PCT和hs-CRP、IL-6结合Ranson评分对急性胰腺炎严重程度评估价值及PCT指导其抗生素应用的临床研究
发布时间：2018-07-28 12:10
【摘要】：[目的]急性胰腺炎(Acute pancreatitis, AP)是临床常见急腹症之一。大部分急性胰腺炎为一种轻度的自限性疾病,通常不伴有并发症。但是,仍有10%到20%的患者发展为重症急性胰腺炎,由于剧烈的炎症反应,造成了多脏器损伤,延长了住院时间,并出现较高的死亡率[1]。所以判断急性胰腺炎的严重程度对治疗及预后的判断有重要意义,目前临床对急性胰腺炎严重程度的判断,在临床症状及影像学表现的基础上,主要依据的指标包括:PCT(procalcitonin)、CRP(C-reactive protein)、IL-6(Interleukin-6)等炎症因子及相关评分标准。为了提高临床对急性胰腺炎严重程度判断的准确性、高效性,可以考虑监测PCT的同时监测IL-6、CRP等传统炎症指标,并对比Ranson评分。另一方面,针对急性胰腺炎患者,我们应该选择有针对性的个体化抗生素治疗(个性化抗生素管理”,Individual,Patient-adapted Antibiotic Therapy: “Antibiotic Stewardship”),以强化抗生素的合理应用,减少二重感染发生。本研究将探讨监测PCT在急性胰腺炎严重程度评估中运用的指导意义,并对比hs-CRP、IL-6以及常规白细胞计数、中性粒细胞比值等常用炎症指标,最后评估PCT联合hs-CRP、IL-6、Ranson评分,探索联合监测在急性胰腺炎严重程度诊断方面的意义,同时将探索动态监测PCT对急性胰腺炎抗生素应用的指导意义。[方法]本研究采用回顾性分析方法,所有收集资料来自于昆明医科大学第二附属医院的2013年7月至2016年8月诊断为急性胰腺炎的住院患者154例(女49例,男105例,年龄16-75岁)。患者纳入标准:符合急性胰腺炎诊治指南[2](2014年)诊断标准。排除标准:对未诊断为急性胰腺炎,临床资料不完整者均排除在本研究之外。入院患者收集记录患者性别、年龄、病因等一般资料。104例AP患者根据急性胰腺炎诊治指南[2](2014年)严重程度分级标准,记录相关数据,测算Marshall评分并结合临床证据,分为轻症急性胰腺炎(54例)、中重症急性胰腺炎(28例)和重症急性胰腺炎(22例)即A、B、C三组。分别于入院24小时内采用电化学发光法法测定PCT、hs-CRP、IL-6含量,同时收集48小时内的相关数据,测算Ranson评分。再将100例中重症及重症急性胰腺炎患者分为:D组,动态监测PCT并应用抗生素,后根据PCT数值变化判断是否停用抗生素,中重症急性胰腺炎和重症急性胰腺炎患者(50例);E组,已应用抗生素者并未动态监测PCT数值,经一般常用炎症指标及传统临床证据(包括白细胞计数、中性粒细胞比值、体温、心率等)指导判断是否停用抗生素,中重症急性胰腺炎和重症急性胰腺炎患者(50例)。应用spss19.0软件对数据进行统计分析:1.PCT、hs-CRP、IL-6、Ranson评分与急性胰腺炎严重程度判断的关系;2.其对于急性胰腺炎分级诊断的价值;3.PCT、hs-CRP、IL-6、Ranson评分与急性胰腺炎严重程度的相关性。4.D、E两组间抗生素使用时长、住院时长、抗生素单一使用或联合使用的区别的。[结果]1.共纳入患者104例,中重症及重症急性胰腺炎所占比例约为48%。三组急性胰腺炎患者的 PCT (中位数)为{0.14(0.07,0.34) , 0.92(0.50,1.42),6.69(4.82,11.57)ng/ml}; hs-CRP 为(中位数){70.94±76.22,157.94±88.96,202.75±104.05}; IL-6 为(中位数){37.20(8.45,71.38),97.80(53.94,178.36),161.40(78.76,274.13)}; Ranson评分为(中位数){1.00(1.00,2.00), 5.00(4.00,5.00),8.00(6.75,8.00)};三组 PCT、hs-CRP、IL-6、Ranson 评分经 Kruskal-Wallis H 检验,三组总体差异均有明显统计学意义(P 0.001)。进一步运用LSD法对三组hs-CRP进行组间两两比较结果显示,轻症急性胰腺炎hs-CRP明显低于中重症急性胰腺和重症急性胰腺炎组,差异均有统计学意义(P 0.05);但中重症急性胰腺和重症急性胰腺炎组hs-CRP差异无统计学意义(P 0.05)。运用Mann-whitney U检验对三组PCT、IL-6、Ranson评分分别进行组间比较结果显示,重症急性胰腺炎组PCT明显高于轻症急性胰腺炎和中重症急性胰腺组,同时中重症急性胰腺组也明显高于轻症急性胰腺炎组,差异均有统计学意义(P 0.05)。IL-6结果与hs-CRP 一致。Ranson 评分结果与 PCT 一致。三组 CT 分级经 Kruskal-Wallis H检验,差异有统计学意义(P 0.05)。三组一般资料,包括年龄、心率经统计学分析,三组总体差异有统计学意义(P 0.05);平均动脉压经、性别差异无统计学意义(P 0.05)。对三组患者血液学相关指标,包括中性粒细胞比值(N%)、血钙、白细胞(WBC)、血糖、LIPASE分别进行统计学分析,三组总体差异有统计学意义(P 0.05),AMY三组总体差异无统计学意义(P 0.05)。2.共纳入患者104例,中重症及重症急性胰腺炎所占比例约为48%。为了获得PCT、hs-CRP、IL-6、Ranson评分四者对于诊断中重症及重症急性胰腺炎的精确性及临阈值,采用受试者特征曲线(Receiver Operating Characteristic Curve,ROC)分析,结果提示四者的曲线下面积分别为:PCT (0.948±0.020)、hs-CRP (0.802±0.045)、IL-6 (0.801±0.043)、Ranson (0.980±0.014),对于中重症及重症急性胰腺炎的诊断阈值分别为PCT ( 0.4825ng/ml)、hs-CRP(91.69mg/l)、IL-6 (74.25pg/ml)、Ranson 评分(3.5 分),敏感性(Sensitivity,SE)(%)及特异性(Specificity,SP)(%)四者分别为:PCT(88%,88.9%)、hs-CRP(86%,70.4%)、IL-6 (72%, 77.8%)、Ranson (92%,100%)。应用 PCT 联合 hs-CRP两个阈值联合测定分析,曲线下面积为:(0.945±0.021),敏感性及特异性为:(80%,96.3%)。应用PCT联合Ranson评分两个阈值联合测定分析,曲线下面积为:(0.997±0.003),敏感性及特异性为:(100%,96.3%)。3.共纳入患者104例,中重症及重症急性胰腺炎所占比例约为48%。PCT、hs-CRP、IL-6、Ranson评分四者与急性胰腺炎严重程度呈正相关,结果分别为PCT (r=0.839, P 0.001 )、hs-CRP (r=0.531,P 0.001 )、IL-6 (r=0.541,P 0.001 )、Ranson 评分(r=0.879, P 0.001)。PCT、hs-CRP、IL-6、Ranson 评分四者两两间分析,均呈正相关。4.共纳入患者100例,两组患者年龄、性别、Ranson评分没有统计学差别。D组抗生素使用时长、住院时长结果(均数)分别为:(13.58±8.42, 15.52±6.25),E组抗生素使用时长、住院时长结果(均数)分别为:(17.34±4.95, 22.68±6.14,天);D组、E组抗生素使用时长、住院时长经两独立样本t检验,P 0.05。两组抗生素单一使用或联合使用的情况经x2检验,P 0.05。[结论]1.PCT、Ranson评分、CT分级可作为判断急性胰腺炎严重程度分级的参考标准,三者数值或分级越高提示急性胰腺炎程度越重;IL-6、hs-CRP可作评估轻型胰腺炎的参考指标。2.对于中重症及重症急性胰腺炎的诊断阈值分别为PCT (0.4825ng/ml)、hs-CRP(91.69mg/l)、IL-6 (74.25pg/ml)、Ranson 评分(3.5 分);对于急性胰腺炎严重的诊断价值:PCT联合Ranson评分 Ranson评分 PCT PCT联合hs-CRP hs-CRP IL-6,说明PCT联合Ranson评分对中重症急性胰腺炎和重症急性胰腺炎的的诊断效果最好,说明二者联合诊断要优于其各自诊断价值。PCT联合hs-CRP二者联合诊断要优于hs-CRP诊断,次于PCT诊断。3.PCT、hs-CRP、IL-6、Ranson评分四者与急性胰腺炎严重程度呈正相关,四者间两两相分析亦为正相关。4.动态监测PCT数值可作为指导中重症和重症急性胰腺炎抗生素治疗的有效参考指标。
