降钙素原在急性胰腺炎病情判断中的意义  

Significance of procalcitonin in judgment of disease situation of acute pancreatitis

作　　者：高艳霞[1] 李莉[1] 李毅[3] 于学忠[3] 孙同文[2] 兰超[2] 

机构地区：[1]郑州大学第一附属医院急诊科,河南郑州450052 [2]郑州大学第一附属医院综合ICU,河南郑州450052 [3]北京协和医院急诊科,北京100730

出　　处：《中国中西医结合急救杂志》2014年第3期201-204,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家临床重点专科建设项目（2012-649;2012-650）;河南省卫生科技创新型人才工程（豫卫科2010～52）

摘　　要：目的探讨降钙素原（PCT）在急性胰腺炎（AP）病情严重程度判断中的意义。方法采用前瞻性研究方法，选择2013年4月至12月郑州大学第一附属医院收治的AP患者98例，按病情严重程度分为轻型胰腺炎（MAP）48例和重症急性胰腺炎（SAP）50例；依据病因分为胆源性AP（58例）和非胆源性AP（40例），再按照病情严重程度分为胆源性SAP组、胆源性MAP组、非胆源性SAP组、非胆源性MAP组。检测各组患者入院后1d、2d静脉血PCT水平，并评价PCT与Ranson评分、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、CT分级、器官衰竭数目、重症监护病房（ICU）住院时间、总住院时间的相关性。结果入院后2d不同病因、不同病情严重程度各组PCT水平均较1d时升高，且SAP组明显高于MAP组[3，723（2．538，9．023）比0．282（0．166，1．348），P〈0．01]，胆源性AP组高于非胆源性AP组[2．567（1．483，8．412）比2．391（1．262，7．453），P〉O．05]，胆源性SAP组高于胆源性MAP组升高[4．023（3．273，10．015）比0．305（0．244，1．413），P〈0．01]，非胆源性SAP组高于非胆源性MAP组[3．624（2．454，8．993）比0．256（0．144，1．137），P〈0．01]。入院1d和2d PCT与Ranson评分[相对危险度（RR1）=0．643，P．=0．001，95％可信区间（95％CI1）为0．435～1．596；RR2=0．762，P，=0．001，95％CI2为0．692～1．541]、APACHEⅡ评分（RR1=0．543，P1=0．009，95％CI1为0．842～1．512；RR2=0．672．P2=0．001，95％CI2为0．747～1．234）、CT分级（RR1=0．231，P1=0．048，95％CI1为0．596～1．412；RR2=0．256，P2=0．032，95％CI2为0．702～1．324）均呈正相关；器官衰竭数目越多，其PCT越高（RR1=0．321，P1=0．023，95％CI1为0．763～2．588；RR2=0．389，P2=0．020，95％CI2为0．683～1．742）；PCT还与ICU住院时间有较好的相关性（RR1=0．423，P1=0．019，95％CI1为Objective To approach the significance of proealcitonin （PCT） in judgment of the degree of severity in patients with acute pancreatitis （AP）. Methods A prospective method was conducted in the study. Ninety-eight patients with AP admitted from April 2013 to December 2013 in the First Affiliated Hospital of Zhengzhou University were enrolled. They were divided into mild AP （MAP, 48 cases） and severe AP （SAP, 50 cases） groups, biliary AP （58 cases） and non biliary AP （40 cases） groups, and biliary SAP and biliary MAP groups, non biliary SAP and non biliary MAP groups. The venous blood levels of PCT on the first day and second day after admission were assayed for all the patients, and the correlations between PCT levels on tbe two time points respectively and each of the following items were calculated ： Ranson score, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ ） score, CT grade, number of organ dysfunction, intensive care unit （ICU） time of stay and total time of hospitalization. Results On the second day after admission, the PCT levels in groups different in etiology and groups different in severity were all elevated and higher than those on the first day, the level in SAP group being significantly higher than that of MAP group [ 3.723 （2.538, 9.023 ） vs. 0.282 （0.166, 1.348）, P〈 0.011, the level in biliary AP group being higher than that in non biliary AP group [2.567 （1.483,8.412） vs. 2.391 （ 1.262,7.453 ）, P〉 0.051, the level in biliary SAP group being higher than that in biliary MAP group [4.023 （3.273,10.015） vs. 0.305 （0.244,1.413）, P〈0.011, and the level in non biliary SAP group being higher than that in non biliary MAP group [ 3.624 （2.454,8.993） vs. 0.256 （0.144, 1.137）, P〈 0.011. The correlations between PCT levels on the first day and second day after admission and each of the following items were respectively as follows ： the correlations with RansoM score [ relative risk （RR1） =0.643, P1=0.001,95% confiden

关 键 词：急性胰腺炎 降钙素原 RANSON评分 急性生理学与慢性健康状况评分系统Ⅱ评分 

分 类 号：R657.51[医药卫生—外科学]