急性胰腺炎患者血清sCD40早期检测的临床意义.pdf

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1、胃肠病学2014年第19卷第1期·21急性胰腺炎患者血清sCD40早期检测的临床意义朱一凡陈卫昌杨璇钱夷婷栾富娟苏州大学附属第一医院消化内科(215006)背景：CD40是免疫应答中的共刺激分子，通过与其配体CD40L结合，参与介导免疫调节信号。研究显示在多种疾病状态下，外周血和体液可溶性CIM0(sCD40)水平异常增高。目的：检测急性胰腺炎(AP)患者的人院早期血清sCD40水平并探讨其临床意义。方法：随机选取72例住院AP患者(MAP44例，SAP28例)，以ELISA法检测入院24h内血清sC

2、D40水平，21例健康体检者作为对照。以ROC曲线评价早期血清sCIM0对AP以及AP相关急性肺损伤(ALI)的诊断效能。结果：AP组入院24h内血清sCD40水平显著高于对照组(P<0．01)，其中SAP组又高于MAP组，并与入院24h内血清CRP水平呈显著正相关(r=0．413，P=0．000)。血清sCD40诊断AP的ROC曲线下面积(AUC)为0．806，最佳诊断界值为I>29．45pg／mL；预测AP相关ALI的AUC为0．808，诊断效能明显高于APACHEII评分(AUC=0．733)、

3、Ranson评分(AUC=0．648)和血清CRP(AUC=0．625)，最佳诊断界值为≥47．96pg／mL。结论：早期检测血清sCIM0有助于早期识别AP、判断病情严重程度以及预测AP相关ALI的发生。关键词抗原，CD40；胰腺炎；多器官功能衰竭；急性肺损伤ClinicalSignificanceofEarlyDetectionofSerumsCD40inPatientswithAcutePancreatitisZHUYifan，CHENWeichang，YANGXuan，QIANYiting，L

4、UANFujuan．DepartmentofGastroenterology，TheFimtAfiliatedHospitalofSoochowUniversity，Suzhou，angsuPr0vince(215006)C0rresp0ndenceto：CHENWeichang，Email：weichangchen@126．comBackground：CD40isaco—stimulatorymoleculeinimmuneresponse，andplaysanimportantroleinthem

5、ediationofimmunoregulatorysignalsviabindingtoitsligandCIMOL．PreviousstudiesrevealedthatsolubleCD40(sCIM0)wasextraordinarilyup—regulatedinperipheralbloodandbodyfluidinvariousdiseasedstatus．Aims：ToexploretheselqlmlevelofsCD40inpatientswithacutepancreatiti

6、s(AP)atearlystageofadmissionanditsclinicalsignificance．Methods：Atotalofseventy—twoinpatientswithAP(44casesofMAPand28casesofSAP)wererandomlyselectedandtheserumlevelofsCD40wasmeasuredbyELISAwithin24hoursafteradmission．Twenty—onehealthysubjectsreceivingrou

7、tinemedicalexaminationwereservedascontrols．ThediagnosticperformanceofearlystageseFumsCIM0foridentifyingAPandpredictingAP—associatedacutelunginjury(ALI)wasevaluatedbyROCcurve．Results：SerumsCD40levelwithin24hoursafteradmissionwassignificantlyhigherinAPpat

8、ientsthaninhealthycontrols(P<0．01)，andthatinSAPwashigherthanthatinMAPwithnosignificance．AsignificantpositivecorrelationwasfoundbetweenserumsCD40andserumCRPinAPpatientswithin24hoursafteradmission(r=0．413，P=0．000)．AreaundertheROCcu