Clinical value of serum PAI-1 and TLR4 levels in predicting recurrence after seton placement for high-position complex anal fistulas
Li Yanna
Liu Yuhu
Sun Xingwei
Li Hong
Xiao Bin
Cao Kai
Liu Jingfeng
Abstract：Objective To investigate the clinical value of serum plasminogen activator inhibitor-1(PAI-1)and Toll-like recep-tor 4(TLR4)levels in predicting recurrence after seton placement for high-position complex anal fistulas.Methods A total of 110 patients with high-position complex anal fistulas treated with seton placement at Xi'an Hospital of Traditional Chinese Medicine from August 2022 to September 2023 were included in the study.The patients were followed for 12 months and assigned to a recurrence group(n=21)and a non-recurrence group(n=89)based on whether recurrence occurred during the follow-up period.Serum PAI-1 and TLR4 levels before surgery were measured using enzyme-linked immunosorbent as-say(ELISA).Receiver operating characteristic(ROC)curve analysis was used to assess the predictive value of serum PAI-1 and TLR4 levels for recurrence after seton placement.Multivariate logistic stepwise regression analysis was performed to explore the factors influencing recurrence after seton placement.Results The serum PAI-1 and TLR4 levels were signifi-cantly higher in the recurrence group than in the non-recurrence group(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)for the combined prediction of recurrence after seton placement by serum PAI-1 and TLR4 levels was 0.918(95％CI:0.868-0.963),which was higher than the AUC for PAI-1 alone(AUC=0.781,95％CI:0.736-0.831)and TLR4 alone(AUC=0.865,95％CI:0.820-0.915),and the differences were statistically significant(Z=9.075,11.742,P＜0.001).The recurrence group had a significantly higher proportion of patients with a history of smok-ing,previous fistula surgery,and unclear internal opening compared to the non-recurrence group(P＜0.05).Multivariate logistic stepwise regression analysis showed that a history of fistula surgery(OR=2.492,95％CI:1.371-4.530),un-clear internal opening(OR=2.354,95％CI:1.262-4.390),elevated PAI-1(OR=3.487,95％CI:1.929-6.302),and elevated TLR4(OR=3.238,95％CI:1.813-5.784)were independent risk factors for recurrence after seton place-ment for high-position complex anal fistulas(P＜0.05).Conclusion Serum PAI-1 and TLR4 levels are significantly elevat-ed in patients with recurrence after seton placement for high-position complex anal fistulas.Serum PAI-1 and TLR4 levels have high predictive value for recurrence,and combined testing of both can markedly promote predictive efficacy.
Keywords：Plasminogen activator inhibitor-1Toll-like receptor 4High-position complex anal fistulaRecurrencePredic-tive value
Publication Date：2025-09-20
Online Publishing Date：2026-01-06(First online date of this platform, not the publication date of the document)
Pages：7( 81-87 )