促炎细胞因子在急性胰腺炎预后早期评估中的作用

Proinflammatory cytokines in early assessment of the prognosis of acute pancreatitis.

作者信息

Chen C C, Wang S S, Lee F Y, Chang F Y, Lee S D

机构信息

Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taiwan, Republic of China.

出版信息

Am J Gastroenterol. 1999 Jan;94(1):213-8. doi: 10.1111/j.1572-0241.1999.00709.x.

DOI:10.1111/j.1572-0241.1999.00709.x

PMID:9934758

Abstract

OBJECTIVE

Proinflammatory cytokines are involved in the pathogenesis of acute pancreatitis. The value of serum levels of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, and interleukin-8 in predicting the outcome of acute pancreatitis was evaluated.

METHODS

In 50 patients with acute pancreatitis, the serum concentrations of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, interleukin-8, and C-reactive protein were determined on days 1, 2, 3, 4, and 7 after admission. Acute Physiology and Chronic Health Evaluation (APACHE II) scores were recorded on days 1, 2, and 3.

RESULTS

Serum concentrations of interleukin-1-beta, interleukin-6, interleukin-8, and C-reactive protein on days 1-7 were significantly higher in patients with severe pancreatitis than in patients with mild pancreatitis. Patients with severe attacks had significantly elevated serum tumor necrosis factor-alpha concentrations on days 1-3 compared with those with mild attacks, but not on days 4 and 7. The median peak value of tumor necrosis factor-alpha, interleukin-1-beta, interleukin-6, and interleukin-8 was reached on day 1, in contrast to the median peak of C-reactive protein, which was reached on day 2. Using cutoff levels of 12 pg/ml for tumor necrosis factor-alpha, 1 pg/ml for interleukin-1-beta, 400 pg/ml for interleukin-6, 100 pg/ml for interleukin-8, 12 mg/dl for C-reactive protein, and 10 for the Acute Physiology and Chronic Health Evaluation (APACHE II) score, the accuracy rates for detecting severe pancreatitis were 72%, 82%, 88%, 74%, 80%, and 72%, respectively, on day 1 and 78%, 74%, 80%, 76%, 80%, and 78%, respectively, on day 2.

CONCLUSION

Among the proinflammatory cytokines, interleukin-6 is the most useful parameter for early prediction of the prognosis of acute pancreatitis.

摘要

目的

促炎细胞因子参与急性胰腺炎的发病机制。评估血清肿瘤坏死因子-α、白细胞介素-1-β、白细胞介素-6和白细胞介素-8水平在预测急性胰腺炎预后方面的价值。

方法

对50例急性胰腺炎患者，在入院后第1、2、3、4和7天测定血清肿瘤坏死因子-α、白细胞介素-1-β、白细胞介素-6、白细胞介素-8和C反应蛋白的浓度。在第1、2和3天记录急性生理与慢性健康状况评分系统（APACHE II）评分。

结果

重症胰腺炎患者在第1 - 7天的血清白细胞介素-1-β、白细胞介素-6、白细胞介素-8和C反应蛋白浓度显著高于轻症胰腺炎患者。与轻症发作患者相比，重症发作患者在第1 - 3天血清肿瘤坏死因子-α浓度显著升高，但在第4天和第7天无明显差异。肿瘤坏死因子-α、白细胞介素-1-β、白细胞介素-6和白细胞介素-8的中位数峰值出现在第1天，而C反应蛋白的中位数峰值出现在第2天。采用肿瘤坏死因子-α的临界值为12 pg/ml、白细胞介素-1-β为1 pg/ml、白细胞介素-6为400 pg/ml、白细胞介素-8为100 pg/ml、C反应蛋白为12 mg/dl以及急性生理与慢性健康状况评分系统（APACHE II）评分为10，在第1天检测重症胰腺炎的准确率分别为72%、82%、88%、74%、80%和72%，在第2天分别为78%、74%、80%、76%、80%和78%。