肠道菌群代谢产物外周血中性粒细胞NETs与急性胰腺炎肺损伤及预后的关系分析

doi:10.3969/j.issn.1006-6233.2025.04.018

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摘要 目的: 分析肠道菌群代谢产物、外周血中性粒细胞胞外诱捕网(NETs)与急性胰腺炎肺损伤(AP-ALI)及预后的关系。方法: 将2022年5月至2024年5月收治的150例AP-ALI患者作为观察组,同期60例单纯急性胰腺炎(AP)患者作为对照组。收集入选对象粪便标本、外周血标本,分别检测肠道菌群代谢产物(乙酸、丙酸、丁酸)、NETs水平,Logistic回归分析法评估肠道菌群代谢产物、NETs是否与AP-ALI相关。依据确诊后90d预后情况,将150例AP-ALI患者分为预后不良组、预后良好组,收集临床资料,Logistic多因素回归分析法筛选影响AP-ALI患者预后不良的危险因素,ROC曲线评估肠道菌群代谢产物、NETs预测AP-ALI患者预后不良的效能。结果: 与对照组比较,观察组乙酸、丙酸、丁酸水平较低(P<0.05),NETs水平较高(P<0.05)。乙酸(OR=1.222)、丙酸(OR=1.342)、丁酸(OR=1.229)、NETs(OR=1.282)与AP-ALI密切相关(P<0.05)。与预后良好组比较,预后不良组体质指数(BMI)、糖尿病占比及降钙素原、D-乳酸、NETs水平较高,血氧饱和度、乙酸、丙酸、丁酸水平较低,差异具有统计学意义(P<0.05)。BMI(OR=1.252)、糖尿病(OR=1.242)、血氧饱和度(OR=1.229)、降钙素原(OR=1.305)、D-乳酸(OR=1.304)、乙酸(OR=1.410)、丙酸(OR=1.424)、丁酸(OR=1.404)、NETs(OR=1.442)是影响AP-ALI患者预后不良的独立危险因素(P<0.05),即与AP-ALI患者预后不良相关。ROC曲线结果显示,肠道菌群代谢产物(乙酸、丙酸、丁酸)、NETs联合预测AP-ALI患者预后不良的敏感度、AUC分别为90.50%、0.907,预测效能良好。结论: AP-ALI患者肠道菌群代谢产物(乙酸、丙酸、丁酸)、NETs水平异常变化,且其与AP-ALI的发生及患者预后密切相关,为临床早期识别AP-ALI及改善患者预后提供了参考依据。

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	张志超
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关键词 ：急性胰腺炎, 急性肺损伤, 肠道菌群代谢产物, 中性粒细胞胞外诱捕网

Abstract：Objective: To analyze the relationship between intestinal flora metabolites, neutrophil extracellular traps (NETs), and acute pancreatitis lung injury (AP-ALI) and prognosis. Methods: A total of 150 patients with AP-ALI admitted from May 2022 to May 2024 were established as the observation group and 60 patients with simple acute pancreatitis (AP) were established as the control group during the same period. Feces and peripheral blood samples were collected to detect intestinal flora metabolites (acetic acid, propionic acid, butyric acid) and NETs levels, Logistic regression analysis was used to determine whether intestinal flora metabolites and NETs were related to AP-ALI. According to the prognosis within 90 days, 150 AP-ALI patients were divided into a poor prognosis group and a good prognosis group. Clinical data were collected, Logistic regression analysis was used to screen risk factors affecting the poor prognosis of AP-ALI patients, ROC curve was plotted to evaluate the efficacy of intestinal flora metabolites and NETs in predicting poor prognosis of AP-ALI patients. Results: Compared with the control group, acetic acid, propionic acid, and butyric acid levels in the observation group were lower (P<0.05) and NETs levels were higher (P<0.05). Acetic acid (OR=1.222), propionic acid (OR=1.342), butyric acid (OR=1.229), and NETs (OR=1.282) were closely related to AP-ALI (P<0.05). Compared with the good prognosis group, BMI, diabetes proportion, and procalcitonin, D-lactic acid, and NETs levels in the poor prognosis group were higher, and oxygen saturation, acetic acid, propionic acid, butyric acid levels were lower, with statistically significant difference (P<0.05). BMI (OR=1.252), diabetes mellitus (OR=1.242), oxygen saturation (OR=1.229), procalcitonin (OR=1.305), D-lactic acid (OR=1.304), acetic acid (OR=1.410), propionic acid (OR=1.424), butyric acid (OR=1.404) and NETs (OR=1.442) were independent risk factors for poor prognosis in AP-ALI patients (P<0.05). ROC curve showed that the sensitivity and AUC of intestinal flora metabolites (acetic acid, propionic acid, butyric acid) and NETs in predicting poor prognosis of AP-ALI patients were 90.50% and 0.907 respectively, and the predictive value was good. Conclusion: The abnormal changes of intestinal flora metabolites (acetic acid, propionic acid, butyric acid) and NETs levels in AP-ALI patients are closely related to the occurrence and prognosis of AP-ALI, which provides a reference basis for early recognition of AP-ALI and improvement of prognosis of patients.

Key words： Acute pancreatitis Acute lung injury Intestinal flora metabolites Neutrophils extracellular trap

基金资助:内蒙古自治区教育厅,(编号:NJZZ22651);内蒙古自然科学基金,(编号:2020MS08195)

通讯作者: 要瞰宇

引用本文:

张志超, 朱学河, 王琦, 要瞰宇. 肠道菌群代谢产物外周血中性粒细胞NETs与急性胰腺炎肺损伤及预后的关系分析[J]. 河北医学, 2025, 31(4): 636-648.
ZHANG Zhichao, ZHU Xuehe, WANG Qi, et al. Analysis of the Relationship Between Intestinal Flora Metabolites Peripheral Neutrophils NETs and Lung Injury and Prognosis in Acute Pancreatitis. HeBei Med, 2025, 31(4): 636-648.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.04.018 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I4/636

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