凝血功能检查对急性胰腺炎的早期诊断价值

The early diagnostic value of coagulation function in acute pancreatitis

目的对胰腺炎患者的PT、APTT、TT、FIB、D-D五项检测指标进行分析,探讨血凝五项指标对胰腺炎的诊断价值。方法采用前瞻性病例对照研究方法。选取2016年10月至2018年10月河南科技大学第一附属医院确诊为慢性胰腺炎(CP组)患者54例、轻症急性胰腺炎患者(MAP组)47例、重症急性胰腺炎患者(SAP组)62例和同期健康体检者(NC组)50例的血凝五项指标及肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)和中性粒细胞CD64(CD64)4种炎性因子进行分析研究。结果①与NC相比,CP的各项结果无显著性差异。②与正常人相比,MAP血凝五项中D-二聚体检测结果明显升高(P<0.05),而SAP的各项结果均显明显升高,D-二聚体检测均值是正常人的4.5倍(P<0.01)。③在急性胰腺炎患者中,SAP血浆中D-二聚体含量是MAP的3.8倍(P<0.01)。④与NC相比,SAP组患者的4种炎性因子TNF-α、PCT、CRP和CD64水平最高,其次为MAP组和CP组,差异具有统计学意义(P<0.01)。结论AP时凝血、抗凝血以及纤溶系统的功能发生紊乱,急性时相炎症因子水平升高,动态监测AP尤其是SAP的血凝五项指标及TNF-α、PCT、CRP和CD64水平,有助于了解SAP患者微循环障碍情况,及早预防MODS和DIC的发生。

Objective Analyzing the coagulation indicators of PT,APTT,TT,FIB and D-D in patients with pancreatitis to explore the early diagnostic value of the five indicators in pancreatitis.Methods We conducted this case-control study enrolled 54 newly diagnosed with chronic pancreatitis(CP),47 newly diagnosed with miled acute pancreatitis(MAP),62 newly diagnosed with severe acute pancreatitis(SAP)and another 50 healthy subjects as the normal control(NC)group from October 2016 to October 2018 at The First Affiliated Hospital of Henan University of Science and Technology and analyzed the five coagulation indicators of PT,APTT,TT,FIB,D-D in these patients and the inflammatory factors of tumor necrosis factor-alpha(TNF-α),procalcitonin(PCT),c-reactive protein(CRP)and neutrophil CD64(CD64).Results①Compared with NC,the results of CP showed no significant difference.②Compared with normal people,D-D test results of the five coagulation indicators were significantly increased(P<0.05),while all of the five coagulation indicators were significantly increased in SAP patients and the mean value of D-D test was 4.5 times higher than that of normal people(P<0.01).③In patients with acute pancreatitis,the plasma content of D-D in SAP was 3.8 times higher than that in MAP patients(P<0.01).④Compared with NC,the SAP group had the highest levels of TNF-α,PCT,CRP and CD64,followed by the MAP group and CP group,with statistically significant differences(P<0.01).Conclusion The function of coagulation,anticoagulation and fibrinolytic system is disturbed during AP,and the level of inflammatory factors in acute phase is increased.Dynamic monitoring of the five coagulation indicators in AP,especially SAP,as well as the levels of TNF-,PCT,CRP and CD64 is helpful to understand the microcirculation disorders of SAP patients and prevent the occurrence of MODS and DIC as early as possible.