血液标志物预测急性胰腺炎严重程度的研究进展
Research Progress of Blood Markers in Predicting the Severity of Acute Pancreatitis
DOI: 10.12677/acm.2024.14102768, PDF,   
作者: 刘红玲, 郭宇琴, 陶 武*:重庆医科大学附属永川医院重症医学科,重庆
关键词: 急性胰腺炎血液标志物研究进展Acute Pancreatitis Blood Marker Research Progress
摘要: 急性胰腺炎(acute pancreatitis, AP)是由高脂血症、胆石症、酒精等原因引起的胰腺组织自我消化,导致胰腺水肿、出血和坏死等炎性损害。有相关研究报道,约10%~25% AP患者可发展为重症急性胰腺炎(severe acute pancreatitis, SAP)。SAP病情进展迅速,并发症较多、死亡率高。持续恶化的器官功能衰竭是导致SAP患者死亡的主要因素之一。炎症瀑布式反应在急性胰腺炎的发病及病情进展中发挥着重要的作用,炎症因子或细胞因子水平的变化可以在血液反应出来。近年来,血液标志物对AP严重程度及SAP预后的预测越来越受到人们的重视。深入了解AP的相关炎症因子或血液标志物有助于找到精确的治疗靶点,对早期干预AP发展有一定的指导意义。因此,本文对AP涉及到的部分重要血液标志物进行综述。
Abstract: Acute pancreatitis (AP) is caused by hyperlipidemia, cholelithiasis, alcohol and other causes of pancreatic tissue self-digestion, resulting in pancreatic edema, bleeding and necrosis and other inflammatory damage. It has been reported that about patients with 10%-25% AP can develop into severe acute pancreatitis. The disease of SAP progressed rapidly, with many complications and high mortality. Worsening organ failure is one of the main factors leading to death in patients with SAP. Inflammatory cascade reaction plays an important role in the pathogenesis and progression of acute pancreatitis, and the changes of inflammatory factors or cytokines can be reflected in the blood. In recent years, people have paid more and more attention to the prediction of blood markers on the severity of AP and the prognosis of SAP. In-depth understanding of AP-related inflammatory factors or blood markers will help to find accurate treatment targets, and have a certain guiding significance for early intervention in the development of AP. Therefore, some important blood markers involved in AP are reviewed in this paper.
文章引用:刘红玲, 郭宇琴, 陶武. 血液标志物预测急性胰腺炎严重程度的研究进展[J]. 临床医学进展, 2024, 14(10): 1067-1072. https://doi.org/10.12677/acm.2024.14102768

参考文献

[1] 郑智, 曲元旭, 丁乙轩, 等. 急性胰腺炎发病机制的研究进展[J]. 中华肝胆外科杂志, 2021, 27(2): 152-155.
[2] Feng, S., Wei, Q., Hu, Q., Huang, X., Zhou, X., Luo, G., et al. (2018) Research Progress on the Relationship between Acute Pancreatitis and Calcium Overload in Acinar Cells. Digestive Diseases and Sciences, 64, 25-38. [Google Scholar] [CrossRef] [PubMed]
[3] Li, Z., Xu, C., Tao, Y., Liang, Y., Liang, Q., Li, J., et al. (2020) Anisodamine Alleviates Lipopolysaccharide-Induced Pancreatic Acinar Cell Injury through NLRP3 Inflammasome and NF-κb Signaling Pathway. Journal of Receptors and Signal Transduction, 40, 58-66. [Google Scholar] [CrossRef] [PubMed]
[4] Ropolo, A., Grasso, D. and Vaccaro, M.I. (2019) Measuring Autophagy in Pancreatitis. In: Ktistakis, N. and Florey, O., Eds., Autophagy: Methods and Protocols, Springer, 541-554. [Google Scholar] [CrossRef] [PubMed]
[5] Antonucci, L., Fagman, J.B., Kim, J.Y., Todoric, J., Gukovsky, I., Mackey, M., et al. (2015) Basal Autophagy Maintains Pancreatic Acinar Cell Homeostasis and Protein Synthesis and Prevents ER Stress. Proceedings of the National Academy of Sciences, 112, E6166-E6174. [Google Scholar] [CrossRef] [PubMed]
[6] Lee, P.J. and Papachristou, G.I. (2019) New Insights into Acute Pancreatitis. Nature Reviews Gastroenterology & Hepatology, 16, 479-496. [Google Scholar] [CrossRef] [PubMed]
[7] 冷芳, 杨力, 常志刚. 急性胰腺炎分类——2012: 亚特兰大分类和定义修订的国际共识[J]. 临床肝胆病杂志, 2013, 29(4): 后插1-后插7.
