| ObjectiveDetection of different severity in patients with acute cholangitis of serum neutrophil count/lymphocyte count ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT)and interleukin 4(IL-4),interleukin-7(IL-7),and other indicators,to study the assessment of disease severity in patients with acute cholangitis application value.MethodsA total of 56 patients with acute cholangitis admitted to our hospital were selected.According to the currently recognized diagnostic criteria of "Tokyo Guidelines for Acute Biliary tract Infection 2018",the patients were divided into grade I group(24 cases),grade II group(15 cases),and grade III group(17 cases)according to the severity of the disease.Patients with chronic cholecystitis hospitalized at the same period were selected as the control group(9 cases).Serum IL-4,IL-7,NLR,PCT and CRP at admission were counted,and the differences among the groups were compared.Through pair comparison(SNK-q test),the differences among each group were compared.Receiver operating characteristic curve(ROC curve)was used to analyze and calculate the optimal diagnostic threshold value,sensitivity and specificity of each group.IL-4 and IL-7 were tested in strict accordance with the kit instructions.The data of PCT,NLR and CRP were obtained from the medical record system.ResultsAccording to the analysis of variance,the overall differences of IL-4,IL-7,NLR,PCT and CRP were statistically significant(P < 0.05).According to the results of SNK-q test,there were statistically significant differences in NLR,CRP and PCT among all groups(P < 0.05).There was no statistically significant difference in IL-4 and IL-7 among patients in grade I,II,and III(P=0.18).In the ROC curve,(1)PCT has the best diagnostic efficiency.In the curves of grade I group compared with grade II group,the optimal cut-off value was 0.26,sensitivity was93.3%,and specificity was 100%.When the grade I group was compared(grade II+ grade III group),the sensitivity and specificity were 100% when the optimal cut-off value was 1.3ug/L.The sensitivity and specificity of 2.81ug/L were 94.1%and 76.9% for differentiating cholangitis between grade I group and(grade II +III group).(2)The diagnostic efficiency of NLR is second only to PCT;In the ROC curve of the(Grade I +II)group compared with the Grade II group,the optimal cut-off value was 8.37,the sensitivity was 93.9% and the specificity was100%.When the grade I group was compared with the grade II +III group,the optimal cut-off value was was 20.82,the sensitivity was 82.4%,and the specificity was 87.2%.(3)In the analysis of ROC curve results,the sensitivity and specificity were 93.3% and 87.5% for differentiating patients with grade I and II cholangitis when CRP was 12.5.In the grade I comparison group(grade II +III),the sensitivity and specificity were 88.2% and 95.8% when the cutoff value was 63.In the identification of grade I +II,the optimal value of diagnosis was 75.5,the sensitivity was 88.2%,and the specificity was 75.4%..(4)There were differences in the mean values of IL-4 and IL-7 among all groups,but there was no statistical significance in the ROC curve of each group(P > 0.05).Therefore,it is not recommended to replace the existing test indexes for the time being.ConclusionsNLR,PCT and CRP are of great significance in the assessment of severity of acute cholangitis,among which PCT has the highest application value and NLR has the highest specificity in the grading of severity of acute cholangitis.The poor prognosis of acute biliary tract infection may be related to the overexpression of inflammatory cytokines,lymphocyte apoptosis and immune system inactivation.IL-4 and IL-7 have a protective effect on lymphocytes in the acute inflammatory phase.Through the detection of serum IL-4 and IL-7 levels in patients with acute cholangitis of different severity,the mean expression was as follows: the lowest in the control group,the lowest in the grade I group,the highest in the II group,and the lowest in the III group,suggesting that IL-4 and IL-7 in patients with acute obstructive suppurative cholangitis may be depleted. |
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