SIGIRR、IL-1、Treg/Th17、NLR与急性胰腺炎继发脓毒症病情程度及预后的关联性

doi:10.3877/cma.j.issn.2095-2015.2025.03.012

目的

分析外周血单免疫球蛋白白细胞介素1 受体相关蛋白（SIGIRR）、白细胞介素-1（IL-1）、调节性T 细胞（Treg）/辅助性T 细胞17（Th17）比值、中性粒细胞/淋巴细胞比值（NLR）与急性胰腺炎患者病情程度及预后的关联性。

方法

回顾性分析2021 年1 月至2024 年1 月安康市人民医院收治的120 例急性胰腺炎患者的临床资料，根据患者病情严重程度分为两组，继发脓毒症组56 例，未继发脓毒症组64 例，另选取同期健康体检者50 例为对照组，随访1 个月，根据患者预后情况，将其分为生存组86 例，死亡组34 例，收集所有受试者的外周血内SIGIRR、IL-1、Treg/Th17、NLR 等资料，比较不同组别患者间的指标水平差异，使用Spearman 分析外周血内SIGIRR、IL-1、Treg/Th17、NLR 与急性胰腺炎继发脓毒症患者病情程度及预后的关联性；采用Logistic 多因素回归模型，评估效能绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC）评估各指标对急性胰腺炎继发脓毒症预后的预测价值。

结果

急性胰腺炎继发脓毒症组SIGIRR、IL-1、Treg/Th17、NLR水平均高于未继发脓毒症组、对照组，未继发脓毒症组各指标水平均高于对照组（P＜0.05），死亡组SIGIRR、IL-1、Treg/Th17、NLR 水平均高于生存组（P＜0.05）。单因素及Logistic 多因素回归分析显示，SIGIRR≥80.45 pg/L、IL-1≥576.54 ng/L、Treg/Th17≥0.26、NLR≥10.14 均为预测急性胰腺炎继发脓毒症患者预后的危险因素（P＜0.05）。ROC 曲线显示，SIGIRR 的AUC 最高（0.856，95% CI 0.810～0.902），Treg/Th17 次之（0.841，95% CI 0.793～0.889），四项指标联合的AUC 达0.886（95% CI 0.828～0.931），显著高于任一单一指标（Delong 检验，P＜0.05）。联合模型的敏感度为84.4%，特异度为86.7%。

结论

外周血SIGIRR、IL-1、Treg/Th17 和NLR 在急性胰腺炎继发脓毒症患者病情程度及预后呈显著相关，四项指标联合检测具有优异的预测效能，同时监测有助于反映临床诊疗和预后评估。

关键词: 急性胰腺炎, 脓毒症, 白细胞介素-1, 中性粒细胞/淋巴细胞比值, 单免疫球蛋白白细胞介素1 受体相关蛋白, 调节性T 细胞/辅助性T 细胞17 比值

Objective

To investigate the associations between single Ig interleukin-1-related receptor (SIGIRR), interleukin-1 (IL-1), regulatory T cells (Treg)/helper T cell 17 (Th17) and neutrophil/lymphocyte ratio (NLR) and the severity and prognosis of patients with acute pancreatitis.

Methods

The clinical data of 120 patients with acute pancreatitis admitted to Ankang People's Hospital from January 2021 to January 2024 were retrospectively analyzed.According to the severity of the patients' conditions,they were divided into two groups: 56 patients in the secondary sepsis group and 64 patients in the non-secondary sepsis group, and 50 healthy patients with physical examination during the same period were selected as the control group.The patients were followed up for 1 month.According to the prognosis of the patients, they were divided into a survival group (86 cases) and a death group (34 cases).SIGIRR,IL-1, Treg/Th17, NLR and other data in peripheral blood of all subjects were collected, and the difference of indicator levels among different groups of patients was compared.Spearman was used to analyze the correlation between SIGIRR, IL-1, Treg/Th17 and NLR in peripheral blood and the severity and prognosis of patients with acute pancreatitis secondary sepsis.Logistic multi-factor regression model was used to evaluate the performance.Receiver operating characteristic (ROC) curve was drawn and the area under the curve was calculated to evaluate the prognostic value of each index in acute pancreatitis secondary sepsis.