[8] 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021) [J]. 浙江实用医学, 2021, 26(6): 511-519+535.
[9] 付率更, 薛吉山, 李宪. 钙离子、C反应蛋白、降钙素原和免疫球蛋白在急性胰腺炎转归中的意义[J]. 中国社区医师, 2022, 38(22): 79-81.
[10] 严舒, 范婧妍, 吴斌, 等. 红细胞分布宽度与血钙比值结合BISAP评分对急性胰腺炎严重程度的预测价值[J]. 西部医学, 2023, 35(2): 262-265+271.
[11] Vege, S.S., Gardner, T.B., Chari, S.T., Munukuti, P., Pearson, R.K., Clain, J.E., et al. (2009) Low Mortality and High Morbidity in Severe Acute Pancreatitis without Organ Failure: A Case for Revising the Atlanta Classification to Include “Moderately Severe Acute Pancreatitis”. American Journal of Gastroenterology, 104, 710-715. [Google Scholar] [CrossRef
[12] Wilson, C., Heads, A., Shenkin, A. and Imrie, C.W. (1989) C-Reactive Protein, Antiproteases and Complement Factors as Objective Markers of Severity in Acute Pancreatitis. Journal of British Surgery, 76, 177-181. [Google Scholar] [CrossRef] [PubMed]
[13] Lelubre, C., Anselin, S., Zouaoui Boudjeltia, K., Biston, P. and Piagnerelli, M. (2013) Interpretation of C-Reactive Protein Concentrations in Critically Ill Patients. BioMed Research International, 2013, Article ID: 124021. [Google Scholar] [CrossRef] [PubMed]
[14] Cardoso, F.S., Ricardo, L.B., Oliveira, A.M., Canena, J.M., Horta, D.V., Papoila, A.L., et al. (2013) C-Reactive Protein Prognostic Accuracy in Acute Pancreatitis: Timing of Measurement and Cutoff Points. European Journal of Gastroenterology & Hepatology, 25, 784-789. [Google Scholar] [CrossRef] [PubMed]
[15] Khanna, A.K., Meher, S., Prakash, S., Tiwary, S.K., Singh, U., Srivastava, A., et al. (2013) Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. HPB Surgery, 2013, Article ID: 367581. [Google Scholar] [CrossRef] [PubMed]
[16] 沙涛, 易金宏. C-反应蛋白对急性胰腺炎的诊断价值[J]. 检验医学与临床, 2013, 10(8): 962-964.
[17] Párniczky, A., Lantos, T., Tóth, E.M., Szakács, Z., Gódi, S., Hágendorn, R., et al. (2019) Antibiotic Therapy in Acute Pancreatitis: From Global Overuse to Evidence Based Recommendations. Pancreatology, 19, 488-499. [Google Scholar] [CrossRef] [PubMed]
[18] 冯其柱, 卢曼曼, 孙杰, 等. 新型全身性炎症指标对急性胰腺炎早期病情严重程度的预测价值[J]. 实用医学杂志, 2024, 40(14): 1963-1968.
[19] 张白莎, 汤丽平, 罗娜. 血液标志物对预测重症急性胰腺炎继发脓毒症的应用进展[J]. 现代医药卫生, 2024, 40(12): 2094-2098.
