Chen Yan,Lin Chuanwu,Xiong Geng,et al.Value of combined detection of serum secretory phospholipase a2-IIA, interleukin-33 and trypsinogen activation peptide in early identification and disease severity prediction of pediatric acute pancreatitis[J].Journal of Clinical Pediatric Surgery,2026,(08):733-738.[doi:10.3760/cma.j.cn101785-202409080]
血清sPLA2-IIA、IL-33联合TAP检测在小儿急性胰腺炎早期识别与病情预测中的应用价值
- Title:
- Value of combined detection of serum secretory phospholipase a2-IIA, interleukin-33 and trypsinogen activation peptide in early identification and disease severity prediction of pediatric acute pancreatitis
- Keywords:
- Pancreatitis; Acute Necrotizing; Phospholipases A2; Secretory; Interleukin-33; Trypsinogen; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨血清分泌型磷脂酶A2-IIA（secretory phospholipase a2-IIA,sPLA2-IIA）、白细胞介素-33（interleukin-33,IL-33）联合胰蛋白酶原激活肽（trypsinogen activation peptide,TAP）在小儿急性胰腺炎（acute pancreatitis,AP）中的应用价值。方法 本研究采用横断面、回顾性研究方法,选取2020年4月至2023年7月西南医科大学附属医院小儿外科确诊为AP的患儿105例作为AP组，其中重症急性胰腺炎组（severe acute pancreatitis group,SAP）20例，非重症急性胰腺炎组（non-severe acute pancreatitis group,NSAP）85例；选取同期健康体检儿童100例作为健康对照组。比较AP组与健康对照组血清sPLA2-IIA、IL-33及TAP水平；对比SAP组与NSAP组的一般资料及早期实验室检查指标。通过二元Logistic回归分析SAP的独立预测因素。绘制受试者操作特征（receiver operating characteristic,ROC）曲线，计算曲线下面积（area under the curve,AUC），评估血清sPLA2-IIA、IL-33联合TAP检测在小儿AP早期识别及病情预测中的效能。结果 与健康对照组相比，AP组血清sPLA2-IIA[（120.45±20.32）ng/mL比（60.12±15.01）ng/mL]、IL-33[（45.67±10.23）pg/mL比（20.09±5.12）pg/mL]及TAP[（180.56±30.29）U/L比（50.23±10.41）U/L]水平显著升高，差异具有统计学意义（P<0.05）。联合sPLA2-IIA、IL-33及TAP识别小儿AP的灵敏度、特异度及AUC（95%CI）分别为91.42%、90.00%、0.896（0.865~0.925），均优于单一指标检测。较NSAP组，SAP组急性生理与慢性健康状况评分Ⅱ（acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ）[（10.76±2.55）分比（8.50±2.06）分]、发生剧烈腹痛人数占比（100.00%比49.41%）、院内死亡人数占比（10.00%比0）均更高，且住院时长[（14.60±2.74）d比（8.92±2.35）d]更长，差异均具有统计学意义（P<0.05）。SAP组血清C反应蛋白[（200.51±20.65）mg/L比（52.46±7.39）mg/L]、白蛋白[（35.29±4.25）g/L比（28.64±3.37）g/L]、sPLA2-IIA[（151.53±21.45）ng/mL比（113.13±18.09）ng/mL]、IL-33[（56.39±8.62）pg/mL比（43.14±7.73）pg/mL]及TAP[（226.83±26.53）U/L比（169.67±20.41）U/L]水平亦显著高于NSAP组（P<0.05）。Logistic回归分析显示，CRP、ALB、sPLA2-IIA、IL-33及TAP均为SAP的独立预测因子（P<0.05）。在病情预测中，血清sPLA2-IIA、IL-33联合TAP检测灵敏度、特异度及AUC（95%CI）分别为92.83%、90.00%、0.901（0.900~1.000），均显著高于单一指标预测效能。结论 血清sPLA2-IIA、IL-33联合TAP检测在小儿AP早期识别与病情预测中具有良好效能，通过整合多项生物标志物信息，能够更加全面、准确地反映疾病状态，提高诊断灵敏度和特异度，为临床治疗决策提供有力支持。
- Abstract:
- Objective To explore the value of combined detection of serum secretory phospholipase a2-IIA (sPLA2-IIA),interleukin-33 (IL-33) plus trypsinogen activation peptide (TAP) in early identification and disease prediction of acute pancreatitis (AP) in children. Methods From April 2020 to July 2023,cross-sectional retrospective analysis was performed for 105 AP children at Department of Pediatrics or Gastroenterology of our hospital.Besides AP group,severe acute pancreatitis (SAP,n=20) and non-severe acute pancreatitis (NSAP,n=85) groups were also assigned.At the same time,100 healthy children were selected as healthy control group.The serum levels of sPLA2-IIA,IL-33 and TAP were compared between AP and healthy control groups.General profiles and early laboratory parameters of SAP and NSAP group were compared.Multivariate binary Logistic regression analysis was utilized for exploring the independent predictors of SAP.Receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) value calculating for evaluating the efficacy of serum sPLA2-IIA,IL-33 and TAP co-detection in early identification and disease prediction of AP in children. Results As compared with healthy control group,the serum levels of sPLA2-IIA [(120.45±20.32) vs. (60.12±15.01) ng/mL],IL-33 [(45.67±10.23) vs. (20.09±5.12 pg/mL) pg/mL]and TAP [(180.56±30.29) vs. (50.23±10.41) U/L]spiked markedly in AP group (P<0.05).Sensitivity,specificity and AUC (95%CI) of co-detection of sPLA2-IIA,IL-33 and TAP in identifying AP in children were 91.42%,90.00% and 0.896 (0.865-0.925).They were all better than single index detection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [(10.76±2.55) vs. (8.50±2.06) points],severe abdominal pain [(100.00)% vs. (49.41)%]and in-hospital death [(10.00)% vs. (0.00)%]were higher in SAP group than those in NSAP/SAP group.Length of hospitalization stay was longer [(14.60±2.74) vs. (8.92±2.35) day](P<0.05).The levels of serum c-reactive protein (CRP)[(200.51±20.65) vs. (52.46±7.39) mg/L],albumin (ALB)[(35.29±4.25) vs. (28.64±3.37) g/L],sPLA2-IIA [(151.53±21.45) vs. (113.13±18.09) ng/mL],IL-33 [(56.39±8.62) vs. (43.14±7.73) pg/mL]and TAP [(226.83±26.53) vs. (169.67±20.41) U/L]were also significantly higher in SAP group than those in NSAP group (P<0.05).Logistic regression analysis revealed that CRP,ALB,sPLA2-IIA,IL-33 and TAP were independent predictors of SAP (P<0.05).Regarding disease prediction,sensitivity,specificity and AUC (95%CI) of serum sPLA2-IIA,IL-33 plus TAP were 92.83%,90.00% and 0.901 (0.900-1.000).They were all significantly higher than those of single index. Conclusions Combined detection of serum sPLA2-IIA,IL-33 and TAP has a significant application effect in early identification and condition prediction of AP in children.Through integrating multiple biomarker information,it may more comprehensively and accurately reflect disease status,improve diagnostic sensitivity and specificity and provide strong supports for clinical decision-making.
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备注/Memo
收稿日期:2024-9-29。
基金项目:2019年四川省医学(青年创新)科研课题(Q19007)
通讯作者:刘铭,Email:liuming6603@163.com