| Objective:To explore the value of dynamic monitoring of HMGB1,Ghrelin and PCT in the early assessment of Severity and Prognosis of Acute Pancreatitis(AP).Methods: The data of patients with acute pancreatitis(AP)in our department from September 2018 to June 2020 were collected.According to the out/in criteria,100 patients with Mild Acute Pancreatitis were selected and divided into Mild Group,60 patients with Moderate Severe Pancreatitis or Severe Pancreatitis were selected and divided into Non Mild Group(60 cases).All patients were given conventional treatment after admission.During hospitalization,C-reactive protein,blood routine examination,hepatic and renal functions,serum amylase,PCT,fasting plasma glucose(FPG)and other indexes were routinely monitored,and fasting venous serum was reserved for subsequent use.After all cases were included,all the reserved serum was tested and the levels of high mobility group box 1(HMGB1)and Ghrelin protein at each time point after admission were recorded.The levels of procalcitonin(PCT),serum amylase and other indexes on the 1st,3rd,7th day of hospitalization were recorded by consulting the discharged cases,Apache-II and BISAP scores were performed on all patients on the 1st day after admission according to the information provided by the discharged cases.All data were analyzed by statistical methods and tools after collection.Results: there was no significant difference in gender,etiology and age distribution between the two groups(P>0.05);On the 1st day after admission,there was no significant difference in serum amylase level,leukocyte level,FPG and serum calcium level between the two groups(P > 0.05),while CRP level in Non Mild Group was significantly higher than that in Mild Group(P < 0.05).On the 1st,3rd and 7th day after admission,the levels of HMGB1,Ghrelin and PCT in the two groups showed a gradual downward trend,and the intra group differences of each index were statistically significant(P < 0.05).At the above three time points,the levels of HMGB1,Ghrelin and PCT in the Non Mild Group were higher than those in the Mild Group,and all differences were statistically significant(P < 0.05).On the 1st day after admission,the levels of HMGB1,Ghrelin and PCT were positively correlated with APACHE-II and BISAP scores,the correlation coefficients with APACHE II scores were 0.775,0.563,0.621(P < 0.05),the correlation coefficients with BISAP scores were 0.743,0.604,0.638(P < 0.05).To explore the early predictive value of individual or combined application of each index for Non Mild Acute Pancreatitis,we used the test value of each index on the 1st day after admission.Cut-off values of each index were: CRP(≥ 128.41 mg / L),APACHE-II score(≥ 10.5),BISAP score(≥ 2.5),HMGB1(≥ 4.64 UG / L),ghrelin(≥ 674.52 ng / ml),PCT(≥ 3.06 ng / ml).The results showed that HMGB1 had the best value in predicting Non Mild Acute Pancreatitis,the Sensitivity(Se)and Specificity(Sp)were 84.3% and 89.1% respectively,and the Area Under the Curve(AUC)was 0.885.The combined application of HMGB1+Ghrelin+PCT can improve the prediction value,the Se and Sp were 93.3% and 95.0% respectively.To explore the early predictive value on complications of AP,we counted the occurrence of complications in Non Mild Group,the results showed that there were 33 cases of Organ Failure(OF),39 cases of Infectious Pancreatic Necrosis (IPN)and 18 cases of Impaired Fasting Glucose(IFG)or Diabetes Mellitus(DM).The test values of each index of patients in the non mild group on the 1st day after admission were used for analysis,the results showed that HMGB1 had the best Se(89.3%)APACHE-II had the best Sp(85.8%)in predicting OF;The Se and Sp of PCT in predicting IPN were better than other indexes,which were 85.8% and 90.3% respectively;The Se and Sp of ghrelin in predicting IFG / DM were better than other indexes,which were 86.7% and 85.0% respectively.The Se and Sp of HMGB1 + Ghrelin + PCT in predicting the above three complications were higher than that of each index alone;The Se and Sp of the combination are 97.0% and 91.9% respectively for predicting OF,89.7% and 91.3% respectively for predicting IPN,88.9% and 86.7% respectively for predicting IFG / DM.Conclusion:1.The levels of HMGB1,Ghrelin and PCT in peripheral blood are correlated with the severity of AP.2.The levels of HMGB1,Ghrelin and PCT in peripheral blood have certain early predictive value for the occurrence of Non Mild AP.3.HMGB1,Ghrelin and PCT have certain early predictive value for the three complications(OF,IPN,IFG/DM)of Non Mild AP.4.The combination of HMGB1,Ghrelin and PCT has early predictive value for Non Mild AP,OF,IPN,IFG/DM,and its value is better than that of the three alone,and it is also higher than CRP,APACHE-II score and BISAP score. |
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