[20] 杨雅阁, 郑晓永, 王静. 血降钙素原、D-二聚体、NLR水平对急性胆源性胰腺炎病情程度及预后的影响[J]. 河南医学研究, 2024, 33(11): 1994-1997.
[21] Malleo, G., Mazzon, E., Siriwardena, A.K. and Cuzzocrea, S. (2007) TNF-α as a Therapeutic Target in Acute Pancreatitis—Lessons from Experimental Models. The Scientific World Journal, 7, 431-448. [Google Scholar] [CrossRef] [PubMed]
[22] 胡亚丽, 冯超, 刘克勤, 等. 秋水仙碱对大鼠急性胰腺炎的作用及其机制研究[J]. 中国现代医学杂志, 2023, 33(12): 6-10.
[23] Özhan, G., Yanar, H.T., Ertekin, C. and Alpertunga, B. (2010) Polymorphisms in Tumour Necrosis Factor Alpha (TNFα) Gene in Patients with Acute Pancreatitis. Mediators of Inflammation, 2010, Article ID: 482950. [Google Scholar] [CrossRef] [PubMed]
[24] Chen, P., Huang, L., Sun, Y. and Yuan, Y. (2011) Upregulation of PIAS1 Protects against Sodium Taurocholate-Induced Severe Acute Pancreatitis Associated with Acute Lung Injury. Cytokine, 54, 305-314. [Google Scholar] [CrossRef] [PubMed]
[25] El-Ashmawy, N.E., Khedr, N.F., El-Bahrawy, H.A. and Hamada, O.B. (2018) Suppression of Inducible Nitric Oxide Synthase and Tumor Necrosis Factor-Alpha Level by Lycopene Is Comparable to Methylprednisolone in Acute Pancreatitis. Digestive and Liver Disease, 50, 601-607. [Google Scholar] [CrossRef] [PubMed]
[26] 何健, 俞隼, 张静. 血清IL-6和TNF-α对重症急性胰腺炎的早期诊断价值分析[J]. 临床肝胆病杂志, 2023, 39(7): 1657-1664.
[27] 高立生, 刘宁宁, 王青雷, 等. 急性胰腺炎患者血中血小板活化因子、肿瘤坏死因子-α、C反应蛋白水平[J]. 中国老年学杂志, 2013, 33(3): 663-664.
[28] 周泽伟, 孙娟, 向进平. 血清血管紧张素转化酶2、前白蛋白及血小板活化因子水平能够预测重症急性胰腺炎预后[J]. 内科急危重症杂志, 2023, 29(1): 49-50+68.
[29] Formela, L.J., Wood, L.M., Whittaker, M. and Kingsnorth, A.N. (1994) Amelioration of Experimental Acute Pancreatitis with a Potent Platelet-Activating Factor Antagonist. Journal of British Surgery, 81, 1783-1785. [Google Scholar] [CrossRef] [PubMed]
[30] Jankowski, A., Jankowska, B. and Niedworok, J. (2000) The Influence of Aronia melanocarpa in Experimental Pancreatitis. Polski Merkuriusz Lekarski, 8, 395-398.
[31] 方金苗, 夏时海. 血小板活化因子的信号转导途径与急性胰腺炎[J]. 中国急救医学, 2006, 26(5): 369-370.
[32] Rau, B.M., Krüger, C.M. and Schilling, M.K. (2005) Anti-Cytokine Strategies in Acute Pancreatitis: Pathophysiological Insights and Clinical Implications. Roczniki Akademii Medycznej w Bialymstoku, 50, 106-115.