[Abstract]:[Objective] Acute pancreatitis (AP) is one of the most common acute abdominal diseases. Most acute pancreatitis is a mild self limiting disease, usually without complications. However, 10% to 20% of the patients are still developing into severe acute pancreatitis. The severe inflammatory reaction caused multiple organ damage and prolonged hospitalization. And there is a high mortality rate of [1]., so it is important to judge the severity of acute pancreatitis to judge the treatment and prognosis. On the basis of clinical symptoms and imaging manifestations, the main criteria include: PCT (procalcitonin), CRP (C-reactive protein), IL-6 (Interleuk), and IL-6 (Interleuk). In-6) and other inflammatory factors and related scoring criteria. In order to improve the accuracy and efficiency of the clinical assessment of the severity of acute pancreatitis, we can consider monitoring PCT and monitoring traditional inflammatory markers such as IL-6, CRP, and compared the Ranson score. On the other hand, we should choose targeted individualized antibiotics for patients with acute pancreatitis. Treatment (individualized antibiotic management, Individual, Patient-adapted Antibiotic Therapy: "Antibiotic Stewardship") to strengthen the rational use of antibiotics and reduce the occurrence of double infection. This study will explore the guiding significance of monitoring the use of PCT in the assessment of the severity of acute pancreatitis, and compare hs-CRP, IL-6, and conventional whiteness. Cell count, neutrophils ratio and other commonly used inflammatory markers, and finally to evaluate PCT combined with hs-CRP, IL-6, Ranson score, explore the significance of joint monitoring in the diagnosis of acute pancreatitis, and explore the guiding significance of dynamic monitoring of PCT for the application of acute pancreatitis. [Methods] this study adopted a retrospective analysis, all The data were collected from 154 hospitalized patients (49 women, 105 men, 16-75 years old) diagnosed as acute pancreatitis from July 2013 to August 2016 at the Second Affiliated Hospital of Kunming Medical University. The patients were included in the criteria: guidelines for diagnosis and treatment of acute pancreatitis [2] (2014). Exclusion criteria: undiagnosed as acute pancreatitis, clinical data The patients who were incomplete were excluded from this study. The hospitalized patients collected and recorded the patient's sex, age, and etiology,.104 cases AP patients were divided into mild acute pancreatitis (54 cases) with severe acute pancreatitis (54 cases) according to the severity grading standard of acute pancreatitis, according to the severity grading standard of acute pancreatitis diagnosis and treatment guidelines (2014). 28 cases of pancreatitis (28 cases) and severe acute pancreatitis (22 cases), namely, A, B, and C three groups. The PCT, hs-CRP, IL-6 content were measured by Electrochemiluminescence Method within 24 hours of admission, and the relevant data of 48 hours were collected, and the Ranson score was measured. Then 100 cases of severe and severe acute pancreatitis were divided into D group. After the PCT numerical changes were used to determine whether to discontinue antibiotics, severe acute pancreatitis and severe acute pancreatitis (50 cases). In group E, those who had used antibiotics did not dynamically monitor the PCT values, and were guided by commonly used inflammatory markers and traditional clinical evidence (including leukocyte count, neutrophils ratio, body temperature, heart rate, etc.) No use of antibiotics, severe acute pancreatitis and severe acute pancreatitis (50 cases). The data were statistically analyzed by spss19.0 software: the relationship between 1.PCT, hs-CRP, IL-6, Ranson score and the severity of acute pancreatitis; 2. the value for the classification of acute pancreatitis; 3.PCT, hs-CRP, IL-6, Ranson score and acute pancreas The correlation of inflammatory severity was.4.D, the antibiotics used in the E two groups were long, long hospitalized, single use of antibiotics or combined use of antibiotics. [result]1. was included in 104 cases, and the proportion of severe and severe acute pancreatitis in 48%. three groups of acute pancreatitis was {0.14 (0.07,0.34), 0.92 (0.50,1.42), 6.). 