The Clinical Application Value Of Thyroid Hormone And T Lymphocyte Subsets In Acute Pancreatitis

BACKGROUND:Acute pancreatitis（AP）is a common acute abdominal disease in clinical practice,which can rapidly develop from mild self-limited local lesions to severe systemic disease with multiple organ failure.According to the latest epidemiological data,the overall incidence of AP is on the rise.Although the incidence of severe pancreatitis is lower than that of mild patients,its clinical prognosis is poor and the mortality rate is high.Therefore,early and accurate identification of the severity of AP patients and effective disease management and treatment are particularly important.However,so far,there are few indicators or scoring systems to accurately predict the severity of AP,and it is still necessary to develop new scoring systems or laboratory indicators to assist in assessing the severity of AP.In recent years,some studies have found that thyroid hormones and T lymphocyte subsets are related to the severity of AP,which have certain clinical application value.Therefore,we studied the thyroid hormones and T lymphocyte subsets in the peripheral blood of AP patients to explore the correlation between these indicators and the severity of AP and their predictive diagnostic value,hoping to find new judgment methods or ideal laboratory indicators to improve the ability to assess the severity of AP,so as to reduce the mortality of AP patients.OBJECTIVE:To investigate the changes of thyroid hormone and T lymphocyte subsets in peripheral blood of patients with different severity of acute pancreatitis,and to explore the clinical application value of thyroid hormone and T lymphocyte subsets in acute pancreatitis.METHODS:Patients who were hospitalized in Huaihe Hospital of Henan University from January 1,2018 to January 1,2023 and were diagnosed with acute pancreatitis for the first time and had complete clinical data were selected as the research objects.After screening by inclusion and exclusion criteria,398 patients were finally selected.According to the revised Atlanta classification of the Chinese guidelines for the diagnosis and treatment of acute pancreatitis in 2021,the patients were divided into mild group（MAP）,moderately severe group（MSAP）,and severe group（SAP）.The basic clinical characteristics and imaging data of the enrolled population were collected,and the levels of thyroid hormone,T lymphocyte subsets,blood routine,C-reactive protein,liver and kidney function,blood glucose,blood calcium,BASIP score and MCTSI score were recorded within 24 hours after admission.The changes of these indexes in different severity groups were compared.The correlation between statistically significant laboratory indicators and the severity of AP was studied.Logistic regression analysis and receiver operating characteristic curve（ROC curve）were used to explore whether each index was a risk factor for predicting the severity of AP and to determine the diagnostic efficacy of each index.RESULTS:1.There were no significant differences in gender,age and etiology among the three groups of AP patients with different severity of the disease（P>0.05）.2.The results showed that CRP,Ca²⁺,BUN,FT₃,CD4⁺,CD8⁺and CD4⁺/CD8⁺were significantly different among the three groups of AP patients（P<0.05）.CRP,BUN and CD8⁺were positively correlated with the severity of AP（P<0.05,R>0）.Ca²⁺,FT₃,CD4⁺,CD4⁺/CD8⁺were negatively correlated with the severity of AP（P<0.05,R<0）.3.Multivariate logistic regression analysis showed that CRP,FT₃,CD4⁺/CD8⁺,Ca²⁺,BASIP score and MCTSI score were statistically different in AP patients（P<0.05）,as an independent factor for predicting the severity of AP,BUN had no statistical difference（P>0.05）,and could not be used as an independent factor to predict the severity of AP.4.The results showed that the values of FT₃and CD4⁺/CD8⁺in the ICU group were significantly lower than those in the non-ICU group,and the differences were statistically significant（P<0.05）.ROC curve analysis showed that the area under the curve of FT₃was 0.693,the sensitivity was 66.7%,and the specificity was 65.8%.The area under the curve of CD4⁺/CD8⁺was 0.798,the sensitivity was 94.4%,and the specificity was 60.5%.5.When judging the severity of AP using a single laboratory indicator and an AP scoring system,the area under the ROC curve and sensitivity of MCTSI scores were the highest,with an area under the curve of 0.814 and a sensitivity of 77.8%.The specificity of BISAP score was the highest,up to 75.2%.After the combination of indicators,the area under the ROC curve and specificity of FT₃combined with CD4⁺/CD8⁺combined with MCTSI score were the largest,the area under the ROC curve was 0.899,and the specificity was 91.3%.The sensitivity of FT₃combined with CD4⁺/CD8⁺to evaluate the severity of AP was the highest,up to 82.2%,and the area under the curve（AUC=0.806）was greater than that of BISAP score（AUC=0.804）.CONCLUSION:1.CRP,Ca²⁺,BUN,FT₃,CD4⁺,CD8⁺and CD4⁺/CD8⁺are correlated with the severity of AP patients.CRP,BUN and CD8⁺are positively correlated with the severity of AP patients.Ca²⁺,FT₃,CD4⁺,CD4⁺/CD8⁺are negatively correlated with the severity of AP.2.FT₃and CD4⁺/CD8⁺are independent predictors of the severity of AP,which have auxiliary value for whether SAP patients need to be admitted to ICU ward.The predictive value of FT₃combined with CD4⁺/CD8⁺is better than that of FT₃,CD4⁺/CD8⁺or BISAP score alone.3.BISAP score,MCTSI score combined with FT3 and CD4+/CD8+have higher predictive value for the severity of AP patients.