标题：老年重症急性胰腺炎继发胰腺感染的病原菌分布及其与血清PCT、PA、FIB、HSP70和HMGB1的相关性

      作者：王磊 1，2，陈丽莉 1，谢树金 1，张莉 1，孙海燕 1，郭主声 1，2    1.广东医科大学基础学院，广东 东莞 523808；2.东莞东华医院检验科，广东 东莞 523110

      卷次： 2024年35卷3期

      【摘要】 目的 探讨老年重症急性胰腺炎继发胰腺感染患者的病原菌分布及其与血清降钙素原(PCT)、前白蛋白(PA)、纤维蛋白原(FIB)、热休克蛋白70 (HSP70)、高迁徙率族蛋白1 (HMGB1)水平的相关性。方法 选择2019年1月至2022年12月东莞东华医院收治的62例老年重症急性胰腺炎患者作为研究对象，根据是否继发胰腺感染分为感染组20例和未感染组42例，另选择同期健康体检的80例健康者作为对照组。记录感染组患者病原菌分布情况，比较三组受试者及感染组不同病原菌感染类型患者的血清 PCT、PA、FIB、HSP70和HMGB1水平，并采用Pearson相关性分析法分析血清PCT、PA、FIB、HSP70及HMGB1水平和胰腺感染的相关性。结果 感染组患者病原菌感染类型主要为细菌感染，占90.00%，其中细菌感染类型中革兰阴性菌占55.00%，革兰阳性菌占35.00%；感染组患者血清PCT、HSP70、HMGB1水平分别为(2.49±0.53) μg/L、(9.12±1.86) ng/mL、(18.33±2.61) ng/mL，明显高于未感染组的(1.56±0.41) μg/L、(5.73±1.45) ng/mL、(13.62±2.47) ng/mL和对照组的(0.23±0.06) μg/L、(0.97±0.13) ng/mL、(0.73±0.15) ng/mL，PA、FIB分别为(0.17±0.02) g/L、(2.06±0.21) g/L，明显低于未感染组的(0.23±0.04) g/L、(2.75±0.30) g/L和对照组的(0.30±0.03) g/L、(3.23±0.36) g/L，且未感染组患者的血清PCT、HSP70、HMGB1水平均高于对照组，PA、FIB均低于对照组，差异均有统计学意义(P<0.05)；感染组细菌感染患者的血清PCT、HSP70、HMGB1水平分别为(2.74±0.31) μg/L、(11.06±1.43) ng/mL、(20.68±2.05) ng/mL，明显高于真菌感染患者的(2.13±0.25) μg/L、(7.93±1.05) ng/mL、(16.27±1.76) ng/mL，PA、FIB水平分别为(0.11±0.02) g/L、(1.91±0.24) g/L，明显低于真菌感染患者的(0.17±0.04) g/L、(2.58±0.34) g/L，差异均有统计学意义(P<0.05)；经 Pearson相关性分析结果显示，血清 PCT、HSP70、HMGB1与胰腺感染呈正相关(r=0.581、0.613、0.567，P<0.05)，与PA、FIB呈负相关(r=-0.463、-0.531，P<0.05)。结论 老年重症急性胰腺炎继发胰腺感染患者的病原菌类型主要为细菌感染，患者血清PCT、HSP70、HMGB1水平明显升高，PA、FIB明显降低，且与胰腺感染的发生有明显相关性，临床上应予以密切关注。
      【关键词】 重症急性胰腺炎；胰腺感染；降钙素原；前白蛋白；纤维蛋白原；热休克蛋白70；高迁徙率族蛋白1；相关性
      【中图分类号】 R576 【文献标识码】 A 【文章编号】 1003—6350（2024）03—0358—05

