急性胰腺炎血中生长抑素、钙离子及C反应蛋白水平检测及其临床意义

CLINICAL SIGNIFICANCE OF THE CHANGE OF THE SERUM SOMATOSTATIN AND CALCIUMION AND C-REACTIVE LEVELS IN PATIENTS WITH ACUTE PANCREATITIS

目的:探讨急性胰腺炎(acute pancreatitis,AP)病人血清生长抑素(SST)水平、钙离子(Ca^(2+))水平及C反应蛋白(CRP)水平变化与AP病情严重程度的关系以及对预后的评价。方法:根据分级标准将249例AP病人分为轻症急性胰腺炎(MAP)128例,中度重症急性胰腺炎(MSAP)79例,重症急性胰腺炎(SAP)42例。另选择40例健康志愿者作为健康对照组,采用放射免疫法及全自动生化分析方法,分别检测各组的血清SST、Ca^(2+)和CRP水平,将各组数据比较分析。结果:发病<48 h来就诊的AP病人中,MAP组外周血SST水平稍高于健康对照组,但差异无显著性(P>0.05);而MSAP组和SAP组外周血SST水平明显低于健康对照组,SAP组亦明显低于MSAP组,均有显著性差异(P<0.05)。MAP组、MSAP组和SAP组外周血Ca^(2+)水平均明显低于健康对照组,差异均有显著性(P<0.05)。MAP组、MSAP组和SAP组CRP明显高于健康对照组,差异均有显著性(P<0.05)。采用常规剂量SST-14思他宁治疗三组胰腺炎后发现,(1)24 h内血SST水平均可升高,但对于MSAP和SAP,其升高程度仍远低于正常水平,持续常规剂量治疗72 h后,MAP及MSAP血SST水平略高于正常水平,无显著差异(P>0.05),而SAP血SST仍低于正常对照组,差异有显著性(P<0.05);(2)24 h和72 h血Ca^(2+)水平明显提高,MAP和MSAP血Ca^(2+)接近或恢复正常;而SAP组病人血Ca^(2+)较治疗前有所升高,但仍明显低于正常对照组(P<0.05);(3)MAP和MSAP外周血CRP水平均明显下降,MAP基本恢复至正常对照组水平,而MASP尽管下降,但仍明显高于正常对照组(P<0.05)。结论:AP外周血中SST水平和Ca^(2+)及CRP水平的变化可以反映病情严重程度,对评估病人预后具有临床价值。

Objective：To investigate the relationship between the change of serum somatostatin （SST）, Calciumion（ Ca2＋） and C-reactive protein（CRP） levels and severity of illness in patients with acute pancreatitis, and its value in the evaluation of prognosis. Methods： 249 acute pancreatitis patients were divided into three groups according to the classification standard as mild acute pancreatitis（MAP） 128 cases, mediate severe acute pancreatitis （MSAP）79 cases and severe acute pancreatitis （SAP）42 cases,and also 40 healthy volunteers served as control group. The blood SST concentration, Ca2＋ and CRP levels was detected by radioimmunity and automatic biochemical analysis, and to explore the role of them for the assessment of disease severity and prognosis. Results ： Within 48 h of onset of acute pancreatitis, serum levels of SST was slightly higher in MAP group than those in control group（P〉0.05）, but serum levels of SST was significantly lower in MSAP and SAP group than those in control group, and more lower in SAP group than in MSAP（ P〈0.05 ）. Blood Ca2＋ levels was significantly lower in MAP, MSAP and SAP group than those in control group （ P〈0.05 ）. Blood CRP levels was significantly higher in MAP, MSAP and SAP group than those in control group, and more higher in SAP group than in MAP and MSAP group （P〈0.05）. After treatment of SST-14 somatostatin, （ 1 ） all blood SST levels raised within 24 h in three groups, but for MSAP and SAP, the elevated levels was still below normal levels. After 72 h treatment, levels of SST in MAP and MSAP was slightly higher than normal blood levels（P〉0.05 ） ,but levels of SST in SAP is still lower than normal ,the difference was significant（P〈 0.05）. （2）Blood Ca2＋ levels with 24 h and 72 h was significantly increased, but in SAP group, the blood Ca2＋ levels was still lower than the levels in control group（ P〈0.05 ）. （3）Blood CRP levels was significantly decreased in MAP and MSAP, but CRP levels in MASP was still higher than the control group （P〈0.05）. Conclusion： The levels of peripheral blood SST, Ca2＋ and CRP in acute pancreatitis can reflect the severity of the illness and shows clinical value in evaluation of prognosis.