RESUMO
Objective:To investigate the correlations between level of serum heparin binding protein (HBP), procalcitonin (PCT), interleukin-18 (IL-18) and the severity of acute pancreatitis (AP).Methods:A total of 86 patients with AP admitted to the First Affiliated Hospital, University of Science and Technology of China from December 2017 to May 2019 were included and divided into mild AP group (MAP) with 36 cases, moderate AP group (MSAP) with 26 cases, and severe AP group (SAP) with 24 cases. There were 25 healthy subjects were chosen as the control group. Serum HBP, PCT, and IL-18 levels were dynamically monitored in all patients at 1, 3 and 7 days after admission. The Spearman correlation analysis was conducted to detect the correlation between the three indicators and inflammatory factors IL-6, IL-8, TNF-α, and APACHEII and Ranson score, and analyzed the early diagnostic value of HBP, PCT, and IL-18 in SAP patients.Results:In 86 AP patients, 53 were males and 33 were females, aged (48.3±8.0) years. In 25 healthy subjects, 15 were males and 10 were females, aged (40.5±5.9) years. Serum levels of HBP, PCT and IL-18 in AP patients were significantly higher than those of healthy control group at 1, 3 and 7 days after admission ( P<0.05), and the most significant increase was observed on the 1st day. At the meanwhile, HBP, PCT, and IL-18 were positively correlated with level of IL-6, IL-8, TNF-α, APACHEII and Ranson scores ( P<0.05). The AUC area of SAP diagnosis by using HBP, PCT or IL-18 alone was respectively 0.825, 0.896, 0.799, the Yoden index was respectively 0.605, 0.628, 0.583, the sensitivity and specificity were 75.3%, 76.2%, 74.8% and 85.2%, 86.6%, 83.5%. The AUC area, Yoden index, sensitivity and specificity of joint detection were 0.923, 0.787, 85.5%, 93.2%, and the positive predictive value and negative predictive value were also increased. Conclusion:Monitoring of serum HBP, PCT and IL-18 can predict the severity of AP patients, and it may serve as an early diagnostic marker for AP.
RESUMO
Objective To study the therapeutic regimen for the simple third or fourth grade of traumatic spleen rupture in patients with hemorrhagic shock. Methods A total of 58 patients with traumatic spleen rupture complicated with hemorrhagic shock admitted between January 2012 and June 2016 were enrolled for analysis. The causes of the casualties suffering from closed abdominal injuries including 31 traffic accident, 13 falling down from a height, 8 tumbling on the ground, 2 beaten trauma and 4 other traumatic injuries. All the patients were divided into the conventional surgery group or proximal selective spleen artery embolization (PASE) group. Comparisons of surgery and postoperative relevant parameters between two groups were analyzed, and the curative effects of the two kinds of treatments was evaluated. Results There were no statistically significant difference in age, sex, degree of spleen rupture, systolic blood pressure, heart rate, and hemoglobin concentration between two groups (P＞ 0.05). The time consumed for operation (T1),the time required for systolic blood pressure recovery (T2), and the allogeneic blood volume capacity (V2) transfused in PASE group were significantly lesser than those in the conventional surgery group (P＜0.05), however there was no difference in the autologous blood volume reinfusion (V1) (P＞ 0.05). Furthermore, the incidence of fever, infection of incision, ileus, ICU treatment, time required fro intestinal function time and hospital stay in PASE group were significantly lesser than those in conventional surgery group (P＜0.05), but the incidence of left upper abdominal pain in PASE group was higher (P＜0.05). Conclusions Selective spleen artery embolization can rapidly stabilize hemodynamics, and shorten the operation time. It also can reduce the complications and allogeneic blood use, shorten recovery time and hospital stay. It is a preferential choice for treatment of traumatic spleen rupture with shock, and worth popularizing in clinical.