| PART 1.Early changes in immune function in acute pancreatitisObjective:To explore the changes of early immune function in acute pancreatitis(AP),and to provide a reference basis for early clinical judgment of AP.AP patients who met the inclusion and exclusion criteria from December 1,2017 to January 31,2019 in the affiliated hospital of southwest medical university were included.40 cases of mild acute pancreatitis(MAP),40 cases of moderately severe acute pancreatitis(MSAP)and 40 cases of severe acute pancreatitis(SAP)were randomly selected,which were respectively defined as MAP group,MSAP group and SAP group.Observation indicators:1.Basic information: age,gender,etiology;2.T lymphocyte subsets and proportion at admission;3.C-reactive protein(CRP),neutrophil/lymphocyte ratio(NLR),and procalcitonin(PCT)levels at admission.Methods:Results:1.Basic data: there was no significant difference in age,gender composition and etiology between MAP group,MSAP group and SAP group;2.On the first day of admission,the proportion of CD4+T lymphocytes in MAP group,MSAP group and SAP group was(42.49±9.52)%,(33.53±7.09)% and(27.18±8.38)%,respectively,with statistically significant differences among the three groups(P<0.05)The CD4/CD8 of MAP group,MSAP group and SAP group were 2.12±1.31,1.75±0.76 and 1.45±0.67,respectively,and the differences among the three groups were statistically significant(P<0.05).3.On the first day of admission,the NLR of MAP group,MSAP group and SAP group were 6.87±1.96,11.52±4.36 and 15.19±4.46,respectively,with statistically significant differences among the three groups(P<0.05).The CRP of MAP group,MSAP group and SAP group were(60.01±26.47)mg/L,(106.02±37.35)mg/L and(176.43±67.90)mg/L,respectively.The differences among the three groups were statistically significant(P<0.05).The PCT values of MAP group,MSAP group and SAP group were(0.95±0.35)ng/m L,(2.45±0.93)ng/m L and(5.40±2.63)ng/m L,respectively.The differences among the three groups were statistically significant(P<0.05).4.ROC curve results: the AUC of SAP predicted by the proportion of CD4+T lymphocytes was 0.865,the optimal critical value was 35.87%,the sensitivity was 87.50%,and the specificity was 68.70%.The AUC of SAP predicted by NLR was 0.844,the optimal critical value was 9.47,the sensitivity was 90.00%,and the specificity was 66.20%.The AUC of SAP predicted by CRP was 0.883,the optimal critical value was 102.12mg/L,the sensitivity was 87.50%,and the specificity was 72.50%.PCT predicted that the AUC of SAP was 0.908,the optimal critical value was 4.06ng/ml,the sensitivity was 70.00%,and the sensitivity was 96.30%.Part 2.Clinical effects of thymosin ?1 on MSAP and SAP patientsObjective: To explore the clinical effect of thymosin ?1(T?1)in MSAP and SAP patients.Methods:On the basis of the first part of the study,40 cases of msap and 40 cases of sap were divided into control group and treatment group by single blind randomized control study method.The control group included 20 cases of msap(group A1)and 20 cases of sap(group A2),while the treatment group included 20 cases of msap(group B1)and 20 cases of sap(group B2).The control group was given routine AP treatment only,and the treatment group received subcutaneous injection of T?1,3.2mg,qd on the from 1st to 7th day after admission on the basis of routine AP treatment.Observation indicators:1.Basic information: age,gender,etiology;2.Changes in the proportion of T lymphocyte subsets;3.Changes in CRP,NLR and PCT;4.Changes of APACHE II scores;5.Incidence of bloodstream infection,pulmonary infection and abdominal infection;6.Average length of stay and curative ratio.Results:1.Basic data: there was no significant difference between the treatment group and the control group in age,gender composition and etiology composition(P>0.05);There was no significant difference between group A1 and group B1 in age,gender and etiology(P>0.05).There was no significant difference in age,gender and etiology between group A2 and group B2(P>0.05).2.On the 7th day after admission,CD4+T lymphocyte levels in the control group and the treatment group were(33.00±8.21)% and(37.41±7.22)%,respectively,with statistically significant differences(P<0.05).On the 14 th day after admission,CD4+T lymphocyte levels in the control group and the treatment group