标题：术前血清 IFABP、D-D、PLR、PCT联合检测早期预测小儿绞窄性肠梗阻的价值

      作者：汪广兵 1，赵腾府 1，王耀光 1，杨保锋 2    1.濮阳市人民医院小儿外科，河南 濮阳 457000；2.安阳地区医院小儿外科，河南 安阳 455000

      卷次： 2021年32卷13期

      【摘要】 目的 研究术前血清肠脂肪酸结合蛋白(IFABP)、D-二聚体(D-D)、血小板与淋巴细胞比值(PLR)、降钙素原(PCT)联合检测在小儿绞窄性肠梗阻早期预测中的应用价值。方法 回顾性分析濮阳市人民医院小儿外科和安阳地区医院小儿外科2013年1月至2019年12月收治且接受手术治疗的80例肠梗阻患儿的病历资料，将其按照是否绞窄分为绞窄性肠梗阻组46例与非绞窄性肠梗阻组34例。此外，将绞窄性肠梗阻组患儿按照是否出现肠坏死分为坏死组19例和非坏死组27例。检测并比较各组患儿术前血清 IFABP、D-D、PLR、PCT水平。采用Pearson相关性分析上述指标间的相关性，采用受试者工作特征(ROC)曲线分析术前单独或联合检测上述指标早期预测小儿绞窄性肠梗阻的效能。结果 绞窄性肠梗阻组患儿术前血清 IFABP、D-D、PLR、PCT水平明显高于非绞窄性肠梗阻组，且坏死组上述指标水平明显高于非坏死组，差异均有统计学意义(P<0.05)；经Pearson相关性分析结果显示，绞窄性肠梗阻患儿术前血清 IFABP与D-D、PLR、PCT水平均呈正相关(r=0.523、0.567、0.610，P<0.05)，D-D与PLR、PCT水平均呈正相关(r=0.562、0.510，P<0.05)，PLR与PCT水平呈正相关(r=0.589，P<0.05)；经ROC曲线分析发现，术前血清 IFABP、D-D、PLR、PCT联合检测早期预测小儿绞窄性肠梗阻的曲线下面积、灵敏度、特异度均高于上述指标单独检测，差异均有统计学意义(P<0.05)。结论 肠梗阻患儿术前血清 IFABP、D-D、PLR、PCT表达水平异常升高提示可能发生绞窄性肠梗阻。
      【关键词】 绞窄性肠梗阻；肠脂肪酸结合蛋白；血小板与淋巴细胞比值；D-二聚体；降钙素原；诊断
      【中图分类号】 R725.7 【文献标识码】 A 【文章编号】 1003—6350（2021）13—1673—04

Application value of combined detection of preoperative serum IFABP, D-D, PLR, and PCT in early predictionof strangulated intestinal obstruction in children.
WANG Guang-bing 1, ZHAO Teng-fu 1, WANG Yao-guang 1, YANGBao-feng 2. 1. Department of Pediatric Surgery, Puyang People's Hospital, Puyang 457000, Henan, CHINA; 2. Departmentof Pediatric Surgery, Anyang District Hospital, Anyang 455000, Henan, CHINA
【Abstract】 Objective To study the application value of combined detection of preoperative serum intestinalfatty acid binding protein (IFABP), D-dimer (D-D), platelet-to-lymphocyte ratio (PLR), and procalcitonin (PCT) in theearly prediction of strangulated intestinal obstruction in children. Methods Retrospective analysis was performed onthe medical records of 80 children with intestinal obstruction admitted to Department of Pediatric Surgery, Puyang Peo-ple's Hospital and Department of Pediatric Surgery, Anyang District Hospital from January 2013 to December 2019,which were divided into a strangulated intestinal obstruction group (n=46) and a non-strangulated intestinal obstructiongroup (n=34) according to whether they were strangulated or not. In addition, the children in the strangulated intestinalobstruction group were divided into necrotic group (n=19) and non-necrotic group (n=27) according to the occurrence ofintestinal necrosis. Preoperative serum levels of IFABP, D-D, PLR, and PCT in each group were detected and compared.Pearson correlation was used to analyze the correlation between the above indicators, and receiver operating characteris-tic (ROC) curve was used to analyze the efficacy of single or combined detection of the above indicators in the early pre-diction of strangulated intestinal obstruction in children before surgery. Results The preoperative serum levels of IF-ABP, D-D, PLR, and PCT in the strangulated intestinal obstruction group were significantly higher than those in thenon-strangulated intestinal obstruction group, and the above indexes in the necrosis group were significantly higher thanthose in the non-necrosis group (P<0.05). Pearson correlation analysis showed that preoperative serum IFABP was posi-tively correlated with the levels of D-D, PLR, and PCT (r=0.523, 0.567, 0.610, all P<0.05) and D-D was positively corre-lated with the levels of PLR and PCT (r=0.562, 0.510, all P<0.05). PLR was positively correlated with PCT (r=0.589, P<0.05). ROC curve analysis showed that the area under the curve, sensitivity and specificity of preoperative serum IFABP,D-D, PLR, and PCT combined detection for early prediction of strangulated intestinal obstruction in children were high-er than those of the above indicators alone (P<0.05). Conclusion The abnormal increase of serum IFABP, D-D, PLR,and PCT expression levels in children with intestinal obstruction before surgery suggests that strangulated intestinal ob-struction may occur.
      【Key words】 Strangulated intestinal obstruction; Intestinal fatty acid binding protein; Platelet-to-lymphocyte ra-tio; D-dimer; Procalcitonin; Diagnosis