重症急性胰腺炎的血浆TFPI水平和诊断价值  

Diagnostic value of plasma tissue factor pathway inhibitor in patients with severe acute pancreatitis

作　　者：陈荣剑 宋景春 许永春 朱洪亮 陈自力 钱红军 林青伟 

机构地区：[1]解放军94医院普外科,南昌330002 [2]解放军94医院重症医学科,南昌330002 [3]解放军94医院消化内科,南昌330002

出　　处：《军事医学》2015年第8期626-628,F0003,共4页Military Medical Sciences

基　　金：南京军区重点科技创新项目(2013ZD22);江西省卫计委科技计划课题(20133233)

摘　　要：目的检测急性胰腺炎（acute pancreatitis,AP）患者血浆组织因子途径抑制剂（tissue factor pathway inhibitor,TFPI）水平,并评价其诊断重症急性胰腺炎（severe acute pancreatitis,SAP）的临床价值。方法取68名急性胰腺炎患者,包括SAP患者32例,轻型急性胰腺炎（mild acute pancreatitis,MAP）患者36例;另取同期门诊体检者20例为对照,均入院1 h内抽血样,收集临床及实验室参数,计算APACHEⅡ评分和Ranson评分;采用酶联免疫吸附测定（ELISA）方法检测血浆TFPI水平。结果 MAP组患者血浆TFPI浓度[（3026.81±465.76）pg/ml]较对照组明显升高[（2468.73±262.39）pg/ml]（P〈0.05）,SAP患者血浆TFPI浓度[（4274.25±639.83）pg/ml]较MAP组明显升高（P〈0.05）。相关分析显示,AP患者的血浆TFPI水平与白细胞计数（WBC）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、肌酐（Cr）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、降钙素原（PCT）、APACHEⅡ评分和Ranson评分呈显著正相关（P〈0.05）,与PLT呈显著负相关（P〈0.05）。ROC曲线图分析显示,血浆TFPI水平诊断SAP发生的价值AUCSAP=0.902,95%CI=0.845-0.959（P〈0.05）,诊断界值为血浆TFPI浓度4028.83 pg/ml时,敏感度为87%,特异度为78%。结论 SAP患者的血浆TFPI水平可较正常人群和MAP患者显著升高,并与胰腺炎危重程度显著相关,可用于诊断SAP。Objective To examine the levels of plasma tissue factor pathway inhibitor （TFPI） in patients with acute pancreatitis （AP） to assess the clinical value of diagnosis for severe acute pancreatitis （SAP）. Methods Sixty-eight patients were divided into mild acute pancreatitis （MAP）group （n = 36） and SAP group （n = 32）, and twenty volunteers were chosen into normal group （ n = 20）. Clinical data of these patients were collected, including APACHE I1 score and Ranson score. Plasma levels of TFPI were measured by ELISA. Results The plasma levels of TFPI in SAP group, MAP group and control group were （4274.25 ±639.83） ,（3026.81 ±465.76） and （2468.73 ±262.39）pg/ml, respectively（P 〈 0.05）. There were significant positive correlations between TFPI and WBC, AST, ALT, TBIL, Cr, PT, APTT , PCT, APACHE Ⅱ score and Ranson score （ P 〈 0.05 ）. The area under the curve （AUC） of TFPI for SAP was 0.902 （ 95 % CI = 0.845 -0. 959, P 〈0.05 ）. The cutoff value was 4028.83 pg/ml for plasma TFPI with a sensitivity of 87% and a specificity of 78%. Conclusion Plasma levels of TFPI in patients with SAP are significantly increased, which maybe help diagnose SAP.

关 键 词：急性胰腺炎 重症 组织因子途径抑制物 血浆 诊断 

分 类 号：R576[医药卫生—消化系统]