were(35.00±6.84)% and(39.41±7.11)%,respectively,with statistically significant differences(P<0.05).Among them,there was no statistically significant difference in peripheral blood T lymphocyte subsets between group A1 and group B1 on 1st,7th and 14 th day after admission(P>0.05).However,on the 7th day after admission,the proportion of CD4+T lymphocytes in group A2 and group B2 was(28.97±8.87)% and(36.67±7.63)%,respectively,with statistically significant difference(P<0.05).On the 14 th day after admission,the CD4+T lymphocyte ratios of A2 group and B2 group were(30.86±5.15)% and(38.77±8.50)%,respectively,with statistically significant differences(P<0.05),and the CD4/CD8 ratios of A2 group and B2 group were 1.37±0.49 and 1.88±0.71 respectively,with statistically significant differences(P<0.05).3.There was no significant difference in NLR between the control group and the treatment group on the first,seventh and 14 th days after admission(P>0.05).There was no significant difference in NLR and CRP between A1 group and B1 group on the 1st,7th and 14 th day after admission(P>0.05),but on the 14 th day after admission,the NLR of A2 group and B2 group were 6.58±2.98 and 4.88±1.50,respectively,and the difference was statistically significant(P<0.05).4.There was no statistically significant difference in CRP between the control group and the treatment group on the 1st,7th and 14 th day after admission(P>0.05).There was no statistically significant difference in CRP between group A1 and group B1 on 1st,7th and 14 th day after admission(P>0.05).However,on the 14 th day after admission,peripheral blood CRP of group A2 and group B2 were(43.10±12.10)mg/L and(31.62±8.23)mg/L,respectively,with statistically significant differences(P<0.05).5.On the 14 th day after admission,the PCT values of the control group and the treatment group were(1.70 ± 1.60)ng/ml and(1.17±0.89)ng/ml,respectively,with statistically significant differences(P<0.05).There was no significant difference in PCT between A1 group and B1 group on the 1st,7th and 14 th day after admission(P>0.05),but on the 14 th day after admission,PCT of group A2 and group B2 were(3.08±1.25)ng/m L and(1.98±0.50)ng/m L,respectively,and the difference was statistically significant(P<0.05).6.There was no statistically significant difference in APACHE II scores between the control group and the treatment group on the 1st,7th and 14 th days after admission(P>0.05),and there was no statistically significant difference in APACHE II scores between group A1 and group B1,group A2 and group B2 on the 1st,7th and 14 th days after admission(P>0.05).7.There was no statistically significant difference in the incidence of bloodstream infection,lung infection and abdominal infection between the control group and the treatment group(P>0.05),and there was no statistically significant difference in the incidence of bloodstream infection,lung infection and abdominal infection between the group A1 and the group B1(P>0.05).However,the abdominal infection rate in group A2 was 55.00%,and that in group B2 was 20.00%,the difference was statistically significant(P<0.05).8.There was no statistically significant difference between the treatment group and the control group in the average length of stay(P>0.05),and there was no statistically significant difference between the group A1 and group B1 in the average length of stay(P>0.05),the length of stay of the group A2 was 42.65±8.90 days,and the length of stay of the group B2 was 37.05±7.98 days(P<0.05).9.There was no significant difference in curative ratio between treatment group and control group,group A1 and group B1,group A2 and group B2(P>0.05).Conclusion:1.The level of CD4+T lymphocyte and CD4/CD8 ratio in SAP patients were lower than those in MAP and MSAP patients,showing SAP patients have immune dysfunction;2.The levels of CD4+T lymphocytes,NLR,CRP and PCT in peripheral blood of AP patients have a high predictive value for the disease of AP;3.T?-1 can increase the level of CD4+T lymphocytes in peripheral blood of SAP patients and regulate the ratio of CD4/CD8 in peripheral blood of SAP patients;4.T?-1 can reduce the incidence of abdominal infection in SAP patients;5.T?-1 can shorten the average hospitalization time of SAP patients,which has certain clinical application value. |
PDF Full Text Request