天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (1): 61-63.doi: 10.3969/j.issn.0253-9896.2015.01.016

• 临床研究 • 上一篇    下一篇

急性胰腺炎患者实验室指标与疾病严重程度的关系

郑吉敏， 高俊茶， 刘娜#br# #br#   

  1. 河北省人民医院消化科（邮编 050051）

  • 收稿日期:2013-12-10 修回日期:2014-08-14 出版日期:2015-01-15 发布日期:2015-01-30
  • 作者简介:郑吉敏（1972）， 女， 副主任医师， 硕士， 主要从事胰腺疾病及慢性肝病研究
  • 基金资助:
    河北省卫生厅指令课题项目（20130106）

The relationship between laboratory indexes and the severity of disease in patients with acute pancreatitis

ZHENG Jimin, GAO Juncha, LIU Na#br# #br#   

  1. Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050051, China

  • Received:2013-12-10 Revised:2014-08-14 Published:2015-01-15 Online:2015-01-30

摘要： 摘要： 目的 探讨急性胰腺炎（AP）患者血钙、尿素氮（BUN）、D-二聚体、C-反应蛋白（CRP）、纤维蛋白原及淀粉酶水平与疾病严重程度的关系。 方法 114 例 AP 患者中轻度 AP（MAP 组）70 例， 中度 AP（MSAP 组）18 例， 重度 AP （SAP 组）26 例， 比较各组实验室指标水平， 并分析各指标与急性生理学与慢性健康评估系统Ⅱ（APACHE Ⅱ）评分的相关性； ROC 曲线分析 CRP、D-二聚体、纤维蛋白原诊断 SAP 的敏感性。 结果 MSAP 组、SAP 组 BUN、CRP、D-二聚体、纤维蛋白原和 APACHE Ⅱ 评分均高于 MAP 组， 血钙低于 MAP 组； SAP 组 APACHE Ⅱ 评分高于 MSAP 组（P＜ 0.05）； 各组间血淀粉酶差异无统计学意义。 APACHE Ⅱ 评分与 CRP、D-二聚体、纤维蛋白原呈正相关（r 分别是 0.407、0.404、0.245， 均 P＜ 0.05）， 与血钙呈负相关（r= -0.333， P＜ 0.05）。 ROC 曲线显示 CRP 诊断 SAP 曲线下面积最大为 0.752（95%CI 为 0.644～ 0.860）， cut-off 值是 74.45 mg/L， 灵敏度为 86.4%， 特异度为 68.2%。 结论 联合监测 BUN、凝血指标、CRP、血钙等实验室指标， 有助于综合评价 AP 患者的病情， 改善患者的预后。

关键词: 胰腺炎, 急性病, C 反应蛋白质, 血尿素氮, 纤维蛋白原, 淀粉酶类, D-二聚体

Abstract: Abstract： Objective To investigate the relationship between values of blood calcium, serum urea nitrogen (BUN), Ddimer, C- reactive protein (CRP), fibrinogen and amylase with the severity of the disease in patients with acute pancreatitis (AP). Methods There were 70 patients with mild AP (MAP group), 18 patients with moderate AP (MSAP group), 26 pa⁃ tients with severe acute pancreatitis (SAP group) in 114 AP patients. The laboratory indexes were compared between these groups. The correlation between indexes and the acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ ) score was analysed. The diagnostic sensitivity of SAP using CRP, D- dimer and fibrinogen was analysed by ROC curves. Re⁃ sults Compared with MAP group, values of BUN, CRP, D- dimer,fibrinogen and APACHE Ⅱ score were significantly increased in SAP group (P < 0.05), but serum calcium level was significantly decreased (P < 0.05). The APACHEⅡ score were significantly higher in SAP group than that of MSAP group (P < 0.05). There were no significant differences in level of amylases between three groups. There was a positive correlation between APACHEⅡ score, CRP, D- dimer and fibrinogen (r=0.407, 0.404 and 0.245, P＜ 0.05). There was a negative correlation between APACHEⅡ score and serum calcium level (r= -0.333, P＜ 0.05). The area under the ROC curve showed a maximum CRP curve for diagnosing SAP 0.752 (95% CI= 0.644-0.860). The cut-off value was 74.45 mg/L. The sensitivity was 86.4%. And the specificity was 68.2%. Conclusion Combining with monitoring BUN, blood coagulation index, CRP, serum calcium level and other laboratory parameters was useful to overall evaluate AP patients and improve the prognosis.

Key words: pancreatitis, acute disease, C-reactive protein, blood urea nitrogen, fibrinogen, amylases, D-dimer