Goswami Pooja, Sonika Ujjwal, Moka Praneeth, Sreenivas Vishnubhatla, Saraya Anoop
From the *Department of Gastroenterology and Human Nutrition Unit, and †Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Pancreas. 2017 Nov/Dec;46(10):1275-1280. doi: 10.1097/MPA.0000000000000924.
Severe acute pancreatitis (AP) is associated with high mortality due to systemic inflammatory response syndrome in the early phase and secondary infection in the later phase. Concomitant intestinal ischemia often results in gut injury. We studied intestinal fatty acid binding protein (IFABP) and citrulline levels as markers of gut injury to predict prognosis in AP.
Acute pancreatitis patients at admission and controls were studied. Serum IFABP was measured by enzyme-linked immunosorbent assay and plasma citrulline by high-performance liquid chromatography technique. Ultrastructural changes in duodenal biopsy were also compared between the 2 groups.
The IFABP concentration was significantly higher in AP cases (n = 94) compared with controls (n = 100) (mean [standard deviation], 592.5 [753.6] vs 87.8 [67.6] pg/mL; P < 0.001) and in patients with severe AP versus mild AP (738.3 [955.3] vs 404.0 [263.3] pg/ mL, P = 0.03). Citrulline concentration was lower in AP versus controls (29.9 [33.8] vs 83.9 [60.1] μg/L, P < 0.001). We propose a model by which these biomarkers (IFABP >350 pg/mL and citrulline <18 μg/L) are able to predict poor prognosis in 33.9% of patients with AP. The gut injury was also validated via ultrastructural changes.
Intestinal fatty acid binding protein is a promising prognostic marker in acute pancreatitis.
重症急性胰腺炎（AP）在疾病早期可因全身炎症反应综合征、后期可因继发感染而导致高死亡率。同时存在的肠道缺血常导致肠损伤。我们研究了肠脂肪酸结合蛋白（IFABP）和瓜氨酸水平作为肠损伤标志物，以预测AP的预后。
对入院时的急性胰腺炎患者及对照组进行研究。采用酶联免疫吸附测定法检测血清IFABP，采用高效液相色谱技术检测血浆瓜氨酸。同时比较两组十二指肠活检的超微结构变化。
与对照组（n = 100）相比，AP患者组（n = 94）的IFABP浓度显著更高（均值[标准差]，592.5 [753.6] vs 87.8 [67.6] pg/mL；P < 0.001），且重症AP患者高于轻症AP患者（738.3 [955.3] vs 404.0 [263.3] pg/mL，P = 0.03）。AP患者的瓜氨酸浓度低于对照组（29.9 [33.8] vs 83.9 [60.1] μg/L，P < 0.001）。我们提出了一个模型，通过这些生物标志物（IFABP>350 pg/mL且瓜氨酸<18 μg/L）能够预测33.9%的AP患者预后不良。通过超微结构变化也证实了肠损伤。
肠脂肪酸结合蛋白是急性胰腺炎中一个有前景的预后标志物。
