摘要目的:探讨急性胰腺炎(AP)患者血清肝素结合蛋白(HBP)、降钙素原(PCT)、白细胞介素(IL)-18动态监测对评估病情严重程度的临床应用价值。方法:选取2017年12月至2019年5月中国科学技术大学附属第一医院收治的AP患者86例，分为轻症AP(MAP)组36例、中度AP(MSAP)组26例、重症AP(SAP)组24例。25例同期健康体检者为对照组。对所有患者在入院后1、3、7 d动态监测血清HBP、PCT与IL-18水平，Spearman分析3项指标与常规炎症因子IL-6、IL-8、肿瘤坏死因子(TNF)-α及急性生理和慢性健康状况II评分(APACHE II)与Ranson评分的相关性，并探讨HBP、PCT与IL-18对于SAP患者的早期诊断价值。结果:86例AP患者中，男性53例，女性33例，年龄(48.3±8.0)岁。25例对照组中男性15例，女性10例，年龄(40.5±5.9)岁。AP患者在入院第1、3、7天，血清HBP、PCT和IL-18水平均显著高于健康对照组( P<0.05)，而且以第1天的升高最为明显。三项指标均与IL-6、IL-8、TNF-α及APACHE II与Ranson评分呈显著正相关( P<0.05)。单独采用HBP、PCT或IL-18对SAP诊断的曲线下面积(AUC)分别为0.825、0.896、0.799，约登指数分别为0.605、0.628、0.583，灵敏度和特异度分别为75.3%、76.2%、74.8%和85.2%、86.6%、83.5%；联合检测的AUC、约登指数、灵敏度和特异度分别为0.923、0.787、85.5%、93.2%，以及阳性预测值和阴性预测值均有所提高。 结论:血清HBP、PCT和IL-18三项指标的联合动态监测对评估AP的严重程度可起到早期预警作用，对SAP的早期诊断具有一定临床价值。

abstractsObjective: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.