Department of Surgery, Clinical Sciences, Malmö, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden.
Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Gastroenterol. 2021 Aug 28;21(1):337. doi: 10.1186/s12876-021-01910-6.
Most patients with acute pancreatitis (AP) experience mild, self-limiting disease with little or no need for hospital care. However, 20-25% of patients develop a more severe and potentially life-threatening condition with progressive systemic inflammatory response syndrome (SIRS) and multiorgan failure, resulting in high morbidity and mortality rates. Predicting disease severity at an early stage is important, as immediate supportive care has been demonstrated to reduce the incidence of SIRS and organ failure, improving patient outcome. Several studies have demonstrated elevated levels of heparin-binding protein (HBP) in patients with sepsis and septic shock, and HBP is believed to play a part in endothelial dysfunction leading to vascular leakage. As HBP levels increase prior to other known biomarkers, HBP has emerged as a promising early predictor of severe sepsis with organ dysfunction.
Patients admitted to Skåne University Hospital in Malmö between 2010 and 2013 fulfilling the criteria for AP were identified in the emergency department and prospectively enrolled in this study. The primary outcome was measured levels of HBP upon hospital admission in patients with confirmed AP. Correlations among HBP concentrations, disease severity and fluid balance were considered secondary endpoints. The correlation between HBP levels and fluid balance were analysed using Pearson correlation, and the ability of HBP to predict moderately severe/severe AP was assessed using a receiver operating characteristic (ROC) curve.
The overall median HBP level in this study was 529 (307-898) ng/ml. There were no significant group differences in HBP levels based on AP severity. Fluid balance differed significantly between patients with mild versus moderately severe and severe pancreatitis, but we found no correlation between HBP concentration and fluid balance.
HBP levels are dramatically increased in patients with AP, and these levels far exceed those previously reported in other conditions. In this study, we did not observe any significant correlation between HBP levels and disease severity or the need for intravenous fluid. Additional studies on HBP are needed to further explore the role of HBP in the pathogenesis of AP and its possible clinical implications.
大多数急性胰腺炎（AP）患者经历轻度、自限性疾病，几乎不需要住院治疗。然而，20-25%的患者出现更严重和潜在危及生命的情况，表现为进行性全身炎症反应综合征（SIRS）和多器官衰竭，导致高发病率和死亡率。早期预测疾病严重程度很重要，因为已经证实立即给予支持性护理可以降低 SIRS 和器官衰竭的发生率，改善患者预后。几项研究表明，肝素结合蛋白（HBP）在脓毒症和感染性休克患者中升高，并且 HBP 被认为在导致血管渗漏的内皮功能障碍中发挥作用。由于 HBP 水平在其他已知生物标志物之前升高，因此 HBP 已成为具有器官功能障碍的严重脓毒症的有前途的早期预测指标。
在 2010 年至 2013 年间，在马尔默的斯科讷大学医院急诊科确定符合 AP 标准的患者，并前瞻性地纳入本研究。主要结局是测量入院时确诊 AP 患者的 HBP 水平。考虑 HBP 浓度、疾病严重程度和液体平衡之间的相关性作为次要终点。使用 Pearson 相关分析来分析 HBP 水平与液体平衡之间的相关性，使用接收者操作特征（ROC）曲线评估 HBP 预测中度严重/严重 AP 的能力。
本研究中总体 HBP 中位数为 529（307-898）ng/ml。根据 AP 严重程度，HBP 水平无显著组间差异。轻度与中度和重度胰腺炎患者的液体平衡差异显著，但我们没有发现 HBP 浓度与液体平衡之间存在相关性。
AP 患者的 HBP 水平显著升高，这些水平远远超过其他疾病中报道的水平。在本研究中，我们没有观察到 HBP 水平与疾病严重程度或静脉补液需求之间存在任何显著相关性。需要进一步研究 HBP 以进一步探讨 HBP 在 AP 发病机制及其可能的临床意义中的作用。
