Diagnostic value of serum Nrf-2 and HO-1 levels on disease severity and prognosis in children with acute pancreatitis
Objective:To explore the relationship between changes in serum nuclear factor E2 related factor 2(Nrf-2)and heme oxygenase-1(HO-1)levels with severity of disease and prognosis in children with acute pancrea-titis(AP).Methods:From August 2020 to March 2022,173 AP children who visited our hospital were regarded as the AP group,which was separated into mild AP(MAP)group,mediate severe AP(MSAP)group,and severe AP(SAP)group according to Atlanta classification.Another 180 children who underwent physical examinations were regarded as the healthy group.Enzyme linked immunosorbent assay was applied to detect serum Nrf-2 and HO-1 levels.Spearman method was applied for correlation analysis.The children were grouped into survival group and death group based on their survival status after 28 days of follow-up.Logistic regression was applied to analyze the factors affecting the prognosis of AP.Receiver operating characteristic(ROC)curve was applied to analyze the diag-nostic value of Nrf-2 and HO-1 for the severity of AP and their predictive value for prognosis.Clinical decision curve analysis(DCA)was used to evaluate the clinical application value of Nrf-2 and HO-1 in predicting the severi-ty and prognosis of AP.Results:The serum levels of Nrf-2 and HO-1 in the AP group were lower than those in the healthy group(P＜0.05).The serum levels of Nrf-2 and HO-1 in the MAP group,MSAP group,and SAP group decreased sequentially,while the modified CT severity index(MCTSI)score,Ranson score,and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score increased sequentially(P＜0.05).The levels of serum Nrf-2 and HO-1 were negatively correlated with MCTSI score,Ranson score,and APACHE Ⅱ score(P＜0.05).The AUC of Nrf-2 and HO-1 combined diagnosis for AP severity was 0.954,which was better than single indicator diag-nosis(ZNrf-2-combination=3.665,P＜0.001;ZHO-1-combination=2.553,P=0.011),the sensitivity of the combined de-tection was 90.82％,and the specificity was 86.67％.The serum levels of Nrf-2 and HO-1 in the survival group were higher than those in the death group(P＜0.05),while the levels of Interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower than those in the death group(P＜0.05).Nrf-2 and HO-1 were protective factors for the prognosis of AP patients,while IL-6 and TNF-α were risk factors(P＜0.05).The AUC of Nrf-2 and HO-1 combined prediction for AP severity was 0.869,which was better than single indicator prediction(ZNrf-2-combination=2.898,P=0.004;ZHO-1-combination=2.002,P=0.045),the sensitivity of the combined detection was 90.24％,and the specificity was 69.70％.Conclusion:The serum levels of Nrf-2 and HO-1 in children with AP decrease,they have high efficacy in diagnosing the severity of AP and predicting prognosis.
acute pancreatitisnuclear factor E2 related factor 2heme oxygenase 1severity of diseaseprog-nosis
万方数据
维普
