ANXA2、ACE2动态变化对儿童急性胰腺炎预后的增益价值OA

Objective To investigate the incremental value of dynamic changes in serum annexin A2(ANXA2),angiotensin-converting enzyme 2(ACE2),and autophagy related gene 7(ATG7)in prognostic prediction models for children with acute pancreatitis(AP).Methods A total of 212 children with AP admitted to Hainan Women And Children's Medical Center between January 2020 and March 2025 were enrolled.According to the 30-day prognosis after admission,the patients were divided into a poor prognosis group(n=51)and a good prognosis group(n=161).General clinical data and serum levels of ANXA2,ACE2,and ATG7 at admission and 7 days after admission were collected.The changes in these biomarkers(Δ)were calculated and compared between the two groups.Multivariate Logistic regression analysis was performed to identify independent factors associated with poor prognosis.A conventional prediction model(Model 1)and an incremental model incorporating ΔANXA2 and ΔACE2(Model 2)were established.The predictive performance of the two models was evaluated using receiver operating characteristic(ROC)curves and compared by the DeLong test.Results At admission,the poor prognosis group had significantly higher acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores and higher levels of Interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)than the good prognosis group(t=6.564,5.303,and 6.653,respectively,P<0.05).Both at admission and 7 days after admission,serum ANXA2 and ATG7 levels were significantly higher,whereas ACE2 levels were significantly lower in the poor prognosis group than in the good prognosis group(t=2.119-8.582,all P<0.05).The changes in ANXA2(ΔANXA2),ACE2(ΔACE2),and ATG7(ΔATG7)were all significantly smaller in the poor prognosis group than in the good prognosis group(t=6.297-10.393,all P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡ score(OR=1.283,95%CI:1.123-1.465),IL-6(OR=1.237,95%CI:1.107-1.382),and TNF-α(OR=1.312,95%CI:1.135-1.516)were independent risk factors for poor prognosis,whereas ΔANXA2(OR=0.878,95%CI:0.832-0.927)and ΔACE2(OR=0.858,95%CI:0.815-0.903)were independent protective factors(all P<0.05).ΔATG7 was not retained in the final model.The areas under the ROC curve(AUC)of ΔANXA2 and ΔACE2 for predicting poor prognosis were 0.767 and 0.772,respectively(both P<0.05).The AUC of Model 2(0.931)was significantly higher than that of Model 1(0.857)(Z=2.014,P=0.036).Conclusion Dynamic changes in serum ANXA2 and ACE2 levels between admission and 7 days after admission are closely associated with the prognosis of children with acute pancreatitis.Both ΔANXA2 and ΔACE2 independently predict poor prognosis,and their incorporation into a conventional prediction model significantly improves its predictive performance.