Diagnostic Value Of Histidine Decarboxylase,intestinal Fatty Acid Binding Protein,D-dimer In Strangulated Intestinal Obstruction

Objective:To investigate the diagnostic value of Histidine Decarboxylase(HDC),Intestinal Fatty Acid Binding Protein(I-FABP),D-dimer and White Blood Cells(WBC)in strangulated parturient obstruction,and to provide a theoretical basis for clinical diagnosis of intestinal obstruction.Methods:During the period from January 2017 to January 2018,40 patients were treated in the Chinese-Japanese Friendship Hospital of Jilin University for abdominal distention,abdominal distension and nausea,and 20 patients with strangulated intestinal obstruction(including 10 patients Hernia,intestinal adhesion in 4 cases,3 cases of intestinal torsion,intussusception in 2 cases),simple intestinal obstruction in 20 cases.Another 20 patients were selected peritonitis group(including appendicitis in 13 cases,4 cases of gastrointestinal perforation,abdominal trauma in 3 cases),20 healthy control patients.Strangulated intestinal obstruction group inclusion criteria: conservative treatment fails in the selected patients with intestinal obstruction,bowel obstruction found during surgery;Simple intestinal obstruction group inclusion criteria: patients complained of abdominal pain,abdominal distension,nausea,stop the exhaust bowel movements,physical examination found abdominal bulging,gastrointestinal motility wave,bowel sounds hyperactivity,gas water or bowel sounds weakened or disappeared,Auxiliary tests include: the abdomen orthopedic film shows the gas-liquid level or abdominal CT showed significant expansion of the proximal bowel,distal bowel collapse and no gas or liquid shadow or intestine blood flow seen in the surgery was good and not strangulated;Peritonitis group admission criteria: the main complaint of patients with abdominal pain,physical examination found abdominal tenderness,rebound tenderness,muscle tension;auxiliary examination include: abdominal orthopedic film,abdominal ultrasound,abdominal CT and intraoperative confirmation;Health control group: Our hospital physical examination by electrocardiogram,chest X-ray and abdominal ultrasonography were normal,no heart,lung,liver,kidney and other organ serious organic diseases,and no history of abdominal surgery,no burns and abdominal trauma Medical history.Patient data collected after admission(including: current medical history,past history,history of surgery,history of trauma,test results,imaging results).Blood samples were collected from patients on admission,and the time of abdominal pain was recorded.WBC using sheath flow impedance method,laser scattering method,combined with fluorescent staining of flow cytometry cell sorting,counting.D-dime immunoturbidimetric assay.HDC,I-FABP by ELISA.Statistical Methods SPSS 22.0 statistical software for data analysis.Measurement data using X ± S said that by homogeneity of variance test to determine whether the variance is homogeneous.Non-normalized independent samples were compared between groups using Tamhane’s T2 and Dunnett’s T3 methods that did not assume variance homogeneity in the analysis of variance.Mann-Whitney U test and Kolmogorov-Smirnov test were used to compare non-normal distribution of two independent samples.P <0.05 means the difference is statistically significant.The critical values of HDC,I-FABP,D-dimer and WBC were determined by ROC curve.Results :1.The expression of WBC in strangulation group was significantly higher than that in normal control group and simple intestinal obstruction group(P <0.05),while in strangulation group was higher than that in peritonitis group,there was no statistical difference(P> 0.05)There was no significant difference between the intestinal obstruction group and the control group(P> 0.05).2.The level of D-dimer in strangulated intestinal obstruction group only had statistical difference(P <0.05)compared with normal control group,but there was no statistical significance in the group of simple intestinal obstruction(P> 0.05)and peritonitis group(P> 0.05)There was no significant difference in D-dimer level between simple intestinal obstruction group and peritonitis group(P> 0.05).3.Serum HDC levels in strangulated intestinal obstruction group were significantly higher than those in normal control group(P <0.05),simple intestinal obstruction group(P<0.05),peritonitis group(P <0.05).Simple intestinal obstruction group and normal control(P> 0.05),peritonitis group(P> 0.05)no significant difference.4.The level of serum I-FABP was significantly higher in strangulated intestinal obstruction group than in normal control group(P <0.05),simple intestinal obstruction group(P <0.05),peritonitis group(P <0.05)There was no significant difference between normal control group(P> 0.05)and peritonitis group(P> 0.05).5.When HDC≥20.606ng/ml,the sensitivity was 95%,the specificity was 100%,the false negative rate was 5% and the false positive rate was 0%.When I-FABP≥0.3036 ng / ml,the sensitivity was 95 and the specificity was 70 %,The false negative rate was 5%,the false positive rate was 30%;when WBC≥12.29ⅹ109 / L,the sensitivity was 60%,the specificity was 90%,the false negative rate was 40% and the false positive rate was 10%;D-dimer≥1.235 ug / m,the sensitivity was 75%,the specificity was 60%,the false-negative rate was 25% and the false-positive rate was 40%.Conclusion:1.HDC and I-FABP are effective biomarkers for diagnosis of strangulated intestinal obstruction2.WBC and D-dimer have a good guiding role in the diagnosis of severity of acute intestinal obstruction3.Evaluation of acute intestinal obstruction with WBC+D-dimer+X(I-FABP or HDC)is more helpful in the determination of strangulated intestinal obstruction...