FGF21、PERK与轻症急性胰腺炎患者APACHEⅡ评分间关系及对病情进展风险评估

doi:10.3969/j.issn.1007-3205.2024.02.005

摘要/Abstract

摘要： 目的探讨成纤维细胞生长因子21（fibroblast growth factor-21，FGF-21）、蛋白激酶R样内质网激酶（protein kinase R-like endoplasmic reticulum kinase，PERK）与轻症急性胰腺炎（mild acute pancreatitis，MAP）患者急性生理与慢性健康系统Ⅱ（acute physiology and chronic health system Ⅱ，APACHEⅡ）评分间的关系，并分析二者对非手术治疗后病情进展风险评估价值。
方法选取MAP患者169例，根据入院24 h是否进展为中度重症AP（moderately severe AP，MSAP）或重症AP（severe AP，SAP）分为进展组（n=32）和未进展组（n=137）。入院时、入院24 h分别检测血清FGF-21、PERK水平，并评估APACHEⅡ评分。分析血清FGF-21、PERK水平与APACHEⅡ评分的关系及对病情进展的作用，采用受试者工作特性曲线（receiver operating characteristic curve，ROC）、决策曲线分析（decision curve analysis，DCA）评价血清FGF-21、PERK在MAP患者病情进展中的价值。
结果入院时、入院24 h进展组血清FGF-21［（2.37±0.33） vs. （2.05±0.31）、（2.57±0.36） vs. （1.89±0.32）］ ng/L、PERK［（24.68±4.35） vs. （20.43±4.08）、（27.19±4.54） vs. （17.81±4.03）］ μg/L水平及APACHEⅡ评分［（12.54±2.62） vs. （9.87±2.58）、（13.94±2.54） vs. （8.45±2.29）］分高于未进展组（t=5.194、10.566、5.239、11.569、5.256、11.958，P＜0.001）。入院24 h进展组血清FGF-21、PERK水平及APACHEⅡ评分高于入院时，未进展组以上指标均低于入院时（P＜0.05）；入院时、入院24 h患者血清FGF-21（r=0.872、0.445，P＜0.001）、PERK（r=0.852、0.372，P＜0.001）水平与APACHEⅡ评分均呈正相关；Logistic回归分析模型结果显示，FGF-21、PERK是病情进展的独立危险因素（P＜0.05）；FGF-21、PERK联合评估病情进展对应AUC的值为0.872，大于FGF-21（χ2=2.746，P=0.006）、PERK单独评估效能（χ2=2.784，P2=0.005），在阈值0.10~0.88范围内，FGF-21、PERK联合评估病情进展的净受益率均优于单独检测。
结论 MAP患者血清FGF-21、PERK水平变化与APACHEⅡ评分关系密切，是MAP进展的独立危险因素，可为临床评估MAP进展风险提供参考。

关键词: 胰腺炎, 成纤维细胞生长因子21, 蛋白激酶类

Abstract: Objective To investigate the relationship between fibroblast growth factor-21 (FGF-21), protein kinase R-like endoplasmic reticulum kinase (PERK) and acute physiology and chronic health system Ⅱ (APACHE Ⅱ) score in patients with mild acute pancreatitis (MAP), and to analyze the value of the two in evaluating the risk of disease progression after conservative treatment.
Methods A total of 169 patients with MAP were selected and divided into a progression group (n=32) and a non-progression group (n=137) according to whether they progressed to moderately severe AP (MSAP) or severe AP (SAP) within 24 h after admission.The serum FGF-21 and PERK levels were detected at admission and 24 h after admission, and the APACHE II score was evaluated. The relationship between serum FGF-21 and PERK levels and APACHE Ⅱ score and their effects on disease progression were analyzed. Receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to evaluate the value of serum FGF-21 and PERK in the progression of MAP patients.
Results The levels of serum FGF-21 ［(2.37±0.33) vs. (2.05±0.31),(2.57±0.36) vs. (1.89±0.32)ng/L］, PERK［(24.68±4.35) vs. (20.43±4.08), (27.19±4.54) vs. (17.81±4.03)μg/L］ and APACHE Ⅱ score ［(12.54±2.62) vs. (9.87±2.58), (13.94±2.54) vs. (8.45±2.29)］ in the progression group at admission and 24 h after admission were higher than those in the non-progression group (t=5.194， 10.566， 5.239， 11.569， 5.256， 11.958， P＜0.001). The levels of serum FGF-21, PERK and APACHE Ⅱ score in the progression group at 24 h after admission were higher than those at admission, while these indicators in the non-progression group were lower than those at admission (P＜0.05). The serum FGF-21 (r=0.872, 0.445, P＜0.001) and PERK (r=0.852,0.372, P＜0.001) levels were positively correlated with the APACHE Ⅱ score at admission and 24 h after admission (P＜0.05). Logistic regression analysis model showed that FGF-21 and PERK were independent risk factors for disease progression (P＜0.05). The area under the ROC curve (AUC) value of the combined assessment of FGF-21 and PERK for disease progression was 0.872, which was greater than that of FGF-21 （χ2=2.746, P=0.006） and PERK alone (χ2=2.784, P=0.005). Within the threshold range of 0.10 to 0.88, the net benefit rate of FGF-21 and PERK in combination to assess disease progression was superior to that of single detection.
Conclusion The changes of serum FGF-21 and PERK levels in MAP patients are closely related to the APACHE Ⅱ score, and they are independent risk factors for the progression of MAP. They can provide a reference for clinical assessment of the risk of MAP progression.

Key words: pancreatitis, fibroblast growth factors 21, protein kinases

屈少磊, 韩芳, 赵景, 唐井钢. FGF21、PERK与轻症急性胰腺炎患者APACHEⅡ评分间关系及对病情进展风险评估 [J]. 河北医科大学学报, 2024, 45(2): 147-152.

QU Shao-lei, HAN Fang, ZHAO Jing, TANG Jing-gang. The relationship between FGF21, PERK and APACHE Ⅱ score in patients with mild acute pancreatitis and the risk assessment of disease progression [J]. Journal of Hebei Medical University, 2024, 45(2): 147-152.

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FGF21、PERK与轻症急性胰腺炎患者APACHEⅡ评分间关系及对病情进展风险评估

The relationship between FGF21, PERK and APACHE Ⅱ score in patients with mild acute pancreatitis and the risk assessment of disease progression

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