| 赵侃,惠慧,缪志伟,等.血清 Dickkopf相关蛋白 1、趋化因子配体 19与溃疡性结肠炎病人严重程度、预后的关系[J].安徽医药,2025,29(10):1976-1981. |
| 血清 Dickkopf相关蛋白 1、趋化因子配体 19与溃疡性结肠炎病人严重程度、预后的关系 |
| Relationship between serum DKK-1, CCL19 with the severity and prognosis of ulcerative colitis patients |
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| DOI：10.3969/j.issn.1009-6469.2025.10.012 |
| 中文关键词: 结肠炎，溃疡性 Dickkopf相关蛋白 1 趋化因子配体 19 病人病情 预后 |
| 英文关键词: Colitis, ulcerative Dickkopf related protein 1 Chemokine ligand 19 Patient Acuity Prognosis |
| 基金项目:江苏自然科学基金青年基金项目( BK20210134)；苏州市临床重点诊疗专项项目( LCZX202120) |
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| 中文摘要: |
| 目的分析血清 Dickkopf相关蛋白 1(DKK-1)、趋化因子配体 19(CCL19)与溃疡性结肠炎病人严重程度、预后的关系。方法前瞻性选择 2020年 1月至 2023年 6月在张家港市中医医院就诊的溃疡性结肠炎(活动期)病人 110例作为肠炎组，另选择同期在该院进行体检的健康志愿者 110例作为健康组；肠炎组根据改良 Truelove-Witts疾病严重程度分型标准分为重度组(33例)、中度组(41例)和轻度组(36例)根据预后情况分为预后良好组( 72例)和预后不良组( 38例)；血清 DKK-1、CCL19水平采用酶联免疫吸附分析( ELISA)检测；血清，DKK-1、CCL19水平与溃疡性结肠炎严重程度的相关性采用 Spearman相关性分析；溃疡性结肠炎病人预后的影响因素采用多因素 logistic回归分析；血清 DKK-1、CCL19联合对溃疡性结肠炎病人预后预测的曲线下面积( AUC)通过受试者操作特征曲线( ROC曲线)分析获得。结果肠炎组血清 DKK-1、CCL19水平［( 4.08±1.21)μg/L、(439.56±98.67)μg/L］显著高于健康组［( 1.76±0.53)μg/L、(165.84±37.23)μg/L］(P<0.05)。重度、中度、轻度组血清 DKK-1［( 4.72±1.33)μg/L、(4.10±1.22)μg/L、(3.47±1.09)μg/L］、 CCL19水平［( 500.64±114.09)μg/L、(443.17±97.98)μg/L、(379.46±85.32)μg/L］依次降低( P<0.05)。血清 DKK-1、CCL19水平与溃疡性结肠炎严重程度呈正相关( r=0.52、0.51，均 P<0.001)。与预后良好组相比，预后不良组有肠外表现比例显著较高，血红蛋白( Hb)含量降低，红细胞沉降率( ESR)加快， C反应蛋白( CRP)以及血清 DKK-1［( 3.61±1.12)μg/L、(4.97±1.38)μg/L］、 CCL19［( 392.58±96.14)μg/L、(528.57±103.46)μg/L］水平显著升高( P<0.05)。多因素 logistic回归分析显示， CRP、DKK-1、CCL19是影响溃疡性结肠炎病人预后的危险因素( P<0.05)。血清 DKK-1、 CCL19单独以及联合预测溃疡性结肠炎病人预后的 AUC及其 95%CI分别为 0.84(0.75，0.92)、 0.87(0.80，0.93)和 0.95(0.90， 1.00)二者联合预测溃疡性结肠炎病人预后的价值优于 DKK-1(Z=2.38，P=0.017)、 CCL19(Z=1.98，P=0.048)单独预测价值。结论 D，KK-1、CCL19水平在溃疡性结肠炎病人血清中异常升高表达，且与其严重程度密切相关， DKK-1、CCL19联合可提高溃疡性结肠炎病人预后的预测价值。 |
| 英文摘要: |
| Objective To analyze the relationship between serum Dickkopf related protein 1 (DKK-1) and chemokine ligand 19 (CCL19) with the severity and prognosis of ulcerative colitis patients.Methods A prospective selection was made of 110 patients withulcerative colitis (active phase) who visited Zhangjiagang Hospital of Traditional Chinese Medicine from January 2020 to June 2023 asthe enteritis group, and another 110 healthy volunteers who underwent physical examinations at the hospital during the same periodwere regarded as the healthy group. The enteritis group was separated into severe group (33 cases), moderate group (41 cases), and mildgroup (36 cases) according to the modified Truelove Witts disease severity classification criteria. According to the prognosis, they weregrouped into a good prognosis group (72 cases) and a poor prognosis group (38 cases). The serum levels of DKK-1 and CCL19 were de-tected using enzyme-linked immunosorbent assay (ELISA). The correlation between serum levels of DKK-1 and CCL19 and the severityof ulcerative colitis was analyzed using Spearman correlation analysis. The prognostic factors of patients with ulcerative colitis were ana-lyzed using multivariate logistic regression. The area under the curve (AUC) of the receiver operating characteristic curve (ROC curve)for predicting the prognosis of patients with ulcerative colitis using a combination of serum DKK-1 and CCL19 was obtained.Results The serum levels of DKK-1 and CCL19 in the enteritis group [(4.08±1.21) μg/L, (439.56±98.67) μg/L] were obviously higher than those in the healthy group [(1.76±0.53) μg/L, (165.84±37.23) μg/L] (P < 0.05). The levels of serum DKK-1 [(4.72±1.33) μg/L, (4.10±1.22) μg/L, (3.47±1.09) μg/L] and CCL19 [(500.64±114.09) μg/L, (443.17±97.98) μg/L, (379.46±85.32) μg/L] in the severe, moderate,and mild groups decreased sequentially (P < 0.05). The serum levels of DKK-1 and CCL19 were positively correlated with the severity of ulcerative colitis (r = 0.52 and 0.51, both P < 0.001). Compared with good prognosis group, poor prognosis group had an obviouslyhigher proportion of extraintestinal manifestations, a lower hemoglobin (Hb) content, faster erythrocyte sedimentation rate (ESR), andobviously higher levels of C-reactive protein (CRP) and serum DKK-1 [(3.61 ± 1.12) μg/L, (4.97 ± 1.38) μg/L] and CCL19 [(392.58 ± 96.14) μg/L, (528.57 ± 103.46) μg/L] (P < 0.05). Multivariate logistic regression revealed CRP, DKK-1, and CCL19 were risk factors affecting the prognosis of patients with ulcerative colitis (P < 0.05). The AUC 95%CI of serum DKK-1, CCL19, and their combined pre-diction for the prognosis of patients with ulcerative colitis were 0.84 (0.75, 0.92), 0.87 (0.80, 0.93), and 0.95 (0.90, 1.00), respectively.The combined prediction value of DKK-1 and CCL19 for the prognosis of patients with ulcerative colitis was better than that of DKK-1 (Z=2.38, P=0.017) and CCL19 (Z=1.98, P=0.048) alone.Conclusions The levels of DKK-1 and CCL19 are abnormally elevated inthe serum of patients with ulcerative colitis, and are closely related to their severity. The combination of DKK-1 and CCL19 can im-prove the predictive value of prognosis in patients with ulcerative colitis. |
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