急性胰腺炎患者早期凝血功能及血管内皮功能检测及临床意义
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摘要
[目的]探讨急性胰腺炎患者早期凝血功能及血管内皮功能变化及其临床意义。[方法]选择2016年5月～2018年5月于本院就诊的急性胰腺炎(AP)患者作为研究对象,发病时间均<24 h,根据相关分类诊断标准,将纳入患者分为轻症AP(MAP)与重症AP(SAP)2组,其中MAP患者59例,SAP患者51例,另选择同期于我院体检的健康人员50例作为正常对照组(NC)。比较各组凝血功能、血管内皮功能及炎症因子变化,并分析其与急性生理与慢性健康评分Ⅱ(APACHEⅡ)的相关性。[结果]在凝血功能方面,NC组与MAP组的凝血酶原时间(PT)、纤维蛋白原浓度(FIB)、D-二聚体(D-dimer)和部分活化凝血酶原时间(APTT)比较,差异无统计学意义(P>0.05);SAP组患者的PT、APTT、FIB、D-Dimer均明显高于NC组与MAP组,差异有统计学意义(P<0.05)。在血管内皮功能方面,NC组与MAP组的反应性充血指数(RHI)差异无统计学意义(P>0.05);SAP组的RHI明显低于NC组与MAP组,差异有统计学意义(P<0.05);3组增强指数(AI)的差异无统计学意义(P>0.05)。在炎症因子方面,NC组与MAP组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)比较,差异无统计学意义(P>0.05);SAP组患者的IL-6、TNF-α均明显高于NC组与MAP组,差异有统计学意义(P<0.05)。在APACHEⅡ评分方面,SAP组高于MAP组,差异有统计学意义(P<0.05)。Pearson相关分析显示,MAP组患者的PT、APTT、FIB、D-Dimer、RHI、IL-6、TNF-α与APACHEⅡ评分无相关性(P>0.05);SAP组患者的PT、APTT、FIB、D-Dimer、IL-6、TNF-α与APACHEⅡ评分呈正相关(r=0.49、0.61、0.32、0.37;P<0.05);RHI与APACHEⅡ评分呈负相关(r=-0.27;P<0.05)。[结论]MAP患者凝血功能与血管内皮功能基本正常,而SAP患者出现凝血功能与血管内皮功能异常,且与患者严重程度具有相关性。观察AP患者的凝血功能与血管内皮功能指标变化,有助于判断患者严重程度与评估预后。
[Objective]To investigate the changes of coagulation function and vascular endothelial function in patients with acute pancreatitis at early stage and their clinical significance.[Methods]Patients with acute pancreatitis admitted to our hospital from May 2016 to May 2018 were selected as the research objects and the onset time were less than 24 hours. According to the relevant diagnostic criteria, the included patients were divided into two groups: mild AP(MAP) and severe AP(SAP), with 59 cases in MAP group and 51 patients in SAP group. In addition, 50 healthy people who underwent physical examination in our hospital in the same period were selected as the normal control group(NC). We compared the coagulation function, vascular endothelial function and inflammatory factor changes, and analyzed the relevance between these indicators and the acute physiology and chronic health evaluationⅡ(APACHEⅡ). [Results]In terms of coagulation function, there was no significant difference between the NC group and the MAP group(P>0.05).The PT, APTT, FIB and D-Dimer of SAP group were significantly higher than those of NC group and MAP group, and the difference was statistically significant(P<0.05). In terms of vascular endothelial function, there was no significant difference in RHI between NC group and MAP group(P>0.05).The RHI of SAP group was significantly lower than that of NC group and MAP group, and the difference was statistically significant(P<0.05).There was no statistically significant difference in AI between the three groups(P>0.05). In terms of inflammatory factors, there was no significant difference in IL-6 and TNF-α between NC group and MAP group(P>0.05). IL-6 and TNF-α in SAP group were significantly higher than those in NC group and MAP group, and the difference was statistically significant(P<0.05). The APACHEⅡ scoring of SAP group was higher than MAP, with statistically significant difference(P<0.05). Pearson correlation analysis showed that there was no relevance between PT, APTT, FIB, D-Dimer, RHI, IL-6, TNF-αand APACHEⅡin MAP group(P> 0.05). In SAP group, the PT, APTT, FIB, D-Dimer, IL-6, TNF-αwith APACHEⅡ scores were positively correlated(r=0.49, 0.61, 0.32, 0.37;P<0.05), and the RHI was negatively correlated with APACHEⅡ score(r=-0.27;P<0.05). [Conclusion]The coagulation function and vascular endothelial function were basically normal in MAP patients, while those indicators were abnormal in SAP patients, which were correlated with the severity of the patients. Observation of the changes of coagulation function and vascular endothelial function indexes in AP patients can help to estimate the severity of patients and evaluate the prognosis.
