Significance Of Endothelial Progenitor Cells In Peripheral Blood As A Biological Marker To Predict Severe Acute Pancreatitis

Objective:(1) To investigate the levels of endothelial progenitor cells (EPCs), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), fibrinogen (FIB) and white blood cell (WBC) among the peripheral blood of healthy volunteers, mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP). Analyze whether there are correlations among these five markers in MAP and SAP.(2) Take the SAP group as the positive group and the MAP group as the negative group to get the ROC curve. Evaluate the diagnostic value of the five markers or assemble of them according to AUC and YI value. Eventually, proposed a optimal marker to predict SAP at the early stage of AP.Methods:Part1We obtained20blood samples from healthy volunteers and71AP patients (MAP n=30, SAP n=30) within2h after admission. Selected blood samples according to the2004criteria and then60cases were allowed. Furthermore, AP patients were classified as mild AP group (MAP, n=30) and severe AP (SAP, n=30) according to the criteria. Quantitate the levels of EPCs, TNF-a, CRP, FIB and WBC by flow cytometry and other laboratory technique. Correlations among the five markers were analyzed using Spearman’s rank correlation.Part2Based on the Part1that there were significant differences of the level of EPCs, TNF-a, CRP, FIB and WBC among healthy volunteers, MAP group and SAP group, we constructed the Receiver operating characteristic (ROC) curve to evaluate the diagnostic value of the five markers. The main references were the area under the curve (AUC) and Youden Index (YI).Results:(1) We obtained20cases of blood samples from healthy volunteers and60cases of AP patients within2h after admission. There were classified into MAP group (n=30) and SAP group (n=30).(2) Results showed that there were significant differences levels of TNF-a, WBC, FIB, and CRP in healthy volunteers, MAP and SAP groups (p<0.05, all). Interestingly, the level of EPCs was higher in the SAP than MAP group (P<O.01), but there was no significant difference between the MAP group and healthy volunteers (P>0.05).(3) We observed a positive relation between EPCs and the other four markers in MAP group and SAP group.(4) Take the SAP group as positive and the MAP group as negative, we got the ROC curve. According to area under the curve (AUC), EPCs and CRP were optimal predictive markers of SAP. When the cutoff-point for EPCs was2.26%, the sensitivity and the specificity of EPCs were90.0%and83.3%, respectively. Although, CRP had the highest specificity (96.7%), EPCs had the highest sensitivity (90.0%) and highest AUC value (0.93) of the five markers. EPCs combine with CRP will improve the diagnostic value of SAP according to YI value.Conclusions:(1) There are significant differences levels of TNF-a, WBC, FIB, and CRP in healthy volunteers, MAP and SAP groups, while the level of EPCs is higher in the SAP than MAP group but there is no significant difference between the MAP group and healthy volunteers.(2) Data suggest that EPCs and CRP are optimal predictive markers of SAP. EPCs may be a new potential marker to predict SAP at the early stage.