血清M-CSF、ICAM-1对儿童腹部手术后发生肠粘连并发肠梗阻的预测价值OA

Objective To investigate the predictive value of serum macrophage colony-stimulating factor(M-CSF)and intercellular adhesion molecule-1(ICAM-1)levels for postoperative adhesive intestinal obstruction in children.Methods A total of 152 pediatric patients with intestinal adhesions after abdominal surgery who were admitted to the Department of General Surgery of the First Hospital of Hebei Medical University from January 2023 to June 2024 were enrolled.Based on imaging findings from upright abdominal radiographs,abdominal ultrasonography,and computed tomography(CT),patients were divided into an intestinal obstruction subgroup(n=50)and a non-obstruction subgroup(n=102).In addition,50 age-and sex-matched healthy children who underwent physical examinations during the same period were included as the healthy con-trol group.Fasting venous blood samples were collected from all participants,and serum levels of M-CSF and ICAM-1 were measured using enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was performed to evaluate the re-lationships between serum M-CSF and ICAM-1 levels and inflammatory indicators,including white blood cell(WBC)count,C-reactive protein(CRP),and procalcitonin(PCT).Multivariate logistic regression analysis was used to identify independent risk factors for postoperative adhesive intestinal obstruction.Receiver operating characteristic(ROC)curves were generated to assess the predictive performance of serum M-CSF and ICAM-1 levels.Results Serum M-CSF and ICAM-1 levels were significantly higher in the adhesive intestinal obstruction group than in the healthy control group(M-CSF:t=11.152,P＜0.001;ICAM-1:t=8.701,P＜0.001).The incidence of intestinal obstruction among the 152 patients with adhesions was 32.89％(50/152).The intestinal obstruction subgroup showed significantly higher WBC,CRP,and PCT levels compared with the non-ob-struction subgroup(WBC:t=13.816,P＜0.00l;CRP:t=34.123,P＜0.001;PCT:t=19.216,P＜0.001).Pearson correlation anal-ysis indicated that serum M-CSF levels were positively correlated with WBC(r=0.683,P=0.013),CRP(r=0.701,P=0.008),and PCT(r=0.782,P=0.027),while serum ICAM-1 levels were positively correlated with WBC(r=0.659,P=0.024),CRP(r=0.712,P=0.011),and PCT(r=0.747,P=0.003).Multivariate logistic regression analysis revealed that elevated WBC,CRP,and PCT levels were independent risk factors for postoperative adhesive intestinal obstruction[WBC:OR=1.317,95％CI(1.233-3.989);CRP:OR=2.429,95％CI(1.506-4.038);PCT:OR=1.103,95％CI(0.738-2.899)].The area under the ROC curve(AUC)for M-CSF,ICAM-1,and their combined detection in predicting adhesive intestinal obstruction was 0.694,0.752,and 0.820,respectively.The AUC of the combined detection was higher than that of either marker alone.Conclusion Serum M-CSF and ICAM-1 levels are elevated in children with postoperative adhesive intestinal obstruction and are associated with disease severity.Combined detection of these two biomarkers provides a higher predictive value for the occurrence of postop-erative adhesive intestinal obstruction than individual testing.