血浆凝血-纤溶功能变化在评价急性胰腺炎病情和预后中的价值

The evaluation and prognosis value of coagulation and fibrinolytic function on acute pancreatitis

目的了解早期血浆凝血-纤溶功能改变与急性胰腺炎病情严重程度及预后的关系。方法 40例急性胰腺炎按急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)系统分为轻症急性胰腺炎(MAP)组和重症急性胰腺炎(SAP)组,检测其72h内血浆凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)、纤维蛋白原(Fib)、D-二聚体(D-D),选健康者20名作为对照组,检测其血浆PT、APTT、INR、Fib、D-D,并对3组凝血5项指标进行比较。结果 MAP组Fib、D-D分别为(4.24±1.00)g/L、(5.09±3.21)mg/L,较健康对照组升高(P<0.05);SAP组Fib、D-D分别为(5.43±2.18)g/L、(8.63±6.40)mg/L,较MAP组升高(P<0.05);SIRS阳性组PT、INR、Fib、D-D分别为(15.01±2.99)s、1.29±0.32、(6.07±2.33)g/L、(10.13±8.05)mg/L较SIRS阴性组升高(P<0.05);SIRS阳性组MOF发生率为50%(5/10)明显高于SIRS阴性组(0%),组间比较差异有统计学意义(P<0.01);SIRS阳性组病死率为20%(2/10)较SIRS阴性组(0%)高,但两组比较差异无统计学意义(P>0.05)。结论血浆凝血-纤溶指标能更加准确地判断AP患者病情演变、严重程度,提高AP患者预后预测的准确性,对治疗有积极作用。

Objective To investigate the relationship of coagulation and fibrinolytic function with the severity and prognosis of acute pancreatitis.Methods Forty patients were randomly divided into MAP group and SAP group according to APACHE-II score and whose PT,APTT,INR,Fib and D-D were measured in the first 72h.Twenty health patients were included as the control group whose same indices were measured.Comparisons of data above between three groups were performed.Results Fib and D-D in the MAP group were higher than the control group（P〈0.05）.Compared with the MAP group,Fib and D-D were increased in the SAP group（P〈0.05）.Compared with the SIRS negative group,PT,INR,Fib and D-D were significantly increased in the SIRS positive group（P〈0.05）.MOF were normal in the SIRS positive group comparing to the SIRS negative group（P〈0.01）.The mortality of the SIRS positive group and the SIRS negative group was no significant difference.Conclusion Coagulation and fibrinolytic function can preciously evaluate the severity and variation of the AP.It improves the accuracy of the prognosis prediction of AP and can be helpful in treatment.