[Objective]To investigate the changes of coagulation function and vascular endothelial function in patients with acute pancreatitis at early stage and their clinical significance.[Methods]Patients with acute pancreatitis admitted to our hospital from May 2016 to May 2018 were selected as the research objects and the onset time were less than 24 hours. According to the relevant diagnostic criteria, the included patients were divided into two groups: mild AP(MAP) and severe AP(SAP), with 59 cases in MAP group and 51 patients in SAP group. In addition, 50 healthy people who underwent physical examination in our hospital in the same period were selected as the normal control group(NC). We compared the coagulation function, vascular endothelial function and inflammatory factor changes, and analyzed the relevance between these indicators and the acute physiology and chronic health evaluationⅡ(APACHEⅡ). [Results]In terms of coagulation function, there was no significant difference between the NC group and the MAP group(P>0.05).The PT, APTT, FIB and D-Dimer of SAP group were significantly higher than those of NC group and MAP group, and the difference was statistically significant(P<0.05). In terms of vascular endothelial function, there was no significant difference in RHI between NC group and MAP group(P>0.05).The RHI of SAP group was significantly lower than that of NC group and MAP group, and the difference was statistically significant(P<0.05).There was no statistically significant difference in AI between the three groups(P>0.05). In terms of inflammatory factors, there was no significant difference in IL-6 and TNF-α between NC group and MAP group(P>0.05). IL-6 and TNF-α in SAP group were significantly higher than those in NC group and MAP group, and the difference was statistically significant(P<0.05). The APACHEⅡ scoring of SAP group was higher than MAP, with statistically significant difference(P<0.05). Pearson correlation analysis showed that there was no relevance between PT, APTT, FIB, D-Dimer, RHI, IL-6, TNF-αand APACHEⅡin MAP group(P> 0.05). In SAP group, the PT, APTT, FIB, D-Dimer, IL-6, TNF-αwith APACHEⅡ scores were positively correlated(r=0.49, 0.61, 0.32, 0.37;P<0.05), and the RHI was negatively correlated with APACHEⅡ score(r=-0.27;P<0.05). [Conclusion]The coagulation function and vascular endothelial function were basically normal in MAP patients, while those indicators were abnormal in SAP patients, which were correlated with the severity of the patients. Observation of the changes of coagulation function and vascular endothelial function indexes in AP patients can help to estimate the severity of patients and evaluate the prognosis.
引文
[1] 吴璟奕,费健,毛恩强.急性胰腺炎流行病学的研究进展[J].外科理论与实践,2015,20(3):270-273.
[2] Yeung YP,Lam B YK,Yip AWC.APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis[J].Hep PancreDise Int,2006,5(2):294-299.
[3] 王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[4] 李建洪.急性重症胰腺炎的诊断与治疗[J].中外医疗,2016,35(15):42-44.
[5] Cuthbertson CM,Christophi C.Disturbances of the microcirculation in acute pancreatitis[J].Bri J Surg,2010,93(5):518-530.
[6] 段培林.凝血功能对急性胰腺炎预后的评估[J].内科急危重症杂志,2016,22(5):361-361.
[7] 李永顺.凝血联合纤溶功能检测在急性胰腺炎中的临床应用[J].浙江临床医学,2012,14(3):273-275.
[8] 韩传操.凝血功能检测及其临床意义的探讨[J].徐州医学院学报,2007,27(2):124-125.
[9] 屠燕钗,黄国永,张小妹,等.纤维蛋白原浓度对机采血小板聚集功能的影响[J].临床血液学杂志,2010,23(5):580-581.
[10] 龚志刚,丁世芳,李志刚.炎症和氧化应激对内皮祖细胞动员及其功能的影响[J].中国组织化学与细胞化学杂志,2013,22(6):552-556.
[11] 何姗姗,王晓燕,赵英帅,等.冠心病患者冠状动脉病变程度与血清胱抑素C及内皮功能相关性分析[J].重庆医学,2017,46(1):64-67.
[2] Yeung YP,Lam B YK,Yip AWC.APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis[J].Hep PancreDise Int,2006,5(2):294-299.
[3] 王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[4] 李建洪.急性重症胰腺炎的诊断与治疗[J].中外医疗,2016,35(15):42-44.
[5] Cuthbertson CM,Christophi C.Disturbances of the microcirculation in acute pancreatitis[J].Bri J Surg,2010,93(5):518-530.
[6] 段培林.凝血功能对急性胰腺炎预后的评估[J].内科急危重症杂志,2016,22(5):361-361.
[7] 李永顺.凝血联合纤溶功能检测在急性胰腺炎中的临床应用[J].浙江临床医学,2012,14(3):273-275.
[8] 韩传操.凝血功能检测及其临床意义的探讨[J].徐州医学院学报,2007,27(2):124-125.
[9] 屠燕钗,黄国永,张小妹,等.纤维蛋白原浓度对机采血小板聚集功能的影响[J].临床血液学杂志,2010,23(5):580-581.
[10] 龚志刚,丁世芳,李志刚.炎症和氧化应激对内皮祖细胞动员及其功能的影响[J].中国组织化学与细胞化学杂志,2013,22(6):552-556.
[11] 何姗姗,王晓燕,赵英帅,等.冠心病患者冠状动脉病变程度与血清胱抑素C及内皮功能相关性分析[J].重庆医学,2017,46(1):64-67.