D-二聚体与急性胰腺炎病情严重程度的相关性研究

Correlation between the level of D-dimer and severity of the disease in patients with acute pancreatitis

目的探讨急性胰腺炎（AP）患者血D～二聚体（D—dimer）水平与疾病严重程度的关系。方法73例AP患者分为轻症AP（MAP组）48例，中重症AP（MSAP组）14例，重症AP（SAP组）11例，比较各组D—dimer水平及其与急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、Ranson评分、改良的CT严重度指数（modified CT severityindex，MCTSI）评分、C-反应蛋白（C-reactivepro—tein，CRP）水平的相关性；ROC曲线分析D—dimer、CRP、APACHEⅡ评分、Ranson评分预测MSAP和SAP的敏感度。结果三组白细胞计数（WBC）、CRP、尿素氮（BUN）、血清乳酸脱氢酶（LDH）随病情严重程度出现不同程度的升高，组间比较差异有统计学意义（P〈0．05）。D—dimer水平：SAP组明显高于MSAP组，MSAP组明显高于MAP组，各组比较差异有统计学意义（P=0．000）。D—dimer水平与APACHEⅡ评分、Ranson评分、MCTSI、CRP呈正相关（r分别为0．799、0．721、0．659、0．619，均P=0．000）。ROC曲线显示，D—dimer预测MSAP＋SAP曲线下的面积仅次于CRP，为0．925（95％CI为0．868～0．982），cut—off值是0．685mg／L，敏感度88％，特异度80％，敏感度、特异度均高于APACHEⅡ评分和Ranson评分。结论D—dimer水平与AP病情严重程度密切相关，对AP早期评估和预测病情的严重程度有重要的临床意义。

Objective To investigate the relationship between values of D-dimer with the severity of the disease in patients with acute pancreatitis （AP）. Methods There were 48 patients with mild AP （MAP group）, 14 patients with moderately severe AP （MSAP group）, Ⅱ patients with severe AP （SAP group） in 73 AP patients. The laboratory indexes were compared between these groups. The correlation between values of D-dimer and the acute physiology and chronic health evaluation system Ⅱ（APACHE Ⅱ ） score, Ranson score, modified CT severity index （MCTSI） and C-reactive protein （CRP） was analyzed. The predicted sensitivity of MSAP and SAP using D-dimer, CRP, APACHE Ⅱ score and Ranson score was analyzed by ROC curves. Results Compared among the three groups, values of WBC, CRP, BUN and LDH were increased with the severity of the disease occurred in varying degrees, there were significant differences between three groups （P 〈 0.05）. The values of D-dimer in SAP group were significantly higher than that in MSAP group, which were significantly higher in MSAP group than that in MAP group. There were significant differences between three groups （P= 0.000）. There was a positive correlation between D-dimer with APACHE Ⅱscore, Ranson score, MCTSI and CRP （r = 0.799, 0.721, 0.659, 0.619, P = 0.000）. The area under the ROC curve showed the CRP curve for predicting MSAP and SAP was 0.925 （95%CI = 0.868 - 0.982）, ranking only second to CRP. The cut-off value was 0.685 mg/L. The sensitivity was 88%, and the specificity was 80%. Conclusion The levels of D-dimet are positively correlated with the severity of the disease in patients with AP, and are useful to assess and predict the severity of the disease in clinic as soon as possible.