凝血指标联合急性胰腺炎严重程度床边指数评分对急性胰腺炎严重程度的预测意义

The significance of combining coagulation with bedside index for severity in acute pancreatitis scores in the severity of acute pancreatitis

目的 探讨凝血指标联合急性胰腺炎严重程度床边指数（BISAP）评分对急性胰腺炎（AP）严重程度的预测意义.方法 选取126例AP患者作为研究对象,根据AP的诊断标准分为轻症急性胰腺炎（MAP）组64例和重症急性胰腺炎（SAP）组62例.同时选取60例健康体检者作为对照组.入院24h内AP患者行BISAP评分,各组次日清晨或者空腹8h后抽取外周静脉血3rnl检测活化部分凝血酶原时间（APTT）、凝血酶原时间（PtT）、D-二聚体及纤维蛋白原（nB）.结果 三组间APTT、PT比较差异无统计学意义（P＞ 0.05）;MAP组和SAP组FIB及D-二聚体高于对照组[（4.25±1.01）、（5.44±2.19） g/L比（3.47±0.49） g/L,（5.08±3.20）、（8.65±6.43） mg/L比（3.41±2.32） mg/L],且SAP组高于MAP组,差异有统计学意义（P＜0.05）.MAP组有17例患者D-二聚体阳性,阳性率为26.6％（17/64）; SAP组有53例患者D-二聚体阳性,阳性率为85.5％（53/62）,两组D-二聚体阳性率比较差异有统计学意义（P＜0.01）.BISAP评分与凝血指标联合BISAP评分预测AP严重程度的曲线下面积（AUC）分别为0.842 （0.775 ～ 0.889）、0.886 （0.839 ～ 0.925）,两者比较差异无统计学意义（P＞0.05）.结论 凝血指标联合BISAP评分在评估AP严重程度方面比单独应用BISAP评分更加准确,并且不会增加临床应用难度,值得临床推广.

Objective To explore the significance of combining coagulation with bedside index for severity in acute pancreatitis （BISAP） scores in evaluation of severity of acute pancreatitis （AP）.Methods One hundred and twenty-six patients with AP were diagnosed according to the AP：mild acute pancreatitis （MAP） group of 64 cases,severe acute pancreatitis （SAP） group of 62 cases,and selected 60 healthy persons as control group.AP patients BISAP scores were calculated in 24 h from admission,and the activity of partial thromboplastic time （AFTT）,prothrombin time （PT）,D-dimer and fibrinogen （FIB） were measured the next morning or after 8 h of fasting peripheral venous blood collected 3 ml.Results There was no significant difference in APTT,PT among three groups （P＞ 0.05）.FIB and D-dimer in MAP group and SAP group were significantly higher than those in control group [（4.25 ± 1.01）,（5.44 ± 2.19） g/L vs.（3.47 ± 0.49） g/L; （5.08 ± 3.20）,（8.65 ± 6.43） mg/L vs.（3.41 ± 2.32） mg/L,P ＜ 0.05],SAP group was significantly higher than that in MAP group（P ＜ 0.05）.The positive rate of D-dimer in MAP group was significantly lower than that in SAP group [26.6％（17/64） vs.85.5％ （53/62）,P ＜0.01].BISAP scores and combining coagulation with BISAP scores predict the severity of AP AUC were 0.842（0.775-0.889）,0.886 （0.839-0.925）,there was no statistically significant difference （P ＞0.05）.Conclusion The significance of combining coagulation with BISAP scores in the severity of AP is more accurate than only use BISAP scores,and will not increase the clinical application difficulty.