血清GP-2、hs-CRP、HMGB1联合检测在重症胰腺炎早期诊断中的价值

The application value of combination detection of serum glycoprotein 2a,hypersensitive C reactive protein and high mobility group protein B1 in the early diagnosis of severe acute pancreatitis

目的分析血清糖蛋白2a(GP-2a)、超敏C-反应蛋白(hs-CRP)和高迁移率族蛋白B1(HMGB1)联合检测在重症胰腺炎早期诊断中的价值。方法将2017年3月至2019年6月诊治的50例重症胰腺炎患者(重症组)和49例轻症胰腺炎患者(轻症组)作为研究对象,同时期45例健康者作为对照组。比较3组受试者血清GP-2、hs-CRP、HMGB1水平,对急性胰腺炎患者进行急性生理与慢性健康评分(APACHE-Ⅱ)和Balthazar CT评分(CTSI),分析急性胰腺炎患者血清GP-2、hs-CRP、HMGB1水平与APACHE-Ⅱ评分、CTSI评分的关系,及单独和联合检测对重症胰腺炎的诊断价值。结果重症组和轻症组血清GP-2、hs-CRP和HMGB1水平均显著高于对照组(P<0.05),重症组血清GP-2、hs-CRP和HMGB1水平均显著高于轻症组(P<0.05);重症组APACHE-Ⅱ评分和CTSI评分均显著高于轻症组(P<0.05);急性胰腺炎患者血清GP-2与APACHE-Ⅱ评分和CTSI评分分别呈显著正相关关系(r=0.709、0.758,P=0.001、0.000),血清hs-CRP与APACHE-Ⅱ评分和CTSI评分分别呈显著正相关关系(r=0.654、0.692,P=0.009、0.005),血清HMGB1与APACHE-Ⅱ评分和CTSI评分分别呈显著正相关关系(r=0.791、0.819,P=0.000、0.000);血清GP-2、hs-CRP、HMGB1单独诊断重症胰腺炎的ROC曲线下面积(AUC)分别为0.739、0.699、0.796,血清GP-2、hs-CRP和HMGB1联合诊断重症胰腺炎的ROC AUC为0.866。结论血清GP-2、hs-CRP和HMGB1对重症胰腺炎均具有一定诊断价值,但三者联合检测能够提高诊断敏感性和特异性,对重症胰腺炎早期诊断及病情评估具有重要临床参考价值。

Objective To investigate the application value of combination detection of serum glycoprotein 2a(GP-2a),hypersensitive C reactive protein(hs-CRP)and high mobility group protein B1(HMGB1)in the early diagnosis of severe acute pancreatitis.Methods A total of 50 patients with severe acute pancreatitis were enrolled as severe case group,at the same time,the other 49 patients with mild pancreatitis were enrolled as mild case group,moreover,the other 45 healthy subjects were enrolled as control group.The serum levels of GP-2,hs-CRP and HMGB1 were observed and compared among the three groups.And the acute physiological score and chronic health score(APACHE-Ⅱ)as well as Balthazar CT score(CTSI)were performed in patients with acute pancreatitis.Moreover the correlation between the serum levels of GP-2,hs-CRP,HMGB1 and the scores of APACHE-Ⅱ,CTSI in patients with acute pancreatitis was analyzed.In addition the diagnostic values of single index detections and combination detection of the indexes in diagnosis of severe acute pancreatitis was analyzed.Results The serum levels of GP-2,hs-CRP and HMGB1 in severe case group and mild case group were significantly higher than those in control group(P<0.05),which in severe case group were significantly higher than those in mild case group(P<0.05),moreover,the APACHE-Ⅱscores and CTSI scores in severe case group were significantly higher than those in mild case group(P<0.05).In addition the serum levels of GP-2,hs-CRP,HMGB1 were closely positively correlated with the scores of APACHE-Ⅱand CTSI in patients with acute pancreatitis(P<0.01).The area under ROC curve(AUC)of serum GP-2,hs-CRP and HMGB1 in diagnosis of severe acute pancreatitis was 0.739,0.699 and 0.796,respectively,the area under ROC curve(AUC)of combination diagnosis of detection GP-2,hs-CRP and HMGB1 in diagnosis of severe acute pancreatitis)was 0.866.Conclusion The detection of serum levels of GP-2,hs-CRP and HMGB1 has a certain application value in diagnosis of severe acute pancreatiti,but the combination detection of the three indexes can improve the sensitivity and specificity of diagnosis,which has a important clinical reference value for early diagnosis and assessment of severe acute pancreatitis.