D-二聚体对重症急性胰腺炎预后预测的价值  

Value of D-dimer to the prognosis of severe acute pancreatitis

作　　者：邓会标 朱涛[2] 周道扬[2] 

机构地区：[1]杭州市下沙医院ICU,浙江杭州310018 [2]浙江大学医学院附属邵逸夫医院ICU

出　　处：《全科医学临床与教育》2015年第6期626-628,642,共4页Clinical Education of General Practice

基　　金：浙江省教育厅科研基金资助项目(YZ201226217)

摘　　要：目的评价血浆D-二聚体对重症急性胰腺炎患者预后判断的意义。方法选择95例重症急性胰腺炎患者,分为死亡组和存活组,比较两组患者入ICU即刻和24 h血浆D-二聚体水平、24 h APACHEⅡ评分、ICU时间、住院总时间、胰腺感染率、外科手术率等。用受试者操作特征曲线(ROC)评价D-二聚体和APACHEⅡ评分预后评价的准确性,分析入ICU 24 h血浆D-二聚体与APACHEⅡ评分的相关性。结果死亡组患者入ICU时CRP、IAH、24 h APACHEⅡ评分及住ICU时间、住院总时间、胰腺感染率、外科手术率均高于存活组患者(t分别=6.57、7.34、4.38、11.56、9.61,χ2分别=7.36、8.21,P均<0.05)。死亡组患者入ICU即刻的血浆D-二聚体水平及入ICU 24 h的血浆D-二聚体水平均明显高于存活组(t分别=7.86、9.37,P均<0.05)。入ICU即刻血浆D-二聚体、入ICU 24 h血浆D-二聚体水平及24 h APACHEⅡ评分预后评价的ROC曲线下面积分别是0.75、0.86和0.92。入ICU 24 h血浆D-二聚体水平与24 h APACHEⅡ评分成正相关性(r=0.78,P<0.05)。结论动态监测重症急性胰腺炎患者血浆D-二聚体水平,可以作为预后评价的指标之一;入ICU 24h血浆D-二聚体水平可以更好地反映患者病情严重程度。Objective To investigate the value of D-dimer to the prognosis of severe acute pancreatitis. Methods A total of 95 patients with severe acute pancreatitis were selected and divided into death group and survival group. The plasma D-dimer level of hospitalized ICU and 24 hours after admission, the acute physiology and chronic health evaluation （APACHE） Ⅱ score of 24 hours, ICU duration, hospitalized duration, pancreatic infection rate, surgical rate were compared. The value of D-dimer and APACHE Ⅱ score to predict the prognostic were evaluated by receiver operating characteristic （ROC） curves. The correlation between 24 hours after admission and APACHE Ⅱ scores was analyzed. Results The levels of C-reactive protein （CRP）, intra- abdominal hypertension （IAH）, scores of APACHE Ⅱ, ICU duration, hospitalized duration, pancreatic infection rate, surgical rate in death group were significantly higher than those in survival group （t=6.57, 7.34 , 4.38, 11.56, 9.61,χ2=7.36, 8.21, P〈0.05）. The plasma D-dimer level of hospitalized ICU and 24 hours after admission in death group were significantly higher than those in survival group （t=7.86, 9.37, P〈0.05）. The area under ROC curve of D-dimer level of hospitalized ICU, 24 hours after admission and the APACHE Ⅱscore of 24 hours were 0.75, 0.86, 0.92 respectively. The plasms D-dimer level of 24 hours after admission was positively correlated with APACHE Ⅱ scores of 24 hours after adimission with SAP （r=0.78,P〈0.05）. Conclusion Dynamic observation of D-dimer can be as one of the indexes for predicting the prognosis of patients with SAP. The 24 hours plasma concentration of D-dimer of SAP can reflect severity of patient＇s condition better.

关 键 词：D-二聚体 重症急性胰腺炎 预后价值 

分 类 号：R576[医药卫生—消化系统]