血清sCD163与MFG-E8对胆总管结石梗阻性黄疸并发急性胆管炎的预测价值

Predictive value of serum sCD163 and MFG-E8 for acute cholangitis in patients with obstructive jaundice caused by common bile duct stones

摘要:

背景与目的 胆总管结石（CBDS）引起的梗阻性黄疸（OJ）是导致急性胆管炎（AC）的常见原因，早期识别高风险患者对改善预后具有重要意义。可溶性CD163（sCD163）和乳脂球表皮生长因子8（MFG-E8）与多种炎症性疾病相关，但其在CBDS合并OJ（CBDS-OJ）患者中预测AC的价值尚不明确。本研究旨在探讨血清sCD163、MFG-E8水平对CBDS-OJ患者发生AC的预测价值。方法 选取2022年1月—2024年6月山东省聊城市第二人民医院收治的142例CBDS-OJ患者为研究对象，并选取同期145名健康体检者作为对照；收集一般资料；ELISA检测血清sCD163、MFG-E8表达水平；根据CBDS-OJ患者入院24 h后是否发生AC将患者分为AC组（n=48）和无AC组（n=94），比较两组临床资料及血清指标差异；采用多因素Logistic回归分析AC的影响因素；绘制受试者操作特征曲线（ROC）曲线评估sCD163、MFG-E8单独及联合预测AC的效能。结果 与对照组比较，CBDS-OJ患者血清sCD163水平明显升高，MFG-E8水平明显降低（均P<0.05）。在CBDS-OJ患者中，AC组的天门冬氨酸氨基转移酶、丙氨酸氨基转移酶及sCD163水平均高于无AC组，而MFG-E8水平更低（均P<0.05）。多因素Logistic回归显示，sCD163升高是AC发生的独立危险因素（OR=3.478，P<0.001），MFG-E8降低为保护因素（OR=0.526，P=0.020）。ROC分析提示，sCD163、MFG-E8单独预测AC的曲线下面积（AUC）分别为0.759和0.787，二者联合预测的AUC为0.920，明显优于单独指标（均P<0.001）。结论 CBDS-OJ患者血清sCD163升高、MFG-E8下降与AC的发生密切相关。sCD163和MFG-E8联合检测可显著提高对AC的早期预测能力，具有潜在的临床应用价值。

Abstract:

Background and Aims Obstructive jaundice (OJ) caused by common bile duct stones (CBDS) is a major risk factor for acute cholangitis (AC). Early identification of high-risk patients is essential for improving prognosis. Soluble CD163 (sCD163) and milk fat globule epidermal growth factor 8 (MFG-E8) are associated with inflammatory diseases, but their predictive value for AC in CBDS-related OJ remains unclear. This study aimed to evaluate the predictive significance of serum sCD163 and MFG-E8 levels for AC in patients with CBDS-OJ.Methods A total of 142 patients with CBDS-OJ admitted from January 2022 to June 2024 were included as the observation group, and 145 healthy individuals undergoing physical examination served as controls. Serum sCD163 and MFG-E8 levels were measured using ELISA. Based on the occurrence of AC within 24 hours after admission, patients with CBDS-OJ were divided into an AC group (n=48) and a non-AC group (n=94). Clinical variables and serological indicators were compared between groups. Multivariate logistic regression was used to identify independent factors associated with AC. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of sCD163, MFG-E8, and their combination.Results Compared with the control group, patients with CBDS-OJ showed significantly elevated serum sCD163 levels and decreased MFG-E8 levels (both P<0.05). Within the observation group, the AC group had higher AST, ALT and sCD163 levels and lower MFG-E8 levels than the non-AC group (all P<0.05). Logistic regression identified elevated sCD163 as an independent risk factor (OR=3.478, P<0.001) and reduced MFG-E8 as a protective factor (OR=0.526, P=0.020) for AC. ROC analysis showed AUC values of 0.759 for sCD163, 0.787 for MFG-E8, and 0.920 for their combined detection, with the combined model outperforming either marker alone (P<0.001).Conclusion Serum sCD163 elevation and MFG-E8 reduction are closely associated with the development of AC in patients with CBDS-OJ. Combined detection of sCD163 and MFG-E8 provides superior predictive value and may serve as a useful tool for early risk stratification in clinical practice.