The Study Of PCSK9 Ang IL-6 In Predicting The Severity Of Hypertriglyceridemia Acute Pancreatitis

Objective:Observe the changes of serum preprotein convertase proprotein convertase subtilisin / kexin type 9(PCSK9)and Interleukin-6(IL-6)levels in patients with high acylglyceremic pancreatitis(Pertriglyceridemic pancreatitis(HTGP),and explore the clinical value of serum PCSK9 combined with IL-6 for early prediction of disease severity in patients with HTGP.Method:Selected 74 HTGP patients hospitalized in the Department of Gastroenterology of Hebei Provincial People’s Hospital from October 2019 to September 2022,As the experimental group,Patients in the HTGP group were recommended by the Emergency Expert Consensus on Hypertriglyceridemia Acute Pancreatitis in 2021 as mild acute pancreatitis(Mild acute pancreatitis,MAP)group in 41 patients,Moderate and severe acute pancreatitis(Moderate severe acute pancreatitis,The MSAP)group of 20 patients,Severe acute pancreatitis(Severe acute pancreatitis,SAP)group of 13 cases.In addition,20 cases were selected as the control group.The levels of PCSK9 and IL-6 in the experimental and control groups were used to analyze the predictive value of PCSK9,IL-6 and its combination on the severity of HTGP.The correlation between PCSK9 and other inflammatory indicators was analyzed,and multivariate Logistic regression was applied to analyze the independent factors of SAP.Further,the working characteristics curve of PCSP9 and IL-6 and SAP subjects(Receiver operating characteristic curve,ROC)were combined,and the area under the curve(Area under curve,AUC)was calculated to evaluate the value of PCSK9 and IL-6 in predicting SAP.In addition,the serum levels of PCSK9,IL-6 in HTGP patients with and without systemic inflammatory response syndrome(Systemic inflammatory response Syndrome,SIRS)were compared.Results:1.The serum PCSK9 level in HTGP group was 0.951±0.301ng/ml,significantly higher than that in healthy control group 0.795±0.111ng/ml(P<0.05);the IL-6 level in HTGP group was36.502±11.471pg/ml,which was significantly higher than the2.058±1.239 pg/ml in the healthy control group(P <0.05).2.In HTGP patients,the serum PCSK9 levels of SAP,MSAP and MAP groups were 1.203±0.284ng/ml,1.148±0.226ng/ml,0.774±0.210ng/ml,and the PCSK9 levels were compared in different severity groups.The results showed that the PCSK9 levels were significantly higher in the SAP and MSAP group than the MAP group.The differences were statistically significant(P <0.05),while the PCSP9 level in the SAP group was higher than the MSAP group(P> 0.05);The level of IL-6 was 46.690±21.085pg/ml,39.390±18.006pg/ml,15.814±9.170pg/ml,respectively,and the IL-6 levels were compared in different severity groups.The results showed that the level of IL-6 in the SAP and MSAP groups were significantly higher than the MAP group was statistically significant(P <0.05),while the level of IL-6 in the SAP group was higher than the MSAP group(P> 0.05).3.In HTGP patients,serum PCSK9 levels were positively associated with IL-6,CRP,PCT,TG,triglyceride-glucose index(triglyceride glucose,TyG index),and the correlation were(r=0.709,P <0.05),(r=0.395,P=0.013),(r=0.305,P=0.017),(r=0.495,P <0.05),(r=0.295,P=0.011).4.with the classification of disease severity as the dependent variable,It is divided into mild group,moderate severe group and severe group,PCSK9,ordered multivariate Logistic regression analysis with IL-6,CRP,PCT,NLR,BUN,TyG index,and HCT as independent variables,The results showed that PCSK9(OR = 2.589,95%CI:0.461-6.047),IL-6(OR=1.374,95%CI:0.006-1.541),CRP(OR=0.057,95%CI:0.001-0.064),TyG index(OR = 1.016,95%CI:0.020-1.023)is an independent risk factor for SAP,Statistically significant value(P <0.05).5.Drawing the ROC curve,And calculated the AUC of the PCSK9,IL-6,CRP,and the TyG index to predict the SAP,result display,The area under the curve(AUC)of PCSK9 and IL-6 was 0.842(95%CI:0.749～0.936);The AUC of SAP by PCSK9 is 0.815(95%CI: 0.693～0.938);The AUC of IL-6 predicted SAP was 0.813(95%CI: 0.707～0.920);The AUC of the SAP is 0.803(95%CI: 0.691～0.916);The AUC of CRP predicted SAP was 0.799(95%CI: 0.678 to 0.921),thus it can be seen,Large AUC values of serum PCSK9 and IL-6 to predict SAP,And when the combination of both detection is higher than the separate index detection,With the highest sensitivity,But the specificity is relatively poor.6.The serum PCSK9 level was 1.035±0.302 significantly higher than the 0.775±0.211ng/ml without SIRS group,statistically significant(P<0.05),The serum IL-6 level in the HTGP with SIRS group was38.076±13.316pg/ml was significantly higher than the 21.205±16.177pg/ml,with a statistically significant difference(P <0.05).Conclusion:1.Serum PCSK9 combined with IL-6 can predict the severity of disease in patients with HTGP,and its value in predicting severe HTGP has obvious advantages.2.Serum PCSK9 levels were positively correlated with IL-6,CRP,PCT,TG,and TyG index in HTGP patients.3.PCSK9,IL-6,CRP,and TyG index were independent risk factors for SAP.4.The significantly increased serum PCSK9 and IL-6 levels are closely associated with the risk of systemic complications in HTGP patients,suggesting that PCSK9 and IL-6 can be used as mediators to promote inflammatory response and participate in the pathological development process of SIRS in pancreatitis.