69 (4.82,11.57) ng/ml}; hs-CRP is (median) {70.94 + 76.22157.94 + 88.96202.75 + 104.05}; IL-6 is (median) {37.20 (8.45,71.38), 97.80 (53.94178.36), 161.40 (78.76274.13)}; the score is (median), 5 (median), 8 (8)}; three groups S H test, the total difference between the three groups had significant statistical significance (P 0.001). Further use of LSD method to compare 22 groups of three groups of hs-CRP showed that the hs-CRP of mild acute pancreatitis was significantly lower than that of severe acute pancreatitis and severe acute pancreatitis (P 0.05), but severe acute pancreas and severe acute pancreatitis were in severe acute pancreatitis. There was no significant difference in hs-CRP in the group of sexual pancreatitis (P 0.05). The results of three groups of PCT, IL-6 and Ranson scores by Mann-whitney U test showed that PCT in severe acute pancreatitis group was significantly higher than that of mild acute pancreatitis and medium severe acute pancreas group, and the severe acute pancreas group was also significantly higher than that of mild acute pancreas. The difference was statistically significant (P 0.05).IL-6 results and hs-CRP consistent.Ranson score coincide with PCT. The three group CT grading by Kruskal-Wallis H test, the difference was statistically significant (P 0.05). The three groups of general data, including age, heart rate by statistical analysis, the three groups were statistically significant (P 0.05); mean arterial pressure The gender differences were not statistically significant (P 0.05). The hematology related indexes in the three groups, including neutrophils ratio (N%), blood calcium, leukocyte (WBC), blood glucose and LIPASE were statistically analyzed, the total difference between the three groups was statistically significant (P 0.05), and the total difference of AMY three groups was not statistically significant (P 0.05).2. was included in 104 patients. The proportion of severe and severe acute pancreatitis was about 48%. in order to obtain the accuracy and threshold value of PCT, hs-CRP, IL-6, Ranson score in the diagnosis of severe acute pancreatitis and severe acute pancreatitis (Receiver Operating Characteristic Curve, ROC). The results showed that the area under the curve of the four were: PCT (0). .948 + 0.020), hs-CRP (0.802 + 0.045), IL-6 (0.801 + 0.043), Ranson (0.980 + 0.014). The diagnostic thresholds for severe and severe acute pancreatitis were PCT (0.4825ng/ml), hs-CRP (91.69mg/l), IL-6 (74.25pg/ml), Ranson score (3.5), sensitivity (Sensitivity,%) and four (88) four (88) %, 88.9%), hs-CRP (86%, 70.4%), IL-6 (72%, 77.8%), Ranson (92%, 100%). Using PCT combined hs-CRP two thresholds combined determination analysis, the area under the curve is (0.945 + 0.021), the sensitivity and specificity are: (80%, 96.3%). The application of PCT combined with Ranson score and two threshold determination analysis, the area under the curve is: (0.997), sensitivity and specificity (100%, 96.3%).3. were included in 104 patients. The proportion of severe and severe acute pancreatitis was about 48%.PCT, hs-CRP, IL-6, and Ranson scores were positively correlated with the severity of acute pancreatitis. The results were PCT (r=0.839, P 0.001), hs-CRP (r= 0.531, P 0.001), IL-6 (0.001, 0.001). .PCT, hs-CRP, IL-6, Ranson scores were analyzed in four