血糖、血浆D-二聚体和炎性因子在急性胰腺炎患者中的表达及与病情严重程度和预后的相关性分析  

Expressions of Blood Glucose,Plasma D-dimer and Inflammatory Factors in Patients with Acute Pancreatitis and Their Correlations with Severity and Prognosis of the Disease

作　　者：徐弋[1] 杨雪莉 李宗美 陈晶晶[1] XU Yi;YANG Xue-li;LI Zong-mei;CHEN Jing-jing(Department of Emergency,Ganzi Hospital of West China Hospital of Sichuan University,Kangding,Sichuan 626001,China)

机构地区：[1]四川大学华西医院甘孜医院急诊科,四川康定626001

出　　处：《解放军医药杂志》2021年第10期67-70,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：四川省科技支撑计划项目(2018SZ0037)。

摘　　要：目的分析血糖、血浆D-二聚体和炎性因子在急性胰腺炎(AP)患者中的表达及与病情严重程度和预后的相关性。方法选取2018年4月—2020年4月收治且经手术病理或生化指标检测确诊的AP 90例为观察组,并按照病情严重程度分为轻症急性胰腺炎(MAP)组68例和重症急性胰腺炎(SAP)组22例;并选取同期体检健康者72例为对照组。分析各组血糖、血浆D-二聚体及降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,影响AP预后的独立危险因素采用多因素Logistic回归分析。结果观察组血糖、血浆D-二聚体及PCT、TNF-α、IL-6水平高于对照组(P<0.01)。与对照组比较,MAP组、SAP组血糖、血浆D-二聚体及PCT、TNF-α、IL-6水平增高,且SAP组高于MAP组(P<0.05)。预后不良组急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、计算机断层扫描严重指数(CTSI)评分≥3分占比、SAP占比、血糖、血浆D-二聚体及PCT、TNF-α、IL-6水平均高于预后良好组(P<0.01)。APACHEⅡ评分、CTSI、SAP及血糖、血浆D-二聚体、PCT、TNF-α、IL-6水平是AP预后不良的独立危险因素(P<0.01)。结论AP患者存在凝血功能和纤溶系统异常、高血糖、炎症反应,血糖、血浆D-二聚体和炎性因子与AP病情严重程度具有一定关系,检测上述指标水平可有效评估患者预后。Objective To analyze expressions of blood glucose,plasma D-dimer(DD)and inflammatory factors in patients with acute pancreatitis(AP)and their correlations with the severity and prognosis of the disease.Methods A total of 90 AP patients who had been diagnosed by surgical pathology or biochemical indicators between April 2018 and April 2020 were enrolled as observation group,and the patients were divided into mild acute pancreatitis(MAP)subgroup(n=68)and severe acute pancreatitis(SAP)subgroup(n=22)according to severity of the disease.Other 72 healthy people who had undergone physical examinations at the same period were selected as control group.Levels of blood glucose,plasma DD,procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were analyzed in all groups.Multivariate Logistic regression analysis was used to analyze independent risk factors affecting the prognosis of AP.Results Levels of blood glucose,plasma DD,PCT,TNF-αand IL-6 levels in observation group were significantly higher than those in control group(P<0.01).Levels of blood glucose,plasma DD,PCT,TNF-αand IL-6 in MAP and SAP subgroups were significantly higher than those in control group,and the levels in SAP subgroup were significantly higher than those in MAP subgroup(P<0.05).Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,proportion of computed tomography severity index(CTSI)equal or more than 3,SAP proportion,and levels of blood glucose,plasma DD,PCT,TNF-αand IL-6 in patients with poor prognoses were significantly higher than those in patients with good prognosis(P<0.01).APACHEⅡscore,CTSI,SAP,blood glucose,plasma DD,PCT,TNF-α,and IL-6 levels were independent factors for poor prognoses of AP patients(P<0.01).Conclusion AP patients have abnormalities in coagulation function and fibrinolytic system,hyperglycemia and inflammatory reactions.Blood glucose,plasma DD and inflammatory factors are associated with the severity of AP.Detections of the above indexes may effectively assess the prognoses of patients.

关 键 词：急性胰腺炎 降钙素原 肿瘤坏死因子-α 白细胞介素-6 血浆D-二聚体 血糖 预后 

分 类 号：R576[医药卫生—消化系统]