背景:急性胰腺炎(AP)的特征是全身性炎症,对诊断和预后评估提出了挑战。脂质代谢异常,尤其是三酰甘油(TAG)水平,据报道,表明它们作为急性胰腺炎生物标志物的潜力。然而,TAG周期的性能,包括磷脂和甘油脂代谢,在AP患者中尚未报道。
方法:本研究纳入了91例急性胆源性胰腺炎(ABP)患者,27患有高脂血症性急性胰腺炎(HLAP),和58个健康对照(HCs),他们的血浆磷脂和甘油脂水平通过液相色谱-质谱分析。首先收集AP患者血浆的磷脂和甘油脂含量,第三,还测量了住院的第七天。正交偏最小二乘判别分析模型用于区分ABP,HLAP和HC组,通过测试集和验证集的受试者工作特征曲线评估潜在诊断性脂质。使用Spearman方法对临床数据与血脂之间的相关性进行分析。通过“mfuzz”R包和Kruskal-WallisH检验进行聚类以监测住院期间的变化。
结果:与HC相比,磷脂酰胆碱(PC)的水平,磷脂酰乙醇胺(PE),AP患者中磷脂酸(PA)较低,而磷脂酰肌醇(PI)和磷脂酰甘油(PG)的水平则显示出相反的趋势。有趣的是,ABP患者TAG水平与白细胞计数呈正相关,和含有44-55个碳原子的TAG与HLAP患者的血浆TAG水平高度相关。磷脂水平与AP标志物呈负相关,与甘油脂相比,与这些标记呈正相关。此外,PE(O-16:0/20:4)和PE(18:0/22:6)成为潜在的生物标志物,因为它们能够区分ABP和HLAP患者与HCs,曲线下面积(AUC)值分别为0.932和0.962。PG(16:0/18:2),PG(16:0/20:4),PE(P-16:0/20:2),PE(P-18:2/18:2),PE(P-18:1/20:3),PE(P-18:1/20:4),PE(O-16:0/20:4),改善的ABP患者的TAG(56:6/FA18:0)明显改变。对于HLAP患者,PC(18:0/20:3),标签(48:3/FA18:1),PE(P-18:0/16:0),和TAG(48:4/FA18:2)在患者中显示出不同的改善和恶化趋势,这可能用于预后。
结论:发现磷脂和甘油脂是急性胰腺炎的潜在生物标志物,这为这种疾病提供了新的诊断和治疗见解。
BACKGROUND: Acute pancreatitis (AP) is characterized as a systemic inflammatory condition posing challenges in diagnosis and prognosis assessment. Lipid metabolism abnormalities, especially triacylglycerol (TAG) levels, have been reported, indicating their potential as biomarkers in acute pancreatitis. However, the performance of the TAG cycle, including
phospholipid and glycerolipid metabolism, in AP patients has not yet been reported.
METHODS: This study enrolled 91 patients with acute biliary pancreatitis (ABP), 27 with hyperlipidaemic acute pancreatitis (HLAP), and 58 healthy controls (HCs), and their plasma
phospholipid and glycerolipid levels were analyzed through liquid chromatography‒mass spectrometry. The
phospholipid and glycerolipid contents of plasma collected from AP patients on the first, third, and seventh days of hospitalization were also measured. An orthogonal partial least squares discriminant analysis model served to differentiate the ABP, HLAP and HC groups, and potentially diagnostic lipids were evaluated via receiver operating characteristic curves in both the test and validation sets. Correlations between clinical data and lipids were conducted using Spearman\'s method. Clustering via the \'mfuzz\' R package and the Kruskal‒Wallis H test were conducted to monitor changes during hospitalization.
RESULTS: Compared with those in HCs, the levels of phosphatidylcholine (PC), phosphatidylethanolamine (PE), and phosphatidic acid (PA) were lower in AP patients, whereas the levels of phosphatidylinositol (PI) and phosphatidylglycerol (PG) showed the opposite trend. Interestingly, TAG levels were positively correlated with white blood cell counts in ABP patients, and TAGs containing 44-55 carbon atoms were highly correlated with plasma TAG levels in HLAP patients.
Phospholipid levels exhibited an inverse correlation with AP markers, in contrast to glycerolipids, which demonstrated a positive correlation with these markers. Additionally, PE (O-16:0/20:4) and PE (18:0/22:6) emerged as potential biomarkers because of their ability to distinguish ABP and HLAP patients from HCs, showing area under the curve (AUC) values of 0.932 and 0.962, respectively. PG (16:0/18:2), PG (16:0/20:4), PE (P-16:0/20:2), PE (P-18:2/18:2), PE (P-18:1/20:3), PE (P-18:1/20:4), PE (O-16:0/20:4), and TAG (56:6/FA18:0) were significantly changed in ABP patients who improved. For HLAP patients, PC (18:0/20:3), TAG (48:3/FA18:1), PE (P-18:0/16:0), and TAG (48:4/FA18:2) showed different trends in patients with improvement and deterioration, which might be used for prognosis.
CONCLUSIONS: Phospholipids and glycerolipids were found to be potential biomarkers in acute pancreatitis, which offers new diagnostic and therapeutic insights into this disease.