cases, all of which were positively correlated with 100 patients. There was no statistical difference in age, sex, and Ranson scores in the two groups. The length of antibiotics used in the.D group was long, and the length of hospitalization was (13.58 + 8.42, 15.52 + 6.25). The length of the antibiotics used in the E group and the length of the length of hospitalization (all the mean number) were respectively. (17.34 + 4.95, 22.68 + 6.14, day); group D, group E antibiotics used long, long through two independent samples t test, P 0.05. two antibiotics single use or combined use of x2 test, P 0.05.[conclusion]1.PCT, Ranson score, CT classification can be used as a criterion for judging the severity of acute pancreatitis, three values or scores. The higher the level of acute pancreatitis, the higher the severity of acute pancreatitis; IL-6, hs-CRP can be used as a reference index for the assessment of mild pancreatitis,.2. for severe and severe acute pancreatitis, the diagnostic threshold is PCT (0.4825ng/ml), hs-CRP (91.69mg/l), IL-6 (74.25pg/ml), Ranson score (3.5), and the diagnostic value for acute pancreatitis: PCT combined Ranson The score of Ranson score PCT PCT combined with hs-CRP hs-CRP IL-6, indicating that the combination of PCT and Ranson score is the best for the diagnosis of severe acute pancreatitis and severe acute pancreatitis. It shows that the combined diagnosis of the two cases is better than the diagnostic value of.PCT combined with hs-CRP two. 6, the Ranson score four was positively correlated with the severity of acute pancreatitis, and the 22 phase analysis between the four was also a positive correlation.4. dynamic monitoring PCT value as an effective reference index for the guidance of severe and severe acute pancreatitis in the treatment of antibiotics.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
本文编号：2150093
[Abstract]:[Objective] Acute pancreatitis (AP) is one of the most common acute abdominal diseases. Most acute pancreatitis is a mild self limiting disease, usually without complications. However, 10% to 20% of the patients are still developing into severe acute pancreatitis. The severe inflammatory reaction caused multiple organ damage and prolonged hospitalization. And there is a high mortality rate of [1]., so it is important to judge the severity of acute pancreatitis to judge the treatment and prognosis. On the basis of clinical symptoms and imaging manifestations, the main criteria include: PCT (procalcitonin), CRP (C-reactive protein), IL-6 (Interleuk), and IL-6 (Interleuk). In-6) and other inflammatory factors and related scoring criteria. In order to improve the accuracy and efficiency of the clinical assessment of the severity of acute pancreatitis, we can consider monitoring PCT and monitoring traditional inflammatory markers such as IL-6, CRP, and compared the Ranson score. On the other hand, we should choose targeted individualized antibiotics for patients with acute pancreatitis. Treatment (individualized antibiotic management, Individual, Patient-adapted Antibiotic Therapy: "Antibiotic Stewardship") to strengthen the rational use of antibiotics and reduce the occurrence of double infection. This study will explore the guiding significance of monitoring the use of PCT in the assessment of the severity of acute pancreatitis, and compare hs-CRP, IL-6, and conventional whiteness. Cell count, neutrophils ratio and other commonly used inflammatory markers, and finally to evaluate PCT combined with hs-CRP, IL-6, Ranson score, explore the significance of joint monitoring in the diagnosis of acute pancreatitis, and explore the guiding significance of dynamic monitoring of PCT for the application of acute pancreatitis. [Methods] this study adopted a retrospective analysis, all The data were