[33] Matull, W.R. (2006) Biochemical Markers of Acute Pancreatitis. Journal of Clinical Pathology, 59, 340-344. [Google Scholar] [CrossRef] [PubMed]
[34] Pastor, C.M., Morel, D.R., Vonlaufen, A., Schiffer, E., Lescuyer, P. and Frossard, J. (2011) Delayed Production of IL-18 in Lungs and Pancreas of Rats with Acute Pancreatitis. Pancreatology, 10, 752-757. [Google Scholar] [CrossRef] [PubMed]
[35] Soyalp, M., Yalcin, M., Oter, V. and Ozgonul, A. (2017) Investigation of Procalcitonin, IL-6, Oxidative Stress Index (OSI) Plasma and Tissue Levels in Experimental Mild and Severe Pancreatitis in Rats. Bratislava Medical Journal, 118, 137-141. [Google Scholar] [CrossRef] [PubMed]
[36] 李小锋, 曹小平, 龚君佐, 等. 血清PCT、CRP、IL-6对急性胰腺炎病情严重性及预后判断[J]. 湖南师范大学学报(医学版), 2020, 17(4): 106-109.
[37] Ding, L., Yang, Y., Li, H., Wang, H. and Gao, P. (2020) Circulating Lymphocyte Subsets Induce Secondary Infection in Acute Pancreatitis. Frontiers in Cellular and Infection Microbiology, 10, Article No. 128. [Google Scholar] [CrossRef] [PubMed]
[38] 邓兴锋, 罗灿桦, 林美红, 等. 红细胞分布宽度与血小板之比评估急性胰腺炎严重程度的价值[J]. 广州医科大学学报, 2020, 48(2): 26-30.
[39] Zhou, H., Mei, X., He, X., Lan, T. and Guo, S. (2019) Severity Stratification and Prognostic Prediction of Patients with Acute Pancreatitis at Early Phase. Medicine, 98, e15275. [Google Scholar] [CrossRef] [PubMed]
[40] Fujimura, Y., Hirota, M., Ichihara, A., Takamori, H. and Baba, H. (2008) Platelet Count as a Sensitive and Convenient Parameter for Assessing the Prognosis in Acute Pancreatitis. Pancreas, 37, 225-227. [Google Scholar] [CrossRef] [PubMed]
[41] Mangalesh, S., Dudani, S. and Mahesh, N.K. (2023) Development of a Novel Inflammatory Index to Predict Coronary Artery Disease Severity in Patients with Acute Coronary Syndrome. Angiology, 75, 231-239. [Google Scholar] [CrossRef] [PubMed]
[42] 常晨阳, 胡绍雯, 邓国平, 等. 中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值[J]. 实用医学杂志, 2023, 39(22): 2958-2963.
[43] Wang, R., Wen, W., Jiang, Z., Du, Z., Ma, Z., Lu, A., et al. (2023) The Clinical Value of Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Index (SII), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Inflammation Response Index (SIRI) for Predicting the Occurrence and Severity of Pneumonia in Patients with Intracerebral Hemorrhage. Frontiers in Immunology, 14, Article ID: 1115031. [Google Scholar] [CrossRef] [PubMed]
[44] Biyik, M., Biyik, Z., Asil, M. and Keskin, M. (2022) Systemic Inflammation Response Index and Systemic Immune Inflammation Index Are Associated with Clinical Outcomes in Patients with Acute Pancreatitis? Journal of Investigative Surgery, 35, 1613-1620. [Google Scholar] [CrossRef] [PubMed]
[45] Lu, L., Feng, Y., Liu, Y., Tan, H., Dai, G., Liu, S., et al. (2021) The Systemic Immune-Inflammation Index May Be a Novel and Strong Marker for the Accurate Early Prediction of Acute Kidney Injury in Severe Acute Pancreatitis Patients. Journal of Investigative Surgery, 35, 962-966. [Google Scholar] [CrossRef] [PubMed]
[46] Zhang, F., Li, Z., Zhang, Z. and Ma, X. (2019) Prognostic Value of Red Blood Cell Distribution Width for Severe Acute Pancreatitis. World Journal of Gastroenterology, 25, 4739-4748. [Google Scholar] [CrossRef] [PubMed]