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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2018, Vol. 11 ›› Issue (01) : 17 -21. doi: 10.3877/cma.j.issn.1674-6880.2018.01.003

所属专题： 文献；

论著

性激素水平对急性胰腺炎患者炎症反应及预后的影响
孟丽君1, 刘微丽1,†(), 路国涛1   
  1. 1. 225001　江苏扬州，扬州大学附属医院重症医学科
  • 收稿日期:2017-04-14 出版日期:2018-02-01
  • 通信作者: 刘微丽
  • 基金资助:
    中国博士后科学基金项目(2014M562664)

Effect of sex hormones on the inflammatory level and prognosis in patients with acute pancreatitis

Lijun Meng1, Weili Liu1,†(), Guotao Lu1   

  1. 1. Department of Intensive Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou 225001, China
  • Received:2017-04-14 Published:2018-02-01
  • Corresponding author: Weili Liu
  • About author:
    Corresponding author: Liu Weili, Email:
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孟丽君, 刘微丽, 路国涛. 性激素水平对急性胰腺炎患者炎症反应及预后的影响[J]. 中华危重症医学杂志(电子版), 2018, 11(01): 17-21.

Lijun Meng, Weili Liu, Guotao Lu. Effect of sex hormones on the inflammatory level and prognosis in patients with acute pancreatitis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(01): 17-21.

目的

探讨性激素表达水平对急性胰腺炎患者炎症水平及预后的影响。

方法

选择2014年9月至2016年12月扬州大学附属医院急诊科、消化内科、普外科以及重症医学科收治的105例急性胰腺炎患者，分为轻症组（57例）和重症组（48例）。比较两组患者的一般资料及性激素包括雌二醇、孕酮和睾酮的表达水平，并分析其与超敏C反应蛋白（hs-CRP）和降钙素原的相关性。

结果

两组急性胰腺炎患者间急性病生理学和长期健康评价（APACHE）Ⅱ评分、全身性感染相关性器官功能衰竭评分（SOFA）、hs-CRP及降钙素原表达水平比较，差异均有统计学意义（t=4.408、9.607、5.478、3.214，P均< 0.05）；而雌二醇、孕酮及睾酮表达水平比较，差异均无统计学意义（U=56.000、105.500、70.000，P=0.452、0.228、0.104）。根据生存与否，将重症组患者分为存活组（36例）和死亡组（12例）。结果显示，存活组患者的雌二醇表达水平高于死亡组（U=5.000，P=0.022），而两组患者孕酮及睾酮表达水平比较，差异均无统计学意义（U=10.000、7.000，P=0.909、0.425）。Spearman相关分析显示，轻症组患者雌二醇、孕酮及睾酮的表达水平与hs-CRP（r=-0.208、0.065、0.029，P=0.352、0.775、0.897）和降钙素原（r=-0.197、-0.016、0.113，P=0.621、0.942、0.618）均无相关性；重症组患者雌二醇表达水平与hs-CRP呈正相关（r=0.709，P=0.022），与降钙素原无相关性（r=0.389，P=0.216），而孕酮及睾酮的表达水平与hs-CRP（r=-0.224、0.199，P=0.228、0.582）和降钙素原（r=0.369、-0.165，P=0.777、0.649）均无相关性。

结论

雌二醇表达水平与急性重症胰腺炎患者炎症水平具有相关性，可作为急性重症胰腺炎预后的指标。

关键词: 性激素, 急性胰腺炎, 雌二醇, 脓毒症
Objective

To evaluate the effect of sex hormones on the inflammatory level and prognosis in patients with acute pancreatitis.

Methods

From September 2014 to December 2016, a total of 105 patients with acute pancreatitis were selected from departments of emergency, digestive medicine, general surgery and intensive medicine in the Affiliated Hospital of Yangzhou University, who were divided into the mild group (57 cases) and the severe group (48 cases). Their general information and expressions of sex hormones including estradiol, progesterone and testosterone were compared between the two groups, and their relationship with hypersensitive C-reactive protein (hs-CRP) and procalcitonin was analyzed.