collected from 154 hospitalized patients (49 women, 105 men, 16-75 years old) diagnosed as acute pancreatitis from July 2013 to August 2016 at the Second Affiliated Hospital of Kunming Medical University. The patients were included in the criteria: guidelines for diagnosis and treatment of acute pancreatitis [2] (2014). Exclusion criteria: undiagnosed as acute pancreatitis, clinical data The patients who were incomplete were excluded from this study. The hospitalized patients collected and recorded the patient's sex, age, and etiology,.104 cases AP patients were divided into mild acute pancreatitis (54 cases) with severe acute pancreatitis (54 cases) according to the severity grading standard of acute pancreatitis, according to the severity grading standard of acute pancreatitis diagnosis and treatment guidelines (2014). 28 cases of pancreatitis (28 cases) and severe acute pancreatitis (22 cases), namely, A, B, and C three groups. The PCT, hs-CRP, IL-6 content were measured by Electrochemiluminescence Method within 24 hours of admission, and the relevant data of 48 hours were collected, and the Ranson score was measured. Then 100 cases of severe and severe acute pancreatitis were divided into D group. After the PCT numerical changes were used to determine whether to discontinue antibiotics, severe acute pancreatitis and severe acute pancreatitis (50 cases). In group E, those who had used antibiotics did not dynamically monitor the PCT values, and were guided by commonly used inflammatory markers and traditional clinical evidence (including leukocyte count, neutrophils ratio, body temperature, heart rate, etc.) No use of antibiotics, severe acute pancreatitis and severe acute pancreatitis (50 cases). The data were statistically analyzed by spss19.0 software: the relationship between 1.PCT, hs-CRP, IL-6, Ranson score and the severity of acute pancreatitis; 2. the value for the classification of acute pancreatitis; 3.PCT, hs-CRP, IL-6, Ranson score and acute pancreas The correlation of inflammatory severity was.4.D, the antibiotics used in the E two groups were long, long hospitalized, single use of antibiotics or combined use of antibiotics. [result]1. was included in 104 cases, and the proportion of severe and severe acute pancreatitis in 48%. three groups of acute pancreatitis was {0.14 (0.07,0.34), 0.92 (0.50,1.42), 6.). 69 (4.82,11.57) ng/ml}; hs-CRP is (median) {70.94 + 76.22157.94 + 88.96202.75 + 104.05}; IL-6 is (median) {37.20 (8.45,71.38), 97.80 (53.94178.36), 161.40 (78.76274.13)}; the score is (median), 5 (median), 8 (8)}; three groups S H test, the total difference between the three groups had significant statistical significance (P 0.001). Further use of LSD method to compare 22 groups of three groups of hs-CRP showed that the hs-CRP of mild acute pancreatitis was significantly lower than that of severe acute pancreatitis and severe acute pancreatitis (P 0.05), but severe acute pancreas and severe acute pancreatitis were in severe acute pancreatitis. There was no significant difference in hs-CRP in the group of sexual pancreatitis (P 0.05). The results of three groups of PCT, IL-6 and Ranson scores by Mann-whitney U test showed that PCT in severe acute pancreatitis group was significantly higher than that of mild acute pancreatitis and medium severe acute pancreas group, and the severe acute pancreas group was also significantly higher than that of mild acute pancreas. The difference was statistically significant (P 0.05).IL-6 results and hs-CRP consistent.Ranson score coincide with PCT. The three group CT grading by Kruskal-Wallis H test, the difference was statistically significant (P 0.05). The three groups of general data, including age, heart rate by statistical analysis, the three groups were statistically significant (P 