 AP 的严重程度和 BISAP 评分密切相关。因此，我们可以通过测量血清褪黑素水平来评估疾病的严重程度。
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