| Objective To investigate the value of abdominal plain CT combined with se rological markers Intestinal fatty acid-binding proteins(I-FABP)and Ischemia modified albumin(IMA)in the early diagnosis of strangulated intestinal obstruction,in order to provide a basis for the early diagnosis of strangulated intestinal obstruction.Method According to the inclusion and exclusion criteria,patients with acute intestinal obstruction admitted to the general surgery department of Baotou Central hospital from December 2021 to December 2022 were collected as the research objects.A total of 108 patients were enrolled,including 78 cases of simple intestinal obstruction(simple group)and 30 cases of strangulated intestinal obstruction(strangulated group).The simple group was the control group,and the strangulated group was the experimental group.The strangulated group was divided into two subgroups,including 16 cases of strangulated necrosis group and14 cases of strangulated non-necrotic group.Serological intestinal fatty acid binding protein(I-FABP)and ischemia modified albumin(IMA)were detected and the expression differences between groups were analyzed and compared by interpreting CT signs.Result 1.The indexes of lactic acid(LA)and procalcitonin(PCT)in the strangulation group were significantly higher than those in the simple group.There was no significant difference in D-dimer(DD),neutrophil / lymphocyte(NLR)and platelet / lymphocyte(PLR)between the two groups.2.The differences in I-FABP and IMA indexes were statistically significant(P<0.05),and both were significantly higher in the strangulated group than in the simple group.In the strangulated intestinal obstruction subgroup,I-FABP was significantly higher in the strangulated necrosis group than in the strangulated non-necrosis group,and the difference was statistically significant(P<0.05).3.There were statistically significant differences(P<0.05)between the mesenteric effusion sign and the intestinal wall density increase sign(CT value≥50),and both were significantly higher in the strangulated group than in the simple group,and the percentage of positive mesenteric effusion sign was significantly higher in the strangulated necrosis group than in the strangulated nonnecrosis group when comparing between subgroups of the strangulated group.The differences in ascites sign,bird’s beak sign and intestinal wall thickening sign were not statistically significant when comparing between the two groups(P>0.05).4.IFABP,IMA,mesenteric effusion sign and intestinal wall density increased sign(CT value ≥ 50)were positively correlated with strangulated intestinal obstruction,and were independent risk factors for strangulated intestinal obstruction(OR > 1).The probability of strangulated intestinal obstruction in patients with increased1pg/m L in I-FABP increased by 0.004 times(OR=1.004),and the probability of strangulated intestinal obstruction in patients with increased 1U/m L in IMA increased by 0.041 times(OR=1.041).The probability of strangulated intestinal obstruction in patients with mesenteric effusion sign was 7.609 times higher than that in patients without mesenteric effusion sign(OR=7.609).The probability of strangulated intestinal obstruction in patients with intestinal wall density increased sign(CT value ≥ 50)increased by 10.558 times(OR=11.558).However,lactic acid and procalcitonin were not independent influencing factors of strangulated intestinal obstruction(P < 0.05).5.The diagnostic index was 0.408 when the sensitivity was 93.3% and the specificity was 47.2%,and the diagnostic efficacy was better,with a cut-off point of 1114.390 pg/m L for I-FABP.The diagnostic index was 0.546 when the sensitivity was 70.0% and the specificity was 84.6%,and the diagnostic efficacy was better,with a cut-off point of 112.395 U/m L for IMA.6.I-FABP,IMA,mesenteric effusion sign,and intestinal wall density increased sign(CT value ≥ 50),the area under the ROC curve of the combined index of these four indicators was 0.893,standard error 0.037,P=0.000,95%confidence interval(0.821-0.964),diagnostic index = sensitivity-(1-specificity),and the maximum value of diagnostic index was selected as the diagnostic cut-off point.The maximum diagnostic index was 0.695 when the sensitivity was 90.0%and the specificity was 79.5%,and the diagnostic efficacy was better.Conclusion 1.I-FABP and IMA are effective biological indicators for the diagnosis of strangulated intestinal obstruction.2.I-FABP and mesenteric effusion sign have a guiding role in determining the severity of acute intestinal obstruction.3.Mesenteric effusion sign and intestinal wall density increase sign(CT value ≥50)are suggestive of strangulated intestinal obstruction.4.The combination of four indicators,I-FABP,IMA,mesenteric effusion sign and intestinal wall densit y increase sign(CT value ≥50),is more helpful for the determination of strangulated intestinal obstruction,and is better than the diagnosis of the four indicators alone. |
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