Department of Gastroenterology, Peking University People's Hospital, Beijing, China.
Department of Emergency, Peking University People's Hospital, Beijing, China.
Dig Dis Sci. 2021 Jan;66(1):114-120. doi: 10.1007/s10620-020-06138-0. Epub 2020 Mar 19.
Angiopoietin-2 (Ang-2) is a new predictor for acute pancreatitis (AP).
To assess the predictive value of Ang-2 in determining the progress of AP and the subsequent acute gastrointestinal injury (AGI).
This was a prospective study that enrolled 170 patients with AP and 100 healthy controls. Blood samples were collected within 24 h of the onset of AP.
The majority (108) of the patients were categorized as having MAP with the rest (62) classified as suffering from SAP. Considering AGI grading, there were 118 grade 1 and 12 grade 4 patients; in grades 2 and 3, there were 20 patients each. AP was accompanied by MODS and pancreatic necrosis in 46 and 24 cases, respectively. Eighty patients were admitted to the ICU, while mortality was reported among 7.1% patients. The plasma Ang-2 levels were higher among patients with AP than in controls. A similar trend prevailed, in patients with SAP compared to those with MAP. Ang-2 was significantly increased from AGI grade 1 through to grade 4, showing a desirable positive predictive accuracy. Moreover, Ang-2 also showed strong correlations with intestinal permeability as evaluated by d-lactate (DLA), diamine oxidase (DAO), and intestinal fatty acid binding proteins (I-FABPs). Tools (Ranson and APACHE II scores, CRP), which are used more conventionally, could not effectively distinguish the various grades of AGI. Furthermore, Ang-2 predicted poor prognosis and adverse outcomes, including mortality, among patients with AP.
This study showed Ang-2 to be an accurate early predictor for SAP, AGI, and intestinal barrier dysfunction, outperforming conventional biomarkers. Ang-2 levels also predicted the adverse outcomes and mortality due to AP.
血管生成素-2（Ang-2）是急性胰腺炎（AP）的新预测因子。
评估 Ang-2 在确定 AP 进展和随后的急性胃肠损伤（AGI）中的预测价值。
这是一项前瞻性研究，纳入了 170 例 AP 患者和 100 例健康对照者。在 AP 发病后 24 小时内采集血样。
大多数（108 例）患者被归类为 MAP，其余（62 例）被归类为 SAP。考虑 AGI 分级，有 118 例为 1 级，12 例为 4 级；2 级和 3 级各有 20 例。AP 伴有 MODS 和胰腺坏死分别为 46 例和 24 例。80 例患者入住 ICU，死亡率为 7.1%。AP 患者的血浆 Ang-2 水平高于对照组。SAP 患者的水平与 MAP 患者相似。从 AGI 1 级到 4 级，Ang-2 水平显著升高，具有良好的阳性预测准确性。此外，Ang-2 还与通过 d-乳酸（DLA）、二胺氧化酶（DAO）和肠脂肪酸结合蛋白（I-FABPs）评估的肠通透性呈强相关性。更常规使用的工具（Ranson 和 APACHE II 评分、CRP）无法有效区分 AGI 的各个等级。此外，Ang-2 预测了 AP 患者的不良预后和不良结局，包括死亡率。
本研究表明，Ang-2 是 SAP、AGI 和肠屏障功能障碍的准确早期预测因子，优于传统生物标志物。Ang-2 水平也预测了 AP 导致的不良结局和死亡率。
