重症急性胰腺炎患者D-二聚体及凝血指标变化与Ranson评分、APACHEⅡ评分的关系  

Correlation between plasma D⁃dimer,coagulation function changes and Ranson score and APACHEⅡscore in patients with severe acute pancreatitis

作　　者：王琦 苗孟君 董佳宜 WANG Qi;MIAO Mengjun;DONG Jiayi(Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,Beijing China,100038;Department of Neurology,Beijing Shijitan Hospital,Capital Medical University,Beijing,China,100038;Daytime Department of the Seventh Medical Center,the General Hospital of the People's Liberation Army,Beijing,China,100010)

机构地区：[1]首都医科大学附属北京世纪坛医院消化内科,北京100038 [2]首都医科大学附属北京世纪坛医院神经内科,北京100038 [3]中国人民解放军总医院第七医学中心日间诊疗科,北京100010

出　　处：《分子诊断与治疗杂志》2023年第5期901-904,908,共5页Journal of Molecular Diagnostics and Therapy

基　　金：北京市自然科学基金资助项目(7204215)。

摘　　要：目的探究重症急性胰腺炎(SAP)患者血浆中D⁃二聚体(D⁃D)及凝血功能变化与Ranson评分、APACHEⅡ评分的关联性。方法收集2020年3月至2022年7月北京世纪坛医院收治的128例SAP患者的临床资料,依据预后情况分为预后不良组和预后良好组,比较两组血浆D⁃D、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原(FIB)水平、Ranson评分、APACHEⅡ评分的差异性,分析上述指标在SAP患者预后中的诊断效能,并分析D⁃D、PT、APTT、FIB与Ranson评分、APACHEⅡ评分的关联性。结果本研究共纳入SAP患者128例,其中预后良好组95例(74.22%),预后不良组33例(25.78%)。预后不良组肌酐、D⁃D、PT、APTT、FIB、Ranson评分、APACHEⅡ评分均较预后良好组更高,差异有统计学意义(P<0.05)。D⁃D、PT、APTT、FIB、Ranson评分、APACHEⅡ评分均为SAP患者预后不良的危险因素(P<0.05)。D⁃D、PT、APTT、FIB、Ranson评分、APACHEⅡ评分预测SAP患者不良预后的AUC分别为0.938、0.756、0.656、0.677、0.770和0.837(P<0.05)。D⁃D、APTT分别与Ranson评分呈正相关(r=0.337、0.273,P<0.05);PT、FIB均与Ranson评分无明显相关性(r=0.151、0.054,P>0.05)。D⁃D、APTT分别与APACHEⅡ评分评分呈正相关(r=0.321、0.265,P<0.05);PT、FIB均与APACHEⅡ评分无明显相关性(r=0.133、0.063,P>0.05)。结论D⁃D、PT、APTT、FIB、Ranson评分以及APACHEⅡ评分均能够较好地预测SAP患者的预后情况,且D⁃D、APTT与Ranson评分、APACHEⅡ评分存在较好的相关性,能够预测SAP患者的病情严重程度。Objective To explore the correlation between plasma D⁃dimer(D⁃D),coagulation function changes,Ranson score and APACHEⅡscore in patients with severe acute pancreatitis(SAP).Methods The clinical data of 128 patients with SAP admitted to Beijing Shijitan Hospital were collected between March 2020 and July 2022.According to the prognosis,they were divided into the poor prognosis group and the good prognosis group.The differences in plasma D⁃D,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),Ranson score and APACHEⅡscore were compared between the two groups,and the diagnostic efficacy of the above indicators in the prognosis of SAP patients was analyzed,and the correlation between D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore was analyzed.The correlation between D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore was analyzed.Results In the 128 patients with SAP,there were 95 cases(74.22%)in the good prognosis group and 33 cases(25.78%)in the poor prognosis group.The creatinine,D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore in the poor prognosis group were higher than those in the good prognosis group(P<0.05).D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore were risk factors of poor prognosis in SAP patients(P<0.05).The AUC values of D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore for predicting adverse prognosis were 0.938,0.756,0.656,0.677,0.770 and 0.873,respectively(P<0.05).D⁃D and APTT were positively correlated with Ranson score(r=0.337,0.273,P<0.05),but PT and FIB were not significantly correlated with it(r=0.151,0.054,P>0.05).D⁃D and APTT were positively correlated with APACHEⅡscore(r=0.321,0.265,P<0.05),but PT and FIB had no significant correlation with APACHEⅡscore(r=0.133,0.063,P>0.05).Conclusion D⁃D,PT,APTT,FIB,Ranson score and APACHEⅡscore can better predict the prognosis of SAP patients,and there is a good correlation between D⁃D,APTT and Ranson score,APACHEⅡscore,which can predict the condition of SAP patient severity.

关 键 词：急性胰腺炎 RANSON评分 APACHEⅡ评分 D⁃二聚体 凝血酶原时间 部分活化凝血酶原时间 纤维蛋白原 

分 类 号：R576[医药卫生—消化系统]