摘要
背景:急性胰腺炎(acute pancreatitis,AP)是临床常见的消化系统急症,近年来发病率不断上升,特别是重症胰腺炎(severe acute pancreatitis,SAP)病死率仍在20%-30%以上,依然是一种较为凶险的疾病。而早期预测和正确评估急性胰腺炎的严重程度,避免轻症急性胰腺炎(mild acute pancreatitis,MAP)向SAP的转化,在临床工作中就显得尤为重要。另外,急性胰腺炎发病机制还不是完全清楚,现认为其存在凝血纤溶功能的紊乱,该紊乱可导致胰腺循环紊乱,更加重胰腺炎。凝血功能紊乱与胰腺炎严重度密切相关,有报道用抗凝治疗改善了急性胰腺炎的严重度。抗凝治疗可能是急性胰腺炎治疗的方法之一。目前虽有报道急性胰腺炎时凝血功能变化的研究,但没有将急性胰腺炎严重度指标与凝血功能障碍做相关研究。
目的:了解急性胰腺炎严重度指标:APACHEⅡ评分、Ranson评分、BalthazarCT评分与凝血功能障碍的相关关系。评价凝血纤溶指标:凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原浓度(Fib)和D-二聚体(D-dimer)的变化与急性胰腺炎轻重程度的关系及其对急性胰腺炎轻重症分型的早期预测价值。
方法:选取2006-2007年期间在大连医科大学第一附属医院第一次住院治疗的急性胰腺炎病人34例,男性16例,女性18例,年龄最小20岁,最大81岁,排除抗凝药物的影响。根据APACHEⅡ评分及Ranson评分将急性胰腺炎患者分成轻,重两型。轻型22例,重型12例。设正常对照组11例,都为体检合格者。用“免疫散射比浊法”,采用全自动血凝仪于入院24h内检测PT、APTT、Fib和D-dimer。入院第一日行CT检查,对急性胰腺炎组及对照组行APACHEⅡ评分、Ranson评分及CT评分,急性胰腺炎组各评分与PT、APTT、Fib、D-dimer之间进行相关分析。数据在SPSS11.5上进行统计分析。
结果:SAP组各项评分与MAP组,正常对照组相比较,差异有显著意义(P <0.05);MAP组APACHEⅡ评分及CT评分与对照组比较,差异有显著意义(P<0.05);MAP组PT、APTT、和D-dimer与对照组相比,差异无显著意义(P>0.05);MAP组Fib与对照组相比,差异有显著意义(P<0.05);SAP组患者的Fib和D-dimer与MAP组,正常对照组相比较,差异有显著意义(P<0.05)。急性胰腺炎APACHEⅡ评分、Ranson评分和Balathazar CT评分与Fib ,D-dimer值成直线相关关系。
结论:急性胰腺炎APACHEⅡ评分、Ranson评分、Balthazar CT评分与Fib,D-dimer值成直线相关关系。Fib、D-dimer是早期评价急性胰腺炎十分有意义的实验指标,监测Fib、D-dimer值能早期判断评估急性胰腺炎的严重程度及预后。
Background: Acute pancreatitis(AP) is one of most common diseases in alimentary system emergency case. The morbidity has continued to rise in recent years, particularly the mortality of severe acute pancreatitis are still more than 20%-30%,Acute pancreatitis remains a more dangerous disease. So the early predict and correctly assess the severity of acute pancreatitis, Which is particularly important to avoid the transformation from mild acute pancreatitis to serious acute pancreatitis in clinical work. Otherwise, It can,not completely understand the pathogenesy of AP. Now it,s believed that it has the disorder of the coagulating function is really exist. the disorder can make the pancreatitis more serious. It is reported that the anticoagulant therapy improves the situation of AP and it is possible one of methods of the anticoagulant therapy. although the research of coagulation disorder of AP had be reported. But there haven,t the record of the research about the correlation between therapy based on pathological nature severity index of AP and coagulation disorders.
Objective: To find out the relations between the severity of acute pancreatitis and the change of blood coagulation system in acute pancreatitis. To evaluate the relations between Acute physiology and chronic health evaluation(APACHEⅡ)score, Ranson evaluation score, Balthazar computed tomography(CT)score and the changes of Prothrombin time(PT),partially activited Thromboplastin time(APTT), Fibrinogen(Fib ) and D-dimer with pancreatitis.
Methods: We collected 34 cases of AP admitted to First Hospital of dalian Medicial, University from year 2006 to year 2007, 16 males and 18 females, aged between 20 and 81. The effect of anticoagulant was depleted. According to APACHE evaluationⅡscore and Ranson evaluation score divided it into two types: mild acutepancreatitis (MAP) 22 cases and severe acute pancreatitis (SAP) 12 cases. Normal control 11 cases. PT, APTT,Fib and D-dimer of 33 patients in Ap and normal control group were detected By full automatic blood coagulation analyzer. Results in within the initial 24hours of hospitalization. PT, APTT,Fib and D-dimer were measured with nephelomitermeusure method. meanwhile, a CT examination is made within the initial 24hours of hospitalizaion. To record their APACHEⅡscore, Ranson score and CT score Within the initial 24hours of hospitalization. As well as to make correlation analysis with PT、Fib、APTT、D-dimer. SPSS 11.5 statistic software was used to analyze the role of their abnormal expressions in AP.
Results:There was statistical difference which in severity score of AP between SAP group and mild MAP group and NC group(P<0.05). there was statistical difference which in severity score of APACHEⅡ、Ranson between MAP group and NC group(P<0.05).Fib in MAP group was significant difference compared with NC group(P<0.05);But PT,APTT, D-dimer in MAP group was not significant difference compared with NC group(P>0.05).Fib , D-dimer in SAP group was significant differences compared with NC group and MAP group(P<0.05).The correlativity of APACHEⅡevaluation score, Ranson evaluation score, CT score and Fib, D-dimer in AP is linear.
Conclusion:The correlativity of APACHEⅡevaluation score, Ranson score ,CT score and Fib, D-dimer in AP is linear. D-dimer and Fibrinogen is very significance experiment index which early estimate the severity of AP. Monitoring the levels of D-dimer and Fibrinogen may be very useful in the evaluation of the severity and prognosis of AP.
引文
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