血清I-FABP、DAO、IL-6水平在重症急性胰腺炎继发感染性胰腺坏死中的预测价值研究

The Value of Serum I-FABP, DAO, and IL-6 Levels in the Early Diagnosis of Infected Pancreatic Necrosis Secondary to Severe Acute Pancreatitis

摘要: 目的：探究血清中肠道脂肪酸结合蛋白(Intestinal Fatty Acid Binding Protein, I-FABP)、二胺氧化酶(Diamine Oxidase, DAO)、白介素-6 (Interleukin-6, IL-6)水平对于重症急性胰腺炎(Severe Acute Pancreatitis, SAP)继发感染性胰腺坏死(Infected Pancreatic Necrosis, IPN)的预测价值。方法：选取62例SAP患者资料，依据是否发生IPN分为：IPN组(20例)和非IPN组(42例)。采集SAP患者临床资料，通过酶联免疫吸附试验法(ELISA法)检测血清中I-FABP、DAO、IL-6水平，并通过相关性分析以及受试者工作特征(ROC)曲线评判观察指标对SAP患者继发IPN的早期诊断价值。结果：两组患者性别、病因、年龄和白细胞计数(WBC)水平均无显著差异(均P > 0.05)，但IPN组C反应蛋白(CRP)水平和改良CT严重指数(MCTSI)评分比非IPN组均要高(均P < 0.05)；与非IPN组相比较，通过ELISA法检测的IPN组I-FABP、DAO和IL-6表达水平明显升高(均P < 0.05)；相关性分析提示早期I-FABP、DAO和IL-6指标与MCTSI评分呈正相关(r = 0.712、0.678、0.677，均P < 0.001)；ROC曲线分析发现，通过I-FABP、DAO和IL-6水平早期预测SAP患者发生IPN的曲线下面积(AUC) (0.887, 0.830, 0.735)均高于CRP (0.731)、WBC (0.526)，对此三项指标联合实行平行试验提示灵敏度增至0.988，并且其系列试验显示特异度增至0.992。结论：血清I-FABP、DAO、IL-6水平对于SAP继发IPN的早期诊断以及病情严重程度评估具有一定的临床意义，并且三项指标进行联合评估的临床价值更高。

Abstract: Objective: To investigate the predictive value of serum levels of Intestinal Fatty Acid-Binding Protein (I-FABP), Diamine Oxidase (DAO), and Interleukin-6 (IL-6) for Infectious Pancreatic Necrosis (IPN) secondary to Severe Acute Pancreatitis (SAP). Methods: Data from 62 SAP patients were retrospectively analyzed. Based on the occurrence of IPN, patients were divided into two groups: the IPN group (n = 20) and the non-IPN group (n = 42). Clinical data of SAP patients were collected. Serum levels of I-FABP, DAO, and IL-6 were measured using enzyme-linked immunosorbent assay (ELISA). Correlation analysis and Receiver Operating Characteristic (ROC) curve analysis were performed to evaluate the early diagnostic value of these observed indicators for IPN secondary to SAP. Results: There were no significant differences in gender, etiology, age, or White Blood Cell count (WBC) levels between the two groups (P > 0.05). However, C-Reactive Protein (CRP) levels and the Modified CT Severity Index (MCTSI) scores in the IPN group were significantly higher than those in the non-IPN group (P < 0.05). Compared with the non-IPN group, the expression levels of I-FABP, DAO, and IL-6 detected by ELISA in the IPN group were significantly elevated (P < 0.05). Correlation analysis indicated that early I-FABP, DAO, and IL-6 levels were positively correlated with MCTSI scores (r = 0.712, 0.678, 0.677, P < 0.001). ROC curve analysis revealed that the Areas Under the Curve (AUC) for early prediction of IPN in SAP patients using I-FABP, DAO, and IL-6 levels (0.887, 0.830, 0.735) were higher than those for CRP (0.731) and WBC (0.526). Parallel testing combining these three indicators increased sensitivity to 0.988, and series testing combining them increased specificity to 0.992. Conclusion: Serum levels of I-FABP, DAO, and IL-6 have certain clinical significance for the early diagnosis and severity assessment of IPN secondary to SAP. The combined assessment of these three indicators holds higher clinical value.