摘要目的:探讨血清肠型脂肪酸结合蛋白(I-FABP)、肝素结合蛋白(HBP)、白细胞介素-1β(IL-1β)动态监测对急性重症胰腺炎(SAP)并发腹腔间隔室综合征(ACS)的早期预测及病情评估价值。方法:回顾性分析2019年7月至2021年1月安徽医科大学第二附属医院急诊外科诊治的65例SAP患者的临床资料，根据是否并发ACS将其分为无ACS组(48例)、ACS组(17例)，动态监测两组患者血清I-FABP、HBP、IL-1β水平，通过相关性分析以及受试者工作特征(ROC)曲线分别评判各观察指标对SAP患者并发ACS病情严重程度的评估效能及早期预测价值。结果:两组患者年龄、性别、体重指数(BMI)、病因差异均无统计学意义(均 P>0.05)，ACS组CRP水平、WBC水平、入院时急性生理与慢性健康评分Ⅱ(APACHE Ⅱ)以及腹内压(IAP)最大值均高于无ACS组(均 P<0.05)；ACS组第1、4、7天I-FABP[(97.41±15.02)ng/ml vs (37.28±18.34)ng/ml、(103.32±18.40)ng/ml vs (56.96±19.12)ng/ml、(85.69±22.94)μg/L vs (36.88±10.49)ng/ml]、HBP[(92.19±14.59)ng/ml vs (24.56±10.96)ng/ml、(106.11±15.03)ng/ml vs (37.17±13.83)ng/ml、(128.11±16.43)ng/ml vs (68.94±15.91)ng/ml]、IL-1β水平[(15.78±1.44)pg/ml vs (11.26±1.34)pg/ml、(19.34±1.87)pg/ml vs (13.51±2.84)pg/ml、(20.95±1.96)pg/ml vs (16.03±1.04)pg/ml]均持续显著高于无ACS组(均 P<0.01)；相关性分析提示，I-FABP、HBP、IL-1β三项指标与IAP最大值( r＝0.745，0.793，0.770)和入院时APACHE Ⅱ评分( r＝0.510，0.489，0.445)均呈正相关(均 P<0.01)；ROC曲线分析显示，I-FABP、HBP、IL-1β水平单独早期预测ACS的曲线下面积(AUC)(0.846，0.873，0.902)均高于CRP(0.681)、WBC(0.765)、入院时APACHE Ⅱ评分(0.795)，三项指标联合进行平行试验的灵敏度为0.997、联合进行系列试验的特异度为0.994。 结论:血清I-FABP、HBP、IL-1β水平动态监测在评估SAP患者并发ACS的病情严重程度方面具有一定的临床价值；此外，三项指标检测对SAP患者并发ACS亦具有较高的早期预测价值，其中三者联合应用的预测价值更高。

abstractsObjective:To discuss the value of dynamic detection of serum intestinal fatty acid binding protein (I-FABP), heparin binding protein (HBP) and interleukin-1β(IL-1β) in early predicting and evaluating the severity of abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) postoperative patients.Methods:The clinical data of 65 SAP patients treated in the Second Hospital of Anhui Medical University from July 2019 to Jan 2021 were retrospective analyzed. According to whether ACS has occurred, the patients were divided into non ACS group (48 cases) and ACS group (17 cases). The serum I-FABP, HBP and IL-1β of the two groups were dynamically monitored. Correlation analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy and early prediction value of each observation index in evaluating the severity of SAP patients complicated with ACS.Results:There were no significant differences in age, sex, body mass index (BMI) and pathogenesis between the two groups (all P>0.05). The serum levels of C-reactive protein (CRP), white blood cell (WBC), Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score and intra-abdominal pressure (IAP) in ACS group were significantly higher than those in non ACS group (all P<0.05). The serum levels of I-FABP [(97.41±15.02)ng/ml vs (37.28±18.34)ng/ml, (103.32±18.40)ng/ml vs (56.96±19.12)ng/ml, (85.69±22.94)ng/ml vs (36.88±10.49)ng/ml], HBP [(92.19±14.59)ng/ml vs (24.56±10.96)ng/ml, (106.11±15.03)ng/ml vs (37.17±13.83)ng/ml, (128.11±16.43)ng/ml vs (68.94±15.91)ng/ml] and IL-1β[(15.78±1.44)pg/ml vs (11.26±1.34)pg/ml, (19.34±1.87)pg/ml vs (13.51±2.84)pg/ml, (20.95±1.96)pg/ml vs (16.03±1.04)pg/ml] on 1st, 4th, 7th day in ACS group were continuously and evidently higher than those in non ACS group ( P<0.01). Correlation analysis revealed that I-FABP, HBP and IL-1β were positively correlated with IAP ( r=0.745, 0.793, 0.770) and APACHE Ⅱ score ( r=0.510, 0.489, 0.445) (all P<0.01). ROC curve analysis showed that the AUC of early prediction by I-FABP, HBP and IL-1β on the occurrence of ACS were 0.846, 0.873 and 0.902 respectively, which were higher than the CRP (0.681), WBC (0.765) and APACHE Ⅱ score (0.795), the sensitivity and specificity can be significantly improved to 0.997 and 0.994 by parallel and series tests respectively combined with the three indicators. Conclusions:Dynamic detection of serum I-FABP, HBP and IL-1β has a certain clinical value in evaluating the severity of ACS in SAP patients. At the same time, early detection with serum I-FABP, HBP and IL-1β has high predictive power for ACS in SAP patients and the combined application of three has higher predictive value.