0.05); mean arterial pressure The gender differences were not statistically significant (P 0.05). The hematology related indexes in the three groups, including neutrophils ratio (N%), blood calcium, leukocyte (WBC), blood glucose and LIPASE were statistically analyzed, the total difference between the three groups was statistically significant (P 0.05), and the total difference of AMY three groups was not statistically significant (P 0.05).2. was included in 104 patients. The proportion of severe and severe acute pancreatitis was about 48%. in order to obtain the accuracy and threshold value of PCT, hs-CRP, IL-6, Ranson score in the diagnosis of severe acute pancreatitis and severe acute pancreatitis (Receiver Operating Characteristic Curve, ROC). The results showed that the area under the curve of the four were: PCT (0). .948 + 0.020), hs-CRP (0.802 + 0.045), IL-6 (0.801 + 0.043), Ranson (0.980 + 0.014). The diagnostic thresholds for severe and severe acute pancreatitis were PCT (0.4825ng/ml), hs-CRP (91.69mg/l), IL-6 (74.25pg/ml), Ranson score (3.5), sensitivity (Sensitivity,%) and four (88) four (88) %, 88.9%), hs-CRP (86%, 70.4%), IL-6 (72%, 77.8%), Ranson (92%, 100%). Using PCT combined hs-CRP two thresholds combined determination analysis, the area under the curve is (0.945 + 0.021), the sensitivity and specificity are: (80%, 96.3%). The application of PCT combined with Ranson score and two threshold determination analysis, the area under the curve is: (0.997), sensitivity and specificity (100%, 96.3%).3. were included in 104 patients. The proportion of severe and severe acute pancreatitis was about 48%.PCT, hs-CRP, IL-6, and Ranson scores were positively correlated with the severity of acute pancreatitis. The results were PCT (r=0.839, P 0.001), hs-CRP (r= 0.531, P 0.001), IL-6 (0.001, 0.001). .PCT, hs-CRP, IL-6, Ranson scores were analyzed in four cases, all of which were positively correlated with 100 patients. There was no statistical difference in age, sex, and Ranson scores in the two groups. The length of antibiotics used in the.D group was long, and the length of hospitalization was (13.58 + 8.42, 15.52 + 6.25). The length of the antibiotics used in the E group and the length of the length of hospitalization (all the mean number) were respectively. (17.34 + 4.95, 22.68 + 6.14, day); group D, group E antibiotics used long, long through two independent samples t test, P 0.05. two antibiotics single use or combined use of x2 test, P 0.05.[conclusion]1.PCT, Ranson score, CT classification can be used as a criterion for judging the severity of acute pancreatitis, three values or scores. The higher the level of acute pancreatitis, the higher the severity of acute pancreatitis; IL-6, hs-CRP can be used as a reference index for the assessment of mild pancreatitis,.2. for severe and severe acute pancreatitis, the diagnostic threshold is PCT (0.4825ng/ml), hs-CRP (91.69mg/l), IL-6 (74.25pg/ml), Ranson score (3.5), and the diagnostic value for acute pancreatitis: PCT combined Ranson The score of Ranson score PCT PCT combined with hs-CRP hs-CRP IL-6, indicating that the combination of PCT and Ranson score is the best for the diagnosis of severe acute pancreatitis and severe acute pancreatitis. It shows that the combined diagnosis of the two cases is better than the diagnostic value of.PCT combined with hs-CRP two. 6, the Ranson score four was positively correlated with the severity of acute pancreatitis, and the 22 phase analysis between the four was also a positive correlation.4. dynamic monitoring PCT value as an effective reference index for the guidance of severe and severe acute pancreatitis in the treatment of antibiotics.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
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