中国冶金工业医学杂志

血清肝素结合蛋白预测重症急性胰腺炎发生急性肾损伤的价值*

作者：朗恒亮李超柏敏丽韦伍英#

关键词：肝素结合蛋白重症急性胰腺炎急性肾损伤序贯器官衰竭评估中性粒细胞与淋巴细胞比值

分类号：R 687.3

出版年,卷(期):页码：2026,43(1):11-14

摘要：

摘要：目的探讨血清肝素结合蛋白（heparin binding protein，HBP）预测重症急性胰腺炎（severe acute pancreatitis，SAP）患者发生急性肾损伤（acute kidney injury，AKI）的临床价值。方法回顾性总结2021年6月—2023年6月广西壮族自治区脑科医院诊断的SAP患者78例，根据入院72 h后是否存在AKI分为AKI组32例和无AKI组46例。比较两组的临床资料［性别、年龄、体质量指数（body mass index，BMI）、基础疾病、急性生理学与慢性健康状况评价Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE）、序贯器官衰竭评估（sequential organ failure assessment，SOFA）、胰腺炎严重程度（pancreatitis severity，Ranson）评分］和入院24 h血生化指标水平［血淀粉酶、血脂肪酶、血糖、血钙、总胆固醇（total cholesterol，TC）、低密度脂蛋白（low-density lipoprotein，LDL）、白细胞计数、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、C反应蛋白（C-reactive protein，CRP）、降钙素原（procalcitonin，PCT）、白细胞介素-6（interleukin-6，IL-6）、HBP、谷丙转氨酶（alanine aminotransferase，ALT）、血肌酐和胱抑素C（cystatin C，Cys C）］。结果与无AKI组相比，AKI组的年龄、SOFA评分、NLR、IL-6、HBP、血肌酐和Cys C水平显著增加，组间比较差异均有统计学意义（t＝5.659、4.859、5.002、15.326、6.032、19.867、8.032，均P＜0.05）；而其他指标比较均无明显差异（均P＞0.05）。Spearman相关分析显示，血清HBP水平与SOFA评分、NLR、IL-6、血肌酐和Cys C水平呈显著正相关（均P＜0.05）。受试者工作曲线（receiver operating characteristic，ROC）显示，HBP预测SAP患者AKI的曲线下面积（area under the curve，AUC）为0.864（95%CI＝0.812～0.906，P＜0.001），敏感度为80.5%，特异度为89.6%，最佳临界值为6.5 ng/ml。结论 HBP是预测SAP发生AKI的重要标志物，早期检测HBP升高有助于临床准确筛选AKI高危人群并及时干预。

Abstract：Objective To explore the clinical value of serum heparin binding protein （HBP） in predicting the occurrence of acute kidney injury （AKI） in patients with severe acute pancreatitis （SAP）. Methods A retrospective analysis was conducted on 78 patients diagnosed with SAP in Guangxi Zhuang Autonomous Region Brain Hospital from June 2021 to June 2023. Based on the occurrence of AKI within 72 hours after admission, they were divided into AKI group （n＝32） and non-AKI group （n＝46）. The clinical data, including gender, age, body mass index （BMI）, comorbidities, acute physiology and chronic health evaluation II （APACHE II） score, sequential organ failure assessment （SOFA） score, and Ranson scores were collected. Laboratory parameters within 24 hours of admission were compared between the two groups, including serum amylase, lipase, blood sugar, blood calcium, total cholesterol （TC）, low-density lipoprotein （LDL）, white blood cell count, neutrophil to lymphocyte ratio（NLR）, C-reactive protein （CRP）, procalcitonin（PCT）, interleukin-6 （IL-6）, HBP, alanine aminotransferase （ALT）, serum creatinine, and cystatin C （Cys C）. Results Compared with the non-AKI group, the AKI group showed significant higher values of age, SOFA score, NLR, IL-6, HBP, serum creatinine, and Cys C levels, the differences between the two groups were statistically significant （t＝5.659, 4.859, 5.002, 15.326, 6.032, 19.867, 8.032; all P＜0.05）. No significant differences were observed in other indicators （all P＞0.05）. Spearman correlation analysis demonstrated that serum HBP levels were significantly positively correlated with SOFA score, NLR, IL-6, serum creatinine, and Cys C levels （all P＜0.05）. The receiver operating characteristic （ROC） curve analysis showed that HBP had good predictive value for AKI in SAP patients, with the area under the curve （AUC） of 0.864 （95% CI＝0.812～0.906, P＜0.001）, sensitivity of 80.5%, specificity of 89.6%, and an optimal cut-off value of 6.5 ng/ml. Conclusion HBP is a valuable biomarker for predicting the occurrence of AKI in SAP, and early detection of elevated HBP levels may help clinicians identify high-risk patients and facilitate timely intervention.

基金项目：

广西壮族自治区卫生健康委员会自筹经费科研课题（Z20211245）

作者简介：

参考文献：

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