急性胰腺炎患者外周血α—MSH、TNF—α、PCT的动态检测及临床意义(1)
DOI：10.3760/cma.j.issn.1671-0282.2015.04.021
作者单位：230601 合肥，安徽医科大学第二附属医院急诊外科
通信作者：项和平，Email：： xhping1968@gmail.com
【摘要】目的 探讨急性胰腺炎患者外周血α-MSH、TNF-α、PCT的动态变化及其对患者病情严重程度的评估价值。方法 选取安徽医科大学第二附属医院急诊外科2011年3月至2014年3月收治的急性胰腺炎患者68例，其中轻症组36例、重症组32例。所有患者取入院后第1、3、5、7天静脉血，采用酶联免疫吸附法测定α-MSH、TNF-α、PCT水平。结果 与轻症组对比，重症组患者血清α-MSH质量浓度较低(P<0.05)，而血清TNF-α及PCT水平高于轻症组(P<0.05);在病情严重度评估方面，α-MSH敏感度为82.35%、特异度为88.24%、准确性为87.5%; TNF-α敏感度为76.47%、特异度为82.35%、准确性为81.25%;PCT敏感度为70.59%、特异度为76.47%、准确性为75.00%;PCT+TNF-α+α-MSH敏感度为88.24%、特异度为94.12%、准确性为93.75%;PCT、TNF-α、α-MSH及三者联合的曲线下面积分别为0.690、0.696、0.768及0.885。结论 血清α-MSH、TNF-α、PCT含量监测在急性胰腺炎患者病情严重程度评估方面具有一定的临床价值，其中α-MSH在病情评估方面的敏感性、特异性及准确性均高于后两者，而且外周血α-MSH含量较低预示患者病情严重，预后不良;此外，三者联合检测在病情严重程度评估方面具有更高的临床价值。
, http://www.100md.com
【关键词】 α-黑色素细胞刺激素;肿瘤坏死因子-α ;降钙素原;急性胰腺炎
Clinical significance and changes on serum levels of α-MSH， TNF-α， PCT in patients with acute pancreatitis
Gao Ming， Xiang Heping， Zhang Changle，Fu Rui.Emergency Surgery of the Second Affiliated Hospital of Anhui Medical University，Hefei 230601，China
Corresponding author：Xiang Heping，Email： xhping1968@gmail.com
【Abstract】Objective To investigate the dynamic changes in peripheral blood of patients with acute pancreatitis α-MSH， TNF-α， PCT'S and the value of the patient assessment of disease severity.Methods Emergency surgery in the Second Affiliated Hospital of Anhui Medical University from March 2011 to March 2014 were treated 68 cases of acute pancreatitis patients， 36 patients with mild， 32 cases of severe group. All patients were extracted 1，3，5，7 days after admission blood， and α-MSH was measured by enzyme-linked immunosorbent assay， the content of TNF-αand PCT. Results Compared with the mild group， the serum of patients with severe group of α-MSH concentrations were lower (P <0.05)， while serum TNF-α and PCT levels higher than the mild group (P<0.05); in disease severity assessment， α-MSH sensitivity of 82.35% and a specificity of 88.24%， the accuracy was 87.5%， TNF-α sensitivity of 76.47% and a specificity of 82.35%， the accuracy was 81.25%， PCT sensitivity of 70.59% and a specificity of 76.47%， 75.00% accuracy，PCT +TNF-α+α-MSH sensitivity of 88.24% and a specificity of 94.12%， 93.75% accuracy; area under the PCT， TNF-α， α-MSH and the combination of the three curves 0.690，0.696，0.768 and 0.885， respectively.Conclusions Serum α-MSH， monitoring TNF-α， PCT levels have some clinical value in patients with acute pancreatitis disease severity assessment， including α-MSH in the condition assessment of the sensitivity， specificity and positive predictive value were higher than the latter two， and peripheral α-MSH in patients with a low level indicates a serious condition， poor prognosis; addition， combined detection with higher clinical value in the assessment of disease severity., 百拇医药(高明 项和平 张长乐 付锐)
