血清肌酸激酶、C-反应蛋白和D-二聚体的测定在绞窄性肠梗阻早期诊断中的应用价值

Application value of serum creatine kinase, C-reactive protein and D-dimer detection in early diagnosis of strangulated intestinal obstruction

目的探讨血清肌酸激酶、C-反应蛋白和D-二聚体水平的测定在绞窄性肠梗阻早期诊断中的应用价值,以期为绞窄性肠梗阻的早期诊断提供依据。方法 1在手术治疗前2 h采集血液标本测定48例单纯性肠梗阻(单纯性肠梗阻组)和36例绞窄性肠梗阻(绞窄性肠梗阻组)患者的血清肌酸激酶、C-反应蛋白和D-二聚体水平,对照50例健康成年(正常对照组)的血清肌酸激酶、C-反应蛋白和D-二聚体水平。2比较在绞窄性肠梗阻组中15例未发生肠坏死者与48例(单纯性肠梗阻组)血清肌酸激酶、C-反应蛋白和D-二聚体水平。同时比较在绞窄性肠梗阻组中经手术证实的21例肠坏死者与15例未发生肠坏死者的血清肌酸激酶、C-反应蛋白和D-二聚体水平。应用相关性分析研究绞窄性肠梗阻患者的血清肌酸激酶、C-反应蛋白和D-二聚体三个指标之间的相关性。结果 1单纯性肠梗阻组的血清肌酸激酶、C-反应蛋白和D-二聚体水平较正常对照组均无明显升高(P>0.05)。绞窄性肠梗阻组的血清肌酸激酶、C-反应蛋白和D-二聚体水平均较正常对照组及单纯性肠梗阻组明显升高(P<0.001)。2在绞窄性肠梗阻组中无肠坏死者血清肌酸激酶、C-反应蛋白和D-二聚体水平均高于(单纯性肠梗阻组)(分别为P<0.05,P<0.001,P<0.001)。3在绞窄性肠梗阻组中已有肠坏死者血清肌酸激酶、C-反应蛋白和D-二聚体水平均高于无肠坏死者(分别为P<0.005,P<0.001,P<0.05)。4绞窄性肠梗阻患者的血清肌酸激酶、C-反应蛋白和D-二聚体三个血清学指标之间相互呈正相关(分别为:r=0.8211,r=0.8546,r=0.6497;均P<0.001)。结论肠梗阻患者血清肌酸激酶、C-反应蛋白和D-二聚体水平的测定值不仅可以对肠绞窄的早期诊断提供依据,还可以用来判断肠绞窄损伤的程度,而三者的综合测定则对绞窄性肠梗阻早期诊断的临床应用价值更大。

Objective To investigate the application value of serum creatine kinase, C-reactive protein and D-dimer detection in early diagnosis of strangulated intestinal obstruction, in order to provide reference for early diagnosis of strangulated intestinal obstruction. Methods ①The levels of serum creatine kinase, C-reactive protein and D-dimer were detected in 2 h before surgery by blood preparation of 48 simple intestinal obstruction patients （simple intestinal obstruction group） and 36 strangulated intestinal obstruction patients （strangulated intestinal obstruction group）. These were compared with the levels of serum creatine kinase, C-reactive protein and D-dimer of 50 healthy adults （normal control group）. ②The levels of serum creatine kinase, C-reactive protein and D-dimer were compared between 15 strangulated intestinal obstruction cases without intestinal necrosis in the strangulated intestinal obstruction group and 48 cases in the simple intestinal obstruction group. These indexes were also compared between 21 strangulated intestinal obstruction cases with intestinal necrosis and 15 cases without intestinal necrosis in the strangulated intestinal obstruction group. The correlation between the indexes of serum creatine kinase, C-reactive protein and D-dimer in strangulated intestinal obstruction patients was analyzed by correlation analysis. Results ①The levels of serum creatine kinase, C-reactive protein and D-dimer were not obviously increased in simple intestinal obstruction group, compared with those in the normal control group （P〉0.05）, while those of the strangulated intestinal obstruction group were significantly higher than the normal control group （P〈0.001）.②The levels of serum creatine kinase, C-reactive protein and D-dimer were higher in the strangulated intestinal obstruction cases without intestinal necrosis than normal control cases （P〈0.05, P〈0.001, P〈0.001）.③The levels of serum creatine kinase, C-reactive protein and D-dimer were higher in the strangulated intestinal obstruction cases with intestinal necrosis than those without intestinal necrosis （P〈0.005,P〈0.001, P〈0.05）. ④There were positive correlations between the three indexes of serum creatine kinase, C-reactive protein and D-dimer in strangulated intestinal obstruction patients （r=0.8211, r=0.8546, r=0.6497, all P〈0.001）. Conclusion The detection of levels of serum creatine kinase, C-reactive protein and D-dimer can not only provide reference for early diagnosis of strangulated intestinal obstruction, but also be used as judgment of degree of intestinal strangulation injury. The combination detection of the three indexes has more clinical application value for early diagnosis of strangulated intestinal obstruction.