The Study Of Pre-operative Detection Of D-dimer (DD) And Intestinal Fatty Acid-binding Protein (i-FABP) In Early Diagnosis Of Strangulated Bowel Obstruction In Children

Objective:To investigate the effectiveness of pre-operative combination of D-dimer(DD)and intestinal fatty acid-binding protein(i-FABP)detection in early diagnosis of strangulated bowel obstruction(SBO)in children,with purpose to evaluate the clinical value of DD and i-FABP in predicting SBO.Methods:Sixty-five patients with acute intestinal obstruction were recruited prospectively in this study in a tertiary referral hospital between May 2014 and April 2017.Thirty-six cases of strangulated bowel obstruction were confirmed by operation and were considered as experimental group,and were further divided into bowel necrosis group and non-bowel necrosis group based on the bowel vitality during the operation.Twenty-nine patients with non-strangulated bowel obstruction were considered as control group.The clinical data of demographic characteristics,clinical manifestations and results of laboratory studies prior to surgical interventions were recorded and statistically analyzed.The serum DD and i-FABP levels were retrospectively compared between the patients with strangulated bowel obstruction and those with non-strangulated bowel obstruction,and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve.Meanwhile,the sensitivity,specificity,positive likelihood rate(+RL),negative likelihood rate(-RL)and area under the curve of ROC were reckoned.Results:Among 36 patients with strangulated bowel obstruction,11 patients were diagnosed with bowel necrosis and 25 patients with non-bowel necrosis were confirmed during the operation.The serum DD and i-FABP levels were significantly higher in the patients with strangulated bowel obstruction with bowel necrosis than those observed in the patients with non-bowel necrosis(means,1115.55±469.39?g/l vs.576.20±195.22?g/1),(means,63.75±20.72ng/ml vs.21.90±10.76ng/ml)(p<0.05).The serum DD and i-FABP levels were significantly higher in the patients with strangulated bowel obstruction with non-bowel necrosis than those observed in the patients with non-strangulated bowel obstruction(means,576.20±195.22?g/l vs.338.07±179.53?g/l),(means,21.90±10.76ng/ml vs.13.83±9.09ng/ml)(p<0.05).On the other hand,the serum DD and i-FABP levels were significantly higher in the patients with strangulated bowel obstruction than those observed in the patients with non-strangulated bowel obstruction(means,741.00±390.61?g/L vs.338.07±179.53?g/L),(means,34.69±24.17 ng/ml vs.13.83±9.09ng/ml)(p<0.05).Using the DD cut-off value of 551.50?g/L,the sensitivity,specificity,and AUC of ROC were 0.69,0.86,0.86 respectively;Using the i-FABP cut-off value of 24.01 ng/ml,the sensitivity,specificity,and AUC of ROC were 0.58,0.90,0.81 respectively.While DD and i-FABP were used to perform the parallel combined diagnostic tests,the sensitivity and specificity were 0.87 and 0.77,the +RL and-RL were 3.78 and 0.17.Conclusion:Preoperative serum DD and i-FABP are feasible and useful biochemical markers for diagnosing strangulated bowel obstruction in children,and can discriminate the severity of strangulated bowel obstruction.Meanwhile,combined detection of DD and i-FABP can improve the sensitivity and accuracy in diagnosing strangulated bowel obstruction.