肌酸激酶、D-二聚体等检验指标与肠道绞窄程度的相关性研究

Correlations between strangulated intestinal obstruction and levels of creatine kinase,D-dimer and other laboratory test index

目的分析血清肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase-MB,CK-MB)、纤维蛋白原(fibrinogen,Fg)、D-二聚体(D-dimer)、降钙素原(procalcitonin,PCT)与肠道绞窄程度的相关性,探讨以上指标在绞窄性肠梗阻诊断中的应用价值。方法收集新疆石河子大学医学院第一附属医院2015-10至2017-09收治的肠梗阻患者63例,按有无绞窄症状和手术病检分为单纯性肠梗阻组(n=36)、肠道绞窄无坏死组(n=17)、肠道坏死组(n=10),比较各组间CK、CK-MB、Fg、D-dimer、PCT水平,分析组间D-dimer和PCT的相关性。结果(1)肠道坏死组的CK水平高于肠道绞窄无坏死组、单纯性肠梗阻组(χ~2=13.400,P<0.05);组间CK-MB水平无明显差异(χ~2=0.571,P>0.05);Fg水平在单纯性肠梗阻组、肠道绞窄无坏死组、肠道坏死组有增高趋势,但差异无统计学意义(χ~2=5.821,P>0.05)。(2)肠道绞窄无坏死组的D-dimer阳性率高于单纯性肠梗阻组,肠道坏死组D-dimer的强阳性率高于肠道绞窄无坏死组和单纯性肠梗阻组(χ~2=54.714,P<0.01)。(3)单纯性肠梗阻组、肠道绞窄无坏死组、肠道坏死组的PCT阳性率、强阳性率均逐渐增高(χ~2=28.285,P<0.01)。(4)肠梗阻各自的组间D-dimer与PCT之间无明确相关性(r=0.500,P=0.667)。结论 CK-MB、Fg的水平与肠道绞窄和坏死程度无明确相关性,CK、D-dimer、PCT的水平可以为肠道的绞窄和坏死提供诊断依据。

Objective The objective of this study was to analyze the correlations between levels of serum creatine kinase(CK),creatine kinase isoenzyme(CK-MB),fibrinogen(Fg),D-dimer,and procalcitonin(PCT)and the degree of intestinal strangulation,and to discuss the value of the above index in the diagnosis of strangulated intestinal obstruction.Methods A total of63patients with intestinal obstruction treated in the First Affiliated Hospital of the Medical College,Shihezi University from October2015to September2017were collected as the study object.The patients were divided into simple intestinal obstruction group(n=36),intestinal strangulation non-necrosis group(n=17),and intestinal necrosis group(n=10)based on their strangulation symptoms and postoperative pathologic examination.The levels of CK,CK-MB,D-dimer,Fg and PCT between these groups were compared,and the correlation between the levels of D-dimer and PCT was analyzed.Results(1)The level of CK in intestinal necrosis group was higher as compared to the simple intestinal obstruction group and intestinal strangulation non-necrosis group(χ2=13.400,P<0.05);there was no significant difference in blood CK-MB levels between three groups(χ2=0.571,P>0.05);the level of Fg in simple intestinal obstruction group,intestinal strangulation non-necrosis group and intestinal necrosis group increased gradually,but there was no statistical difference(χ2=5.821,P>0.05).(2)The positive rate of D-dimer in intestinal strangulation non-necrosis group was significantly higher than that in simple intestinal obstruction group,the strong positive rate of D-dimer in intestinal strangulation necrosis group was higher than other groups(χ2=54.714,P<0.01).(3)The positive rate and strong positive rate of PCT in simple intestinal obstruction group,intestinal strangulation non-necrosis group,intestinal necrosis group were gradually increased(χ2=28.285,P<0.01).(4)There was no clear correlation between D-dimer and PCT(r=0.500;P=0.667).Conclusions There is no clear correlation between the levels of CK-MB,Fg and the intestinal strangulation or necrosis;the levels of CK,D-dimer,PCT can provide reference for the diagnosis for intestinal strangulation and necrosis.