| Background and aims:Acute pancreatitis(AP)is a serious disease that can be caused by a variety of causes.The clinical course of the patient varies greatly.Most mild patients are not accompanied by changes in organ function and can be cured quickly after active treatment.10%-20% of AP patients can develop severe acute pancreatitis(severe acute pancreatitis,SAP),accompanied by organ failure,a dangerous condition,rapid progress,high case fatality,and organ failure lasting more than 48 hours is a decisive factor in the early death of SAP patients..Studies have shown that early identification of patients at risk of persistent organ failure and active and effective treatment can significantly improve the prognosis of SAP patients and reduce their mortality.Histidine-rich glycoprotein(HRG)is a 75 k Da plasma glycoprotein,mainly produced by the liver in human blood.It is known that HRG can bind to a variety of ligands and cells and participate in the regulation of a variety of physiological and pathological processes.In many inflammatory diseases,including sepsis,the level of HRG in the serum is significantly reduced in the early stage,which can be used as an important marker for predicting the severity of the disease.Experimental studies have shown that circulating HRG levels are reduced in the early stages of acute pancreatitis.This study aims to evaluate the value of serum HRG levels in the early prediction of the severity of acute pancreatitis.Methods:1.Design: A prospective,observational cohort study2.Patients: The healthy volunteers who met the inclusion criteria and AP patients who were diagnosed and treated in the First Affiliated Hospital of Nanchang University from January 2019 to January 2020 and AP patients treated within 48 hours after the onset of illness were included.3.Sample processing and measurement: The selected patients collected venous blood samples within 2 hours after admission,centrifuged at 3000 r/min for 10 minutes,and collected the upper serum solution and stored in the refrigerator at-80°C for later use.Cusabio’s enzyme linked immunosorbent assay(enzyme linked immunosorbent assay,ELISA)kit was used for detection.Strictly operate in accordance with the instructions to determine the HRG content in serum samples.4.Statistical analysis: SPSS 22.0 software is used for data statistical analysis.For measurement data,use the mean ± standard deviation or median(interquartile range)to express,use analysis of variance for each group of normal continuous variables,and use Mann-Whitney rank sum test and grams between groups for non-normal variables.Ruskar-Wallis test for comparison.The result of counting data is expressed as a ratio(percentage).Univariate count data were compared using chi-square test or Fisher’s exact test.Receiver operating characteristic(ROC)curve is used to evaluate the value of early serum HRG level in predicting SAP,and the cut-off value is selected when the Uden index is the largest.All analyses are two-sided,and a P value of <0.05 is statistically significant.Results:1.Baseline characteristics: A total of 14 healthy volunteers and 66 AP patients were included in the study,including 23 mild acute pancreatitis(MAP)patients and20 moderately severe acute pancreatitis(MSAP)patients.Patients and 23 SAP patients.There were no significant differences in age,gender,etiology and body mass index among these four groups.2.Serum HRG levels in different group: serum HRG levels in healthy volunteers,MAP patients,MSAP patients,and SAP patient groups were 72.3(65.4-79.1)μg/ml,61.6(51.4-69)μg/ml,45.8(34.6-56.9)μg/ml and 38.4(31.2-44.1)μg/ml.There were significant differences in serum HRG concentration among the four groups(P<0.001).Serum HRG is negatively correlated with the severity of AP patients.The serum HRG level of SAP patients is significantly lower than that of non-SAP patients(38.4(31.2-44.1)μg/ml vs 53.1(42.8-65.1)μg/ml,P<0.001).3.Evaluation of the value of HRG in predicting SAP: Taking serum HRG≤44μg/ml as the best cut-off value,the sensitivity,specificity and area under curve(AUC)of serum HRG in predicting SAP are 78%,72% and respectively.0.81.The predicted AUC for SAP of C-reactive protein(CRP)and procalcitonin(PCT)are0.73 and 0.78,respectively,which are lower than HRG.Conclusions:1.The serum HRG level of AP patients decreases in the early stage,and the HRG level is negatively correlated with the severity of AP.2.Serum HRG level can predict SAP more accurately in the early stage. |