Pathogenic distribution of pancreatic infection secondary to severe acute pancreatitis in the elderly and itscorrelation with serum PCT, PA, FIB, HSP70, and HMGB1.
WANG Lei 1,2, CHEN Li-li 1, XIE Shu-jin 1, ZHANG Li 1,SUN Hai-yan 1, GUO Zhu-sheng 1,2. 1. School of Basic Medical Sciences, Guangdong Medical University, Dongguan523808, Guangdong, CHINA; 2. Department of Clinical Laboratory, Dongguan Tungwah Hospital, Dongguan 523110,Guangdong, CHINA
【Abstract】 Objective To investigate the pathogenic bacteria distribution and its correlation with serum procal-citonin (PCT), prealbumin (PA), fibrinogen (FIB), heat shock protein 70 (HSP70), high migration group protein 1(HMGB1) levels in elderly patients with severe acute pancreatitis secondary pancreatic infection. Methods A total of62 elderly patients with severe acute pancreatitis admitted to Dongguan Donghua Hospital from January 2019 to Decem-ber 2022 were selected as the research objects. According to the secondary occurrence of pancreatic infection, they weredivided to 20 cases in the infection group and 42 cases in the non-infection group. Eighty healthy people who receivedphysical examination in the hospital during the same period were selected as the control group. The distribution of patho-genic bacteria in the infection group was recorded, and the serum PCT, PA, FIB, HSP70, and HMGB1 levels were com-pared among the three groups and patients with different types of pathogenic bacteria. Pearson correlation analysis wasused to analyze the correlation between serum PCT, PA, FIB, HSP70, and HMGB1 and pancreatic infection. Results Themain type of pathogenic bacteria in the infection group were bacterial infection, accounting for 90.00%, among whichGram-negative bacteria accounted for 55.00% and Gram-positive bacteria accounted for 35.00%. Serum PCT, HSP70, andHMGB1 level in infection group were (2.49±0.53) μg/L, (9.12±1.86) ng/mL, (18.33±2.61) ng/mL, which were significant-ly higher than (1.56±0.41) μg/L, (5.73±1.45) ng/mL, (13.62±2.47) ng/mL of non-infection group and (0.23±0.06) μg/L,(0.97±0.13) ng/mL, (0.73±0.15) ng/mL of the control group; PA and FIB were (0.17±0.02) g/L and (2.06±0.21) g/L,which were significantly lower than (0.23±0.04) g/L, (2.75±0.30) g/L of non-infection group and (0.30±0.03) g/L, (3.23±0.36) g/L of the control group; the serum PCT, HSP70, and HMGB1 levels in the non-infection group were significantlyhigher than those of the control group, and the PA and FIB levels were significantly lower than those of the controlgroup; the differences were statistically significant (P<0.05). Serum PCT, HSP70, and HMGB1 levels in patients withbacterial infection were (2.74±0.31) μg/L, (11.06±1.43) ng/mL, (20.68±2.05) ng/mL, which were significantly higherthan (2.13±0.25) μg/L, (7.93±1.05) ng/mL, (16.27±1.76) ng/mL of patients with fungal infection; PA and FIB levels inpatients with bacterial infection were (0.11±0.02) g/L and (1.91±0.24) g/L, which were significantly lower than (0.17±0.04) g/L, (2.58 ±0.34) g/L of patients with fungal infection; the differences were statistically significant (P<0.05).Pearson correlation analysis showed that serum PCT, HSP70, and HMGB1 was positively correlated with pancreaticinfection (r=0.581, 0.613, 0.567, P<0.05), and negatively correlated with PA and FIB (r=-0.463, -0.531, P<0.05).Conclusion The main type of pathogenic bacteria infection in elderly patients with severe acute pancreatitis secondarypancreatic infection is bacterial infection. Serum PCT, HSP70, and HMGB1 levels in the patients were significantly in-creased, while PA and FIB are significantly decreased, which are significantly correlated with the occurrence of pancreat-ic infection and should be paid close attention to in clinical practice.
      【Key words】 Severe acute pancreatitis; Pancreatic infection; Procalcitonin; Prealbumin; Fibrinogen; Heat shockprotein 70; High migration group protein 1; Correlation