作者单位：230601 合肥，安徽医科大学第二附属医院急诊外科
通信作者：项和平，Email：： xhping1968@gmail.com
【摘要】目的 探讨急性胰腺炎患者外周血α-MSH、TNF-α、PCT的动态变化及其对患者病情严重程度的评估价值。方法 选取安徽医科大学第二附属医院急诊外科2011年3月至2014年3月收治的急性胰腺炎患者68例，其中轻症组36例、重症组32例。所有患者取入院后第1、3、5、7天静脉血，采用酶联免疫吸附法测定α-MSH、TNF-α、PCT水平。结果 与轻症组对比，重症组患者血清α-MSH质量浓度较低(P<0.05)，而血清TNF-α及PCT水平高于轻症组(P<0.05);在病情严重度评估方面，α-MSH敏感度为82.35%、特异度为88.24%、准确性为87.5%; TNF-α敏感度为76.47%、特异度为82.35%、准确性为81.25%;PCT敏感度为70.59%、特异度为76.47%、准确性为75.00%;PCT+TNF-α+α-MSH敏感度为88.24%、特异度为94.12%、准确性为93.75%;PCT、TNF-α、α-MSH及三者联合的曲线下面积分别为0.690、0.696、0.768及0.885。结论 血清α-MSH、TNF-α、PCT含量监测在急性胰腺炎患者病情严重程度评估方面具有一定的临床价值，其中α-MSH在病情评估方面的敏感性、特异性及准确性均高于后两者，而且外周血α-MSH含量较低预示患者病情严重，预后不良;此外，三者联合检测在病情严重程度评估方面具有更高的临床价值。
, http://www.100md.com
【关键词】 α-黑色素细胞刺激素;肿瘤坏死因子-α ;降钙素原;急性胰腺炎
Clinical significance and changes on serum levels of α-MSH， TNF-α， PCT in patients with acute pancreatitis
Gao Ming， Xiang Heping， Zhang Changle，Fu Rui.Emergency Surgery of the Second Affiliated Hospital of Anhui Medical University，Hefei 230601，China
Corresponding author：Xiang Heping，Email： xhping1968@gmail.com
【Abstract】Objective To investigate the dynamic changes in peripheral blood of patients with acute pancreatitis α-MSH， TNF-α， PCT'S and the value of the patient assessment of disease severity.Methods Emergency surgery in the Second Affiliated Hospital of Anhui Medical University from March 2011 to March 2014 were treated 68 cases of acute pancreatitis patients， 36 patients with mild， 32 cases of severe group. All patients were extracted 1，3，5，7 days after admission blood， and α-MSH was measured by enzyme-linked immunosorbent assay， the content of TNF-αand PCT. Results Compared with the mild group， the serum of patients with severe group of α-MSH concentrations were lower (P <0.05)， while serum TNF-α and PCT levels higher than the mild group (P<0.05); in disease severity assessment， α-MSH sensitivity of 82.35% and a specificity of 88.24%， the accuracy was 87.5%， TNF-α sensitivity of 76.47% and a specificity of 82.35%， the accuracy was 81.25%， PCT sensitivity of 70.59% and a specificity of 76.47%， 75.00% accuracy，PCT +TNF-α+α-MSH sensitivity of 88.24% and a specificity of 94.12%， 93.75% accuracy; area under the PCT， TNF-α， α-MSH and the combination of the three curves 0.690，0.696，0.768 and 0.885， respectively.Conclusions Serum α-MSH， monitoring TNF-α， PCT levels have some clinical value in patients with acute pancreatitis disease severity assessment， including α-MSH in the condition assessment of the sensitivity， specificity and positive predictive value were higher than the latter two， and peripheral α-MSH in patients with a low level indicates a serious condition， poor prognosis; addition， combined detection with higher clinical value in the assessment of disease severity., 百拇医药(高明 项和平 张长乐 付锐)