外周血GRA、MLR、TLR-9、B7-H3与重症急性胰腺炎继发感染的相关性及对感染程度的评估价值

doi:10.3969/j.issn.1671-7171.2021.07.030

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摘要【目的】探讨外周血中性粒细胞(GRA)、单核细胞与淋巴细胞比值(MLR)、Toll样受体-9(TLR-9)、B7-H3与重症急性胰腺炎继发感染的关系及对感染程度的评估价值。【方法】选取2017年6月至2020年3月本院收治的123例重症急性胰腺炎患者作为研究对象,根据患者是否继发感染将其分为继发感染组(n=51)和未继发感染组(n=72)。比较两组一般资料及外周血中性粒细胞(GRA)、单核细胞与淋巴细胞比值(MLR)、Toll样受体9(TLR-9)、B7-H3水平,分析重症急性胰腺炎继发感染影响因素及上述外周血指标间相关性,采用受试者工作曲线(ROC)分析外周血指标对重症急性胰腺炎继发感染的诊断价值。【结果】继发感染组外周血GRA、MLR、TLR-9、B7-H3水平显著高于未继发感染组,差异有统计学意义(P<0.05)。Logistic分析显示,外周血GRA、MLR、TLR-9、B7-H3水平均为重症急性胰腺炎继发感染影响因素(P<0.05)。严重感染患者外周血GRA、MLR、TLR-9、B7-H3水平高于局部感染患者,差异有统计学意义(P<0.05)。ROC曲线显示各指标联合诊断重症急性胰腺炎继发感染的AUC面积为0.871,高于任一单一指标,其敏感度为70.59%,特异度为87.50%。【结论】重症急性胰腺炎继发感染患者外周血GRA、MLR、TLR-9、B7-H3均呈高水平表达状态,且其表达水平与感染程度有关,可监测上述指标水平指导临床用药方案制定。

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关键词 ：胰腺炎, 急性坏死性/治疗, 细菌感染, 中性白细胞/分析, Toll样受体9/分析

Abstract：【Objective】To explore the relationship between peripheral blood neutrophilic granulocyte(GRA), monocyte to lymphocyte ratio(MLR), Toll-like receptor-9(TLR-9), B7-H3 and secondary infections of severe acute pancreatitis and the evaluation value of the degree of infection. 【Methods】From June 2017 to March 2020, patients with severe acute pancreatitis in our hospital were selected as the research objects. According to whether the patients had secondary infections, 51 cases were in the secondary infection group and 72 cases were in the non-secondary infection group. The general data, peripheral blood GRA, MLR, TLR-9, B7-H3 of the two groups were compared, and the factors affecting the secondary infection of severe acute pancreatitis and the correlation between the above peripheral blood indicators were analyzed. The receiver operating(ROC) curve was used to analyze the diagnostic value of peripheral blood indicators for the secondary and severe infections of severe acute pancreatitis. 【Results】 The levels of GRA, MLR, TLR-9 and B7-H3 in peripheral blood were all influencing factors of secondary infection of severe acute pancreatitis(P<0.05). There was a positive correlation between GRA, MLR, TLR-9, and B7-H3 in patients with secondary infection of severe acute pancreatitis(P<0.05). The levels of GRA, MLR, TLR-9 and B7-H3 in peripheral blood of patients with severe infection were higher than those of patients with local infection(P<0.05). The ROC curve showed that the AUC areas for the combined diagnosis of severe acute pancreatitis with secondary infection and severe infection were 0.871 and 0.889, which were higher than any single index. 【Conclusion】Peripheral blood GRA, MLR, TLR-9, B7-H3 are all overexpressed in patients with secondary infection of severe acute pancreatitis, and their expression levels are related to the degree of infection. The levels of these indicators can be monitored to guide the formulation of clinical medication regimens.

Key words： Pancreatitis, Acute Necrotizing/TH Bacterial Infections Neutrophils/AN Toll-Like Receptor 9/AN

收稿日期: 2020-11-12

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R657.51

通讯作者: *E-mail:michael_tank@126.com

引用本文:

张涛, 常亮, 张丽, 张晓明, 姚晓雷. 外周血GRA、MLR、TLR-9、B7-H3与重症急性胰腺炎继发感染的相关性及对感染程度的评估价值[J]. 医学临床研究, 2021, 38(7): 1065-1068.
ZHANG Tao, CHANG Liang, ZHANG Li,et al. Relationship between Peripheral Blood GRA, MLR, TLR-9, B7-H3 and Secondary Infection of Severe Acute Pancreatitis and its Evaluation Value for the Degree of Infection. JOURNAL OF CLINICAL RESEARCH, 2021, 38(7): 1065-1068.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.07.030 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I7/1065