硫化氢在评价急性胰腺炎严重程度中的作用研究

摘要

目的 探讨硫化氢(H2S)在急性胰腺炎(AP)严重性程度评价中的价值.方法 选取2013年2月至2015年12月期间在该院住院的51例AP患者,其中21例为重症AP(SAP)组,30例为轻性AP (MAP)组,同时抽取36例非胰腺炎腹痛患者(腹痛组),9例健康人作为对照组(NC组).入院时抽取4组受试者外周静脉血,并进行Ranson评分.在12、24、48h后继续抽取AP患者外周静脉血,使用酶联免疫吸附法(ELISA)监测患者血清H2S水平.使用单因素方差分析和事后分析比较4组受试者入院时血清H2S水平,重复测量的方差分析比较AP患者入院时、12h、24 h和48 h时H2S水平,Spearman相关性分析AP患者血清H2S水平与Ranson评分的关系.结果 入院时,SAP组的H2S水平显著高于MAP组、腹痛组、NC组(P=0.000),MAP组的H2S水平也显著高于腹痛组、NC组(P=0.000),而腹痛组和NC组差异无统计学意义(P=0.131);AP患者在入院时,12 h,24 h和48 h时H2S水平差异均有统计学意义(P=0.000),呈逐渐下降的趋势;AP组入院时的H2S水平与Ranson评分呈显著正相关(r=0.578,P=0.000).结论 血清H2S对诊断患者是否存在AP发生的可能性上有明确意义,血清H2S水平越高,AP为SAP的风险越大.%Objective To explore the value of hydrogen sulfide(H2S) in the evaluation of severity of acute pancreatitis(AP).Methods Fifty-one patients with AP from February 2013 to December 2015 in this hospital were divided into severe acute pancreatitis (SAP,n=21) group and mild acute pancreatitis (MAP,n 30) group.Thirty six non-pancreatitis abdominal patients and 9 healthy persons(NC) were chosen as compare groups.The peripheral venous blood samples from the four groups and the Ranson Score of AP group were obtained after admission,the venous blood samples of 12 h,24 h,48 h of AP group were also obtained.Blood samples were used to detect the concentrations of hydrogen sulfide with ELISA method.We compared the concentrations of H2S between the four groups with one way ANOVA,and post hoc;compared the differences of concentrations of H2S in AP group between after admission,12 h,24 h and 48 h with repeated measures data ANOVA;and explored the relationship between the concentrations of H2S after admission and the Ranson scores in AP group with Spearman correlation analysis.Results The concentra tions of H2S was significant higher in SAP group than MAP,abdominal,and NC group(P=0.000);the concentrations of H2S was also significant higher in MAP group than abdominal,and NC group(P=0.000);there is no significant difference between the abdominal and NC group(P =0.131).There is significant difference of H2S concentrations between the four times in AP group(P =0.000),decreasing gradually over time.The H2S concentrations in AP group after admission was significantly related with their Ranson scores(r=0.578,P=0.000).Conclusion There is certain value of the concentrations of H2S in the diagnosis of AP,the higher H2S level suggests the higher severity of the patients with acute pancreatitis.