缺血修饰白蛋白在急性胆囊炎及其严重程度判断中的有效性。

The Effectiveness of Ischemia Modified Albumin in Determining Acute Cholecystitis and its Severity.

出版信息

Clin Lab. 2021 Sep 1;67(9). doi: 10.7754/Clin.Lab.2021.210116.

DOI:10.7754/Clin.Lab.2021.210116

Abstract

BACKGROUND

Acute cholecystitis (AC) is caused by chemical and bacterial inflammation of the gallbladder. The use of Tokyo guidelines is recommended in determining the diagnosis of AC and its clinical severity. In the early stages of AC, many cytokines are secreted due to the local inflammatory cell activation, leading to exacerbation of inflammation and organ failure. Ischemia modified albumin (IMA) is a type of albumin that occurs in ischemia and oxidation and is used as a marker of hypoperfusion and oxidative stress. This study aims to investigate the effectiveness of ischemia modified albumin, C-reactive protein (CRP), and some other inflammation parameters in predicting the severity of the AC on admittance.

METHODS

Forty-two patients diagnosed with AC and 30 healthy individuals in the control group were included in the study. The severity assessment of the patients was performed based on the revised Tokyo guidelines (TG 13). The patients were divided into 3 groups according to severity of the disease. Blood samples were taken from the subjects on admittance. Serum IMA levels were studied using an ELISA kit. SPSS 22.00 package program was used for statistical analysis.

RESULTS

Thirty (71.4%) of the participants were in the mild group, while 12 (28.6%) were in the moderate group. There were no patients in the severe group. Leukocyte, CRP, and IMA values in the patient group were higher than those of the control group (p > 0.05). According to the Tokyo classification, a significant difference was found between the groups with mild and moderate grades in terms of CRP and IMA values (p < 0.001 and p < 0.05, respectively). When the cutoff value of IMA was 84 ng/mL, the sensitivity was found to be 76% and specificity was determined to be 40% (AUC: 0.665, p = 0.017, 95% Confidence Interval).

CONCLUSIONS

It is considered that IMA could be useful in predicting the clinical severity of TG13-based acute cholecystitis and, therefore, could be used in the management of treatment by the clinician such as medical treatment, early surgery, and interval surgery.

摘要

背景

急性胆囊炎（AC）是由胆囊的化学和细菌炎症引起的。建议使用东京指南来确定 AC 的诊断和其临床严重程度。在 AC 的早期阶段，由于局部炎症细胞的激活，会分泌许多细胞因子，导致炎症加剧和器官衰竭。缺血修饰白蛋白（IMA）是一种在缺血和氧化时发生的白蛋白，用作低灌注和氧化应激的标志物。本研究旨在探讨缺血修饰白蛋白、C 反应蛋白（CRP）和其他一些炎症参数在预测入院时 AC 严重程度方面的有效性。

方法

将 42 名被诊断为 AC 的患者和 30 名健康对照组纳入研究。根据修订后的东京指南（TG13）对患者进行严重程度评估。根据疾病严重程度将患者分为 3 组。在入院时从受试者中抽取血样。使用 ELISA 试剂盒研究血清 IMA 水平。使用 SPSS 22.00 包程序进行统计分析。

结果

30 名（71.4%）参与者为轻度组，12 名（28.6%）为中度组。没有严重组的患者。患者组的白细胞、CRP 和 IMA 值高于对照组（p>0.05）。根据东京分类，轻度和中度组之间在 CRP 和 IMA 值方面存在显著差异（p<0.001 和 p<0.05）。当 IMA 的截断值为 84ng/mL 时，灵敏度为 76%，特异性为 40%（AUC：0.665，p=0.017，95%置信区间）。