Results

The levels of SIGIRR, IL-1, Treg/Th17 and NLR in acute pancreatitis secondary sepsis group were higher than those in non-secondary sepsis group and control group, and the levels of all indexes in non-secondary sepsis group were higher than those in control group (P<0.05).The levels of SIGIRR, IL-1,Treg/Th17 and NLR in the death group were all higher than those in the survival group (P<0.05).Univariate and Logistic multivariate regression analyses showed that SIGIRR≥80.45 pg/L, IL-1≥576.54 ng/L, Treg/Th17≥0.26, and NLR≥10.14 were all risk factors for predicting the prognosis of patients with secondary sepsis due to acute pancreatitis (P<0.05).The ROC curve showed that the AUC of SIGIRR was the highest (0.856, 95% CI 0.810-0.902), followed by Treg/Th17 (0.841, 95% CI 0.793-0.889), the combined AUC of the four indicators reached 0.886 (95% CI 0.828-0.931), which was significantly higher than that of any single indicator (Delong test, P<0.05), the sensitivity of the combined model was 84.4%and the specificity was 86.7%.

Conclusion

Peripheral blood SIGIRR, IL-1, Treg/Th17 and NLR are significantly correlated with the severity and prognosis of patients with secondary sepsis due to acute pancreatitis.The combined detection of the four indicators has excellent predictive efficacy.Meanwhile,monitoring is helpful to reflect clinical diagnosis and treatment as well as prognosis assessment.

Key words: Acute pancreatitis, Sepsis, Interleukin-1, Neutrophil/lymphocyte ratio, Single Ig interleukin-1-related receptor, Regulatory T cells/helper T cells 17 ratio

表1 不同病情严重程度患者与健康对照组临床资料比较（±s ）

临床资料	继发脓毒症组(n=56)	未继发脓毒症组(n=64)	对照组(n=50)	F/χ²	P
年龄(岁, $\overset{ˉ}{x}$ ± s )	45.86±13.62	45.74±14.56	45.55±14.47	0.145	0.525
性别(男/女,例)	30/26	39/25	28/22	0.233	0.656
体重指数(kg/m², $\overset{ˉ}{x}$ ± s)	24.43±2.12	24.54±3.58	24.62±3.55	2.422	0.451
SIGIRR(pg/L, $\overset{ˉ}{x}$ ± s )	83.66±23.62^ab	73.33±24.36^b	63.34±18.37	2.124	＜0.001
IL-1(ng/L, $\overset{ˉ}{x}$ ± s )	697.32±320.12 ^ab	526.28±217.40^b	386.60±117.45	3.320	＜0.001
Treg/Th17( $\overset{ˉ}{x}$ ± s )	0.38±0.14 ^ab	0.25±0.12^b	0.15±0.02	4.712	＜0.001
NLR( $\overset{ˉ}{x}$ ± s )	11.34±1.35 ^ab	9.47±1.33^b	7.58±1.17	8.210	＜0.001

表1 不同病情严重程度患者与健康对照组临床资料比较（±s ）

临床资料	继发脓毒症组(n=56)	未继发脓毒症组(n=64)	对照组(n=50)	F/χ²	P
年龄(岁, $\overset{ˉ}{x}$ ± s )	45.86±13.62	45.74±14.56	45.55±14.47	0.145	0.525
性别(男/女,例)	30/26	39/25	28/22	0.233	0.656
体重指数(kg/m², $\overset{ˉ}{x}$ ± s)	24.43±2.12	24.54±3.58	24.62±3.55	2.422	0.451
SIGIRR(pg/L, $\overset{ˉ}{x}$ ± s )	83.66±23.62^ab	73.33±24.36^b	63.34±18.37	2.124	＜0.001
IL-1(ng/L, $\overset{ˉ}{x}$ ± s )	697.32±320.12 ^ab	526.28±217.40^b	386.60±117.45	3.320	＜0.001
Treg/Th17( $\overset{ˉ}{x}$ ± s )	0.38±0.14 ^ab	0.25±0.12^b	0.15±0.02	4.712	＜0.001
NLR( $\overset{ˉ}{x}$ ± s )	11.34±1.35 ^ab	9.47±1.33^b	7.58±1.17	8.210	＜0.001

表2 不同预后急性胰腺炎患者各指标比较（±s ）

临床资料	死亡组(n=34)	生存组(n=86)	t/χ²	P
年龄(岁, $\overset{ˉ}{x}$ ± s )	45.65±14.32	45.43±13.13	0.080	0.935
性别(男/女,例)	20/14	48/38	0.142	0.706
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	24.13±2.02	24.34±2.18	0.485	0.628
SIGIRR(pg/L, $\overset{ˉ}{x}$ ± s )	84.59±23.24	75.40±22.26	2.012	0.046
IL-1(ng/L, $\overset{ˉ}{x}$ ± s )	688.54±319.32	528.29±221.45	3.130	0.002
Treg/Th17( $\overset{ˉ}{x}$ ± s )	0.39±0.20	0.23±0.15	4.771	＜0.001
NLR( $\overset{ˉ}{x}$ ± s )	11.24±1.21	9.31±1.13	8.263	＜0.001