Results

These two groups were significantly different in acute physiology and chronic health evaluation (APACHE)Ⅱ scores, sofa scores, hs-CRP and procalcitonin expressions (t=4.408, 9.607, 5.478, 3.214; all P < 0.05). However, the expressions of estradiol, progesterone and testosterone in these two groups showed no significant difference (U=56.000, 105.500, 70.000; P=0.452, 0.228, 0.104). According to survival conditions, patients in the severe group were divided into the survival group (36 cases) and the death group (12 cases). The results showed that the estradiol expression was higher in the survival group than in the death group (U=5.000, P=0.022), but the expressions of progesterone and testosterone between the two groups showed no significant difference (U=10.000, 7.000; P=0.909, 0.425). Spearman correlation analysis showed that there was no correlation between estradiol, progesterone and testosterone expressions and hs-CRP (r=-0.208, 0.065, 0.029; P=0.352, 0.775, 0.897), and no correlation between estradiol, progesterone and testosterone expressions and procalcitonin (r=-0.197, -0.016, 0.113; P=0.621, 0.942, 0.618) in the mild group. There was a positive correlation between the estradiol expression and hs-CRP (r=0.709, P=0.022), and no significant correlation between the estradiol expression and procalcitonin (r=0.389, P=0.216) in the severe group. There was also no significant correlation between progesterone and testosterone expressions and hs-CRP (r=-0.224, 0.199; P=0.228, 0.582), and no correlation between progesterone and testosterone expressions and procalcitonin(r=0.369, -0.165; P=0.777, 0.649) in the severe group.

Conclusion

The expression of estradiol is correlated with the inflammatory level in patients with severe acute pancreatitis and could be used as a prognostic index for severe acute pancreatitis.

Key words: Sex hormone, Acute pancreatitis, Estradiol, Sepsis
表1 两组急性胰腺炎患者一般资料比较（±s）
组别 例数 性别比（例，男/女） 年龄（岁） 病因类型[例（%）]
胆源性 脂源性 酒精及其他
轻症组 57 32/25 51 ± 14 21（36.84） 27（47.37） 9（15.79）
重症组 48 29/19 56 ± 15 19（39.58） 22（45.83） 7（14.58）
t/χ2值 ? 0.067 0.964 ? 0.097 ?
P值 ? 0.796 0.430 ? 0.953 ?
组别 例数 APACHEⅡ评分（分） SOFA评分（分） hs-CRP（mg/L） 降钙素原（μg/L）
轻症组 57 7±4 2.5 ± 0.8 12 ± 5 0.9 ± 0.6
重症组 48 19 ± 10 7.1 ± 1.9 33 ± 11 15.4 ± 2.2
t/χ2值 ? 4.408 9.607 5.478 3.214
P值 ? < 0.001 0.036 < 0.001 < 0.001
表2 两组急性胰腺炎患者性激素表达水平的比较[M（P25，P75）]
组别 例数 雌二醇（ng/L） 孕酮（μg/L） 睾酮（μg/L）
轻症组 57 117.8（67.6，117.8） 1.05（0.23，1.14） 2.4（1.2，6.1）
重症组 48 174.6（42.4，269.6） 1.31（0.86，1.58） 1.4（1.2，2.1）
U值 ? 56.000 105.500 70.000
P值 ? 0.452 0.228 0.104
表3 重症组患者存活组和死亡组性激素表达水平的比较[M（P25，P75）]
组别 例数 雌二醇（ng/L） 孕酮（μg/L） 睾酮（μg/L）
存活组 36 256.1（119.5，299.7） 1.29（0.76，1.45） 2.0（1.5，2.1）
死亡组 12 34.1（3.0，45.1） 1.31（0.38，1.98） 1.3（0.6，2.8）
U值 ? 5.000 10.000 7.000
P值 ? 0.022 0.909 0.425
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