急性胰腺炎早期凝血指标与病情严重度的相关性研究

发布时间：2018-11-06 12:37

【摘要】：背景：急性胰腺炎早期常常发生凝血指标异常,并且跟病情严重度紧密相关。然而,目前尚无研究相关研究阐清早期凝血指标变化与急性胰腺炎分级的关联。目的：本研究旨在分析早期凝血指标变化与急性胰腺炎分级之间的关系并分析早期凝血指标在预测胰腺炎患者预后中的价值。方法：研究对象：本研究的研究对象为2008年1月至2012年12月收治南京军区南京总医院(金陵医院)全军普通外科研究所收治的急性胰腺炎患者。所有的患者符合急性胰腺炎(亚特兰大标准),并且入院时离发病时间不超过72小时。排除标准：①患者一周以内使用过抗凝、促凝药物；②原发性肝功能不全③癌症④再生功能障碍⑤怀孕⑥入院时小于18岁。分级标准：根据DBC标准、RAC标准资料收集：基础数据包括入院当天年龄、性别、病因、Sofa评分、Ranson评分(48小时)、APACHE Ⅱ评分及PT、APTT、INR、TT、PLT、FIB和D-dimer等凝血指标。统计方法：本研究统计分析采用SPSS17.0软件完成。所有检验都是双侧检验,P0.05为差异有统计学意义。ROC曲线被采用来分析比较凝血指标和传统评分在对AP患者预后中的诊断价值。Somer's D检验用来分析不同指标跟DBC分级、RAC分级的相关性。不同AUC值和不同Somer's D值之间的比较用Sidak's检验来控制I类误差。用z检验来比较不同指标与DBC分级、RAC分级及死亡率的相关性。Kruskal Wallis检验用来分析凝血指标与DBC分级、RAC分级的相关性,并用均值±标准差表示。卡方检验用来分析不同DBC分级、RAC分级的死亡率差异和其他指标差异,并用百分比表示。结果：凝血指标与急性胰腺炎DBC分级、RAC分级显著相关,其中PT、INR、APTT、 D-dimer和PLT水平有显著差异(P0.05),TT和FIB不同分级之间没有显著的统计学差异(P0.05)。凝血指标与DBC分级、RAC分级的相关性比传统的APACHE Ⅱ, Ranson和Sofa评分要差(Somer's D,表5,p0.05),但是用PT和INR与Ranson评分相比,ROC曲线下面积更高(0.925和0.920 VS.0.735,P=0.029和P=0.037)。PT和INR用来预测死亡的AUC曲线下面积比APACHE Ⅱ和Sofa评分更高,虽然没有统计学差异(Table 8, p0.05).14.95s的PT值是最好的临界值来预测住院死亡率(敏感性,0.875,特异性0.853),1.295 INR值是最好的临界值来预测住院死亡率(敏感性,0.875,特异性为0.853)。结论：急性胰腺炎早期凝血指标与急性胰腺炎DBC分级、RAC分级显著相关；虽然APACHE Ⅱ, Ranson和Sofa评分跟DBC分级、RAC分级的相关性更好,但是用PT和INR来预测死亡率其价值比APACHE Ⅱ, Ranson和Sofa更高。
[Abstract]:Background: coagulation abnormalities often occur in the early stage of acute pancreatitis and are closely related to the severity of the disease. However, there are no studies to elucidate the correlation between the changes of coagulation parameters and the grade of acute pancreatitis. Objective: to analyze the relationship between the changes of early coagulation parameters and the grade of acute pancreatitis and to analyze the value of early coagulation indexes in predicting the prognosis of patients with acute pancreatitis. Methods: the subjects of this study were the patients with acute pancreatitis admitted to the General Hospital of Nanjing military region (Jinling Hospital) from January 2008 to December 2012. All patients met acute pancreatitis (Atlanta standard) and were hospitalized within 72 hours of onset. Exclusion criteria: (1) patients had used anticoagulant and procoagulant drugs within one week; (2) primary liver insufficiency 3 cancer 4 regenerative dysfunction 5 pregnancy 6 were less than 18 years of age at admission. Grading standard: according to DBC standard and RAC standard data collection: the basic data included age, sex, etiology, Sofa score, Ranson score (48 hours), APACHE 鈪，

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