血清ORM2、CD5L和PCT对急性胰腺炎患者病情严重性的预测价值

The Predictive Value of Serum ORM2, CD5L and PCT for the Severity of Acute Pancreatitis in Patients

摘要: 目的：探讨急性胰腺炎(AP)患者血清中ORM2、CD5L和PCT的表达水平及其对重症胰腺炎早期预测病情的价值。方法：收集2021年6月~2022年12月间安徽医科大学第二附属医院急诊外科收治的182例AP患者临床资料及入院24小时内血清标本，根据亚特兰大标准(2012)，分为重症胰腺炎组(SAP)和非重症胰腺炎组(Non-SAP)。采用ELISA法检测两组患者血清中ORM2、CD5L、PCT的表达水平，并通过Spearman相关性分析和Logistic回归分析其与病情严重度的相关性及预测概率。构建ROC曲线评估预测效能，并与Ranson、CTSI、SOFA评分比较其区分度和校准度。结果：相比非重症急性胰腺炎(Non-SAP)组，重症急性胰腺炎组(SAP)其性别、年龄、收缩压、体重指数等指标无明显差异(P > 0.05)。而Ranson、CTSI及SOFA评分及生物标志物ORM2、CD5L和PCT差异显著(P < 0.01)。Spearman分析揭示ORM2、CD5L、PCT与病情严重性正相关。Logistic回归确认这些标志物为独立预测因子，ROC曲线表明ORM2、CD5L、PCT以及各评分系统均为AP患者病情进展的重要预测因子。当三个血清指标联合应用时，AUC下面积为0.920，优于各传统评分系统及单一指标。结论：AP患者入院24 h内的血清ORM2、CD5L和PCT表达水平检测对AP患者病情严重性的早期预测具有重要意义，联合预测效果最佳。

Abstract: Objective: To investigate the expression levels of ORM2, CD5L and PCT in serum of patients with acute pancreatitis (AP) and their value in early prognosis of severe pancreatitis. Methods: Clinical data and serum samples within 24 hours after admission were collected from 182 AP patients admitted to the emergency surgery Department of the Second Affiliated Hospital of Anhui Medical University from June 2021 to December 2022. The patients were divided into severe pancreatitis group (SAP) and Non-SAP group (Non-SAP) according to the Atlanta standard (2012). Serum biomarkers were detected by ELISA, to compare the differences of ORM2, CD5L, PCT and integrated scores. Spearman correlation analysis and Logistic regression analysis were used to analyze the correlation with the severity of the disease and the prediction probability. ROC curve was constructed to evaluate the prediction efficiency, and its differentiation and calibration were compared with Ranson, CTSI and SOFA scores. Results: Compared with the non-severe acute pancreatitis (Non-SAP) group, there were no significant differences in gender, age, systolic blood pressure and body mass index in the severe acute pancreatitis (SAP) group (P > 0.05), but Ranson, CTSI and SOFA scores and biomarkers ORM2, CD5L and PCT were significantly different (P < 0.01). Spearman analysis revealed that ORM2, CD5L and PCT were positively correlated with the severity of the disease. Logistic regression confirmed these markers as independent predictors, ROC curve showed that ORM2, CD5L, PCT and other scoring systems were important predictors of disease progression in AP patients. When the three serum indexes were combined, the area under AUC was 0.920. It is better than traditional integrated scores and single index. Conclusion: Serum ORM2, CD5L, and PCT within 24 h of admission to AP patients are of great significance for the early prediction of the severity of AP patients, and the combined prediction effect is the best.