急性胰腺炎患儿血清Nrf-2、HO-1水平对疾病严重程度和预后的诊断价值-东南大学学报医学版

急性胰腺炎患儿血清Nrf-2、HO-1水平对疾病严重程度和预后的诊断价值

单位：唐山市妇幼保健院小儿外科, 河北唐山 063000

分类号：R576

出版年·卷·期（页码）：2024·43·第五期（756-763）

摘要：

目的: 探究急性胰腺炎(AP)患儿血清核因子E2相关因子2(Nrf-2)、血红素氧合酶1(HO-1)水平变化与疾病严重程度和预后的关系。方法: 选取2020年8月至2022年3月于本院就诊的AP患儿173例为AP组,根据亚特兰大分类分为轻度AP(MAP)组、中度AP(MSAP)组和重度AP(SAP)组;另选取同期体检儿童180例为健康组。采用酶联免疫吸附法检测血清Nrf-2、HO-1水平,用Spearman法进行相关性分析;根据随访28 d后生存情况将AP患儿分为存活组和死亡组,采用Logistic回归分析影响AP预后的因素;受试者工作特征(ROC)曲线分析Nrf-2、HO-1对AP严重程度的诊断价值及预后的预测价值;临床决策曲线(DCA)评估Nrf-2、HO-1预测AP严重程度及预后的临床应用价值。结果: AP组血清Nrf-2、HO-1水平低于健康组(P＜0.05)。MAP组、MSAP组和SAP组血清Nrf-2、HO-1水平依次降低,改良CT严重程度指数(MCTSI)评分、Ranson评分、急性生理学及慢性健康状况Ⅱ(APACHE Ⅱ)评分依次升高(P＜0.05)。血清Nrf-2、HO-1水平与MCTSI评分、Ranson评分、APACHE Ⅱ评分均呈负相关(P＜0.05)。Nrf-2、HO-1联合诊断AP严重程度的AUC为0.954,优于单个指标诊断(Z_Nrf-2-联合=3.665,P＜0.001;Z_HO-1-联合=2.553,P=0.011),联合检测的灵敏度为90.82%,特异度为86.67%。存活组血清Nrf-2、HO-1水平高于死亡组(P＜0.05),白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平低于死亡组(P＜0.05)。Nrf-2、HO-1是AP患儿预后的保护因素,IL-6、TNF-α是危险因素(P＜0.05)。Nrf-2、HO-1联合预测AP严重程度的AUC为0.869,优于单个指标预测(Z_Nrf-2-联合=2.898,P=0.004;Z_HO-1-联合=2.002,P=0.045),联合检测的灵敏度为90.24%,特异度为69.70%。结论: AP患儿血清Nrf-2、HO-1水平降低,对诊断AP严重程度和预测预后具有较高效能。

Objective: To explore the relationship between changes in serum nuclear factor E2 related factor 2(Nrf-2) and heme oxygenase-1(HO-1) levels with severity of disease and prognosis in children with acute pancreatitis(AP). Methods: From August 2020 to March 2022, 173 AP children who visited our hospital were regarded as the AP group, which was separated into mild AP(MAP) group, mediate severe AP(MSAP) group, and severe AP(SAP) group according to Atlanta classification. Another 180 children who underwent physical examinations were regarded as the healthy group. Enzyme linked immunosorbent assay was applied to detect serum Nrf-2 and HO-1 levels. Spearman method was applied for correlation analysis. The children were grouped into survival group and death group based on their survival status after 28 days of follow-up. Logistic regression was applied to analyze the factors affecting the prognosis of AP. Receiver operating characteristic(ROC) curve was applied to analyze the diagnostic value of Nrf-2 and HO-1 for the severity of AP and their predictive value for prognosis. Clinical decision curve analysis(DCA) was used to evaluate the clinical application value of Nrf-2 and HO-1 in predicting the severity and prognosis of AP. Results: The serum levels of Nrf-2 and HO-1 in the AP group were lower than those in the healthy group(P<0.05). The serum levels of Nrf-2 and HO-1 in the MAP group, MSAP group, and SAP group decreased sequentially, while the modified CT severity index(MCTSI) score, Ranson score, and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score increased sequentially(P<0.05). The levels of serum Nrf-2 and HO-1 were negatively correlated with MCTSI score, Ranson score, and APACHE Ⅱ score(P<0.05). The AUC of Nrf-2 and HO-1 combined diagnosis for AP severity was 0.954, which was better than single indicator diagnosis(Z_{Nrf-2-combination}=3.665, P<0.001; Z_{HO-1-combination}=2.553, P=0.011), the sensitivity of the combined detection was 90.82%, and the specificity was 86.67%. The serum levels of Nrf-2 and HO-1 in the survival group were higher than those in the death group(P<0.05), while the levels of Interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were lower than those in the death group(P<0.05). Nrf-2 and HO-1 were protective factors for the prognosis of AP patients, while IL-6 and TNF-α were risk factors(P<0.05). The AUC of Nrf-2 and HO-1 combined prediction for AP severity was 0.869, which was better than single indicator prediction(Z_{Nrf-2-combination}=2.898, P=0.004; Z_{HO-1-combination}=2.002, P=0.045), the sensitivity of the combined detection was 90.24%, and the specificity was 69.70%. Conclusion: The serum levels of Nrf-2 and HO-1 in children with AP decrease, they have high efficacy in diagnosing the severity of AP and predicting prognosis.

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