表2 不同预后急性胰腺炎患者各指标比较（±s ）

临床资料	死亡组(n=34)	生存组(n=86)	t/χ²	P
年龄(岁, $\overset{ˉ}{x}$ ± s )	45.65±14.32	45.43±13.13	0.080	0.935
性别(男/女,例)	20/14	48/38	0.142	0.706
体重指数(kg/m², $\overset{ˉ}{x}$ ± s )	24.13±2.02	24.34±2.18	0.485	0.628
SIGIRR(pg/L, $\overset{ˉ}{x}$ ± s )	84.59±23.24	75.40±22.26	2.012	0.046
IL-1(ng/L, $\overset{ˉ}{x}$ ± s )	688.54±319.32	528.29±221.45	3.130	0.002
Treg/Th17( $\overset{ˉ}{x}$ ± s )	0.39±0.20	0.23±0.15	4.771	＜0.001
NLR( $\overset{ˉ}{x}$ ± s )	11.24±1.21	9.31±1.13	8.263	＜0.001

表3 急性胰腺炎继发脓毒症患者预后的预测风险因素单因素和多因素回归分析

变量	单因素Logistic		多因素Logistic
变量	OR(95% CI)	P	OR(95% CI)	P
年龄	1.003(0.978～1.029)	0.935
性别	1.131(0.524～2.441)	0.706
体重指数	0.961(0.822～1.124)	0.628
SIGIRR	3.124(1.851～5.263)	＜0.001	2.455(1.423～4.235)	0.001
IL-1	4.054(2.382～6.893)	＜0.001	3.303(1.883～5.804)	＜0.001
Treg/Th17	2.785(1.655～4.684)	＜0.001	2.152(1.254～3.706)	0.006
NLR	5.206(3.024～8.956)	＜0.001	4.104(2.302～7.326)	＜0.001

表3 急性胰腺炎继发脓毒症患者预后的预测风险因素单因素和多因素回归分析

变量	单因素Logistic		多因素Logistic
变量	OR(95% CI)	P	OR(95% CI)	P
年龄	1.003(0.978～1.029)	0.935
性别	1.131(0.524～2.441)	0.706
体重指数	0.961(0.822～1.124)	0.628
SIGIRR	3.124(1.851～5.263)	＜0.001	2.455(1.423～4.235)	0.001
IL-1	4.054(2.382～6.893)	＜0.001	3.303(1.883～5.804)	＜0.001
Treg/Th17	2.785(1.655～4.684)	＜0.001	2.152(1.254～3.706)	0.006
NLR	5.206(3.024～8.956)	＜0.001	4.104(2.302～7.326)	＜0.001

图1 多因素预测急性胰腺炎继发脓毒症患者预后的ROC 曲线注：SIGIRR 单免疫球蛋白白细胞介素1 受体相关蛋白；IL-1 白细胞介素-1；Treg/Th17 调节性T 细胞/辅助性T 细胞17 比值；NLR 中性粒细胞/淋巴细胞比值

表4 SIGIRR、IL-1、Treg/Th17、NLR 预测急性胰腺炎继发脓毒症患者预后的效能分析

危险因素	截断值	AUC	95% CI	敏感度(%)	特异度(%)
SIGIRR	80.45 pg/L	0.856	0.810～0.902	78.2	82.5
IL-1	576.54 ng/L	0.826	0.776～0.876	75.6	80.3
Treg/Th17	0.26	0.841	0.793～0.889	77.1	81.8
NLR	10.14	0.828	0.778～0.878	76.3	79.5
联合	-	0.886	0.828～0.931	84.4	86.7

表4 SIGIRR、IL-1、Treg/Th17、NLR 预测急性胰腺炎继发脓毒症患者预后的效能分析

危险因素	截断值	AUC	95% CI	敏感度(%)	特异度(%)
SIGIRR	80.45 pg/L	0.856	0.810～0.902	78.2	82.5
IL-1	576.54 ng/L	0.826	0.776～0.876	75.6	80.3
Treg/Th17	0.26	0.841	0.793～0.889	77.1	81.8
NLR	10.14	0.828	0.778～0.878	76.3	79.5
联合	-	0.886	0.828～0.931	84.4	86.7

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Correlation of SIGIRR, IL-1, Treg/Th17, NLR with severity and prognosis of acute pancreatitis secondary sepsis

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Correlation of SIGIRR, IL-1, Treg/Th17, NLR with severity and prognosis of acute pancreatitis secondary sepsis