D-二聚体、纤维蛋白原、外周血白细胞计数联合检测对急性胰腺炎严重程度的预测价值

Predictive value of combined measurement of D-dimer,fibrinogen,and peripheral blood leukocyte count for severity of acute pancreatitis

目的探讨D-二聚体(D-D)、纤维蛋白原(FIB)及外周血白细胞计数(PBLC)对急性胰腺炎(AP)患者病情严重程度的预测价值。方法收集2014年1月-2016年1月于宁夏医科大学总医院明确诊断为AP的住院患者完整资料134例,按病情严重程度分为轻度急性胰腺炎(MAP)组(n=72)和重度急性胰腺炎(SAP)组(n=62)。再按发病原因分为高脂血症性急性胰腺炎(A组,n=43)和胆源性急性胰腺炎(B组,n=91)。收集所有患者入院与发病时间在24 h内且未经治疗的首次发病的血浆D-D、FIB及PBLC数据。正态分布的计量资料组间比较采用t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ2检验。相关性分析采用Spearman相关性检验和Pearson相关性检验。采用受试者工作特征曲线(ROC曲线)分析D-D、FIB以及PBLC对AP病情严重程度的预测价值。结果与MAP组比较,SAP组患者血浆D-D和FIB水平升高(Z=-3.171,P=0.002;t=-2.339,P=0.021)。B组D-D水平高于A组(Z=-4.178,P<0.001);B组FIB水平均高于A组,但差异无统计学意义(P>0.05)。A组PBLC明显高于B组(t=2.466,P=0.015)。D-D、FIB及PBLC的受试者工作特征曲线下面积(AUC)分别为0.659、0.611、0.591,其中D-D对SAP严重程度的预测价值高于FIB和PBLC。3项指标联合检测的AUC为0.712。血浆D-D、FIB水平与AP病情严重程度均呈正相关(r值分别为0.275、0.192,P值分别为0.001、0.026)。结论 D-D、FIB、PBLC对早期判断AP严重程度均具有重要价值,将三者联合检测意义更大。

Objective To explore the predictive value of combined measurement of D-dimer（ D-D）,fibrinogen（ FIB）,and peripheral blood leukocyte count（ PBLC） for the severity of acute pancreatitis（ AP）. Methods We collected the clinical data of 134 hospitalized patients who were diagnosed with AP in the General Hospital of Ningxia Medical University from January 2014 to January 2016. These patients were divided into mild acute pancreatitis（ MAP） group（ n = 72） and severe acute pancreatitis（ SAP） group（ n = 62）. Also,these patients were divided into hyperlipidemic acute pancreatitis（ HAP） group（ n = 43） and biliogenic acute pancreatitis（ BAP） group（ n = 91）. The initial measurements of D-D,FIB,and PBLC for the patients who were admitted to the hospital within 24 hours of onset and received no treatment before admission were collected. The t test was used for comparison of normally distributed continuous data,while the Mann-Whitney U test was used for non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. In addition,the Spearman correlation test and Pearson correlation test were used for correlation analyses. The receiver operating characteristic（ ROC） curve was used to analyze the predictive values of D-D,FIB,and PBLC for the severity of AP. Results Compared with the MAP group,the SAP group had significantly increased D-D and FIB levels in peripheral blood（ Z =-3. 171,P = 0. 002; t =-2. 339,P =0. 021）. Compared with the HAP group,the BAP group had a significantly higher D-D level（ Z =-4. 178,P 0. 001）,an insignificantly higher FIB level（ P 0. 05）,and a significantly lower PBLC（ t = 2. 466,P = 0. 015）. The areas under the ROC curve（ AUCs） of D-D,FIB,and PBLC were 0. 659,0. 611,and 0. 591,respectively,and D-D had a higher value than FIB and PBLC in predicting the severity of SAP. The AUC of a combination of D-D,FIB,and PBLC was 0. 712. Plasma D-D and FIB levels were positively correlated with the severity of AP（ r = 0. 275 and 0. 192,P = 0. 001 and 0. 026）. Conclusions D-D,FIB,and PBLC are important for early judgment of the severity of AP,and a combination of the three markers has greater significance.