Abstract：Objective: To explore the dynamic changes of serum angiotensin-converting enzyme 2 (ACE2) and interleukin-18 (IL-18) in patients with severe acute pancreatitis (SAP) and their clinical values. Methods: A total of 150 SAP patients from January 2021 to December 2024 were prospectively selected as the research objects and recorded as the SAP group. Meanwhile, 150 healthy volunteers who underwent physical examinations in our hospital during the same period were selected as the control group. According to the prognosis of SAP patients, they were divided into the good prognosis group (n=107) and the poor prognosis group (n=43). The levels of serum ACE2 and IL-18 were detected by enzyme-linked immunosorbent assay (ELISA). The Bedside Index of Severity in Acute Pancreatitis (BISAP) score, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and the Ranson score were used to evaluate the disease severity of SAP patients. Pearson correlation analysis was performed to analyze the correlation between the levels of ACE2 and IL-18 and the severity of SAP. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the levels of ACE2 and IL-18 for the poor prognosis of SAP patients, and Z-test was used to compare the differences in the area under the curve (AUC). Results: Compared with the control group, the level of ACE2 (on the first day) in the SAP group was lower, while the level of IL-18 (on the first day) was higher (P<0.05). On the 1st, 3rd, and 7th days after admission, the levels of ACE2 in SAP patients gradually increased, while the levels of IL-18 gradually decreased (P<0.05). The BISAP score, APACHE Ⅱ score, and Ranson score in the poor prognosis group were all higher than those in the good prognosis group (P<0.05). On the 1st, 3rd, and 7th days after admission, the levels of ACE2 in the poor prognosis group were lower than those in the good prognosis group, and the levels of IL-18 were higher than those in the good prognosis group. Meanwhile, the serum levels of ACE2 in both groups gradually increased, and the levels of IL-18 gradually decreased (P<0.05). In the early stage of the disease (on the first day), the level of ACE2 was negatively correlated with the BISAP score, APACHE Ⅱ score, and Ranson score, while the level of IL-18 was positively correlated with the BISAP score, APACHE Ⅱ score, and Ranson score (P<0.05). In the early stage of the disease, the AUC of the combined prediction of the poor prognosis of SAP patients by ACE2 and IL-18 was 0.882, which was better than that of the individual detection (0.744, 0.761) (all P<0.05). Conclusion: The level of ACE2 in SAP patients is relatively low and gradually increases with the extension of treatment time, while the level of IL-18 is relatively high and gradually decreases with the extension of treatment time. Both are correlated with the disease severity. The combined prediction of the poor prognosis of SAP patients has certain clinical value and provides an effective reference for the prognosis evaluation of patients.
刘生熠, 姚婷, 顾志毅, 姚浩, 李龙. 重症急性胰腺炎患者血清ACE2 IL-18的动态变化及临床价值[J]. 河北医学, 2025, 31(11): 1874-1879.
LIU Shengyi, YAO Ting, GU Zhiyi, et al. The Clinical Values and Dynamic Changes of Serum ACE2 and IL-18 in Patients with Severe Acute Pancreatitis. HeBei Med, 2025, 31(11): 1874-1879.
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2025, Vol. 31 
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