急性胰腺炎凝血功能与疾病预后的关系

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摘要目的：探讨急性胰腺炎患者凝血功能、D-二聚体（D-dimer）与疾病预后的关系。方法：选取2016年1月至2016年12月温州医科大学附属第一医院急性胰腺炎患者208例，以及健康体检者50例为对照组，将急性胰腺炎患者分为轻症急性胰腺炎组（MAP组）和重症急性胰腺炎组（SAP组）。比较各组凝血指标如凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、纤维蛋白原浓度（FIB）、D-dimer、血小板功能等，分析其与急性生理学与慢性健康状况评分（APACHE II）和Ca2+的相关性。结果：急性胰腺炎患者的PT和FIB显著高于对照组（P＜0.01）；SAP组的PT、FIB、D-dimer及APACHE II评分显著高于MAP组（P＜0.01）；凝血功能指标PT、FIB、D-dimer、CRP均与Ca2+呈显著负相关（r=-0.317、-0.249、-0.392、-0.362，P＜0.01）；PT、D-dimer与APACHE II评分存在显著正相关（r=0.270、0.203，P＜0.01）。结论：急性胰腺炎存在凝血功能障碍，以外源性凝血途径为主，且与疾病预后相关；PT联合D-dimer可以更好地预测疾病的严重程度。

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关键词 ：急性胰腺炎, 凝血功能, 预后

Abstract： Objective: To explore the relationship among coagulation function, D-dimer and prognosis in acute pancreatitis (AP). Methods: Two hundred and eight patients with AP and fifty healthy people (control group) in the First Affliated Hospital of Wenzhou Medical University from January 2016 to December 2016 were enrolled. AP patients were divided into mild group (MAP group) and severe group (SAP group). Prothrombin time (PT), part of the activation of prothrombin time (APTT), concentration of fibrinogen (FIB), D-dimer and platelet functions were compared. The relevance to acute physiology and chronic health evaluation (APACHE II) and Ca2+ were analyzed. Results: The PT and FIB in AP patients were significantly higher than that in the control group (P<0.01). The PT, FIB, D-dimer and APACHE II score in SAP group were significantly higher than that in MAP group (P<0.01). Pearson correlation analysis showed that PT, FIB, CRP and D-dimer were negative correlation with Ca2+ (r=-0.317, -0.249, -0.392, -0.362, P<0.01), PT and D-dimer were significantly positive correlation with the APACHE II score (r=0.270, 0.203, P<0.01). Conclusion: There is coagulation dysfunction in AP patients, mainly exogenous coagulation way, it’ s closely associated with the severity and prognosis of diseases. PT plus D-dimer is a better predictive value for AP.

Key words： acute pancreatitis coagulation function prognosis

收稿日期: 2017-03-06

基金资助:温州市公益性科技计划项目（Y20160298，Y20160263）。

作者简介: 夏誉（1986-），男，浙江温州人，住院医师，硕士。

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https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I9/683

[1] 贲其稳, 袁耀宗. 重症急性胰腺炎综合治疗, 我们忽视了什么[J]. 中华医学杂志, 2012, 92(45): 3187-3188.
[2] AKBAL E, DEMIRCI S, KOÇAK E, et al. Alterations of platelet function and coagulation parameters during acute pancreatitis[J]. Blood Coagul Fibrinolysis, 2013, 24(3): 243-246.
[3] 中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编辑委员会, 《中华消化杂志》编辑委员会, 等. 中国急性胰腺炎诊治指南(2013, 上海)[J]. 中华胰腺病杂志, 2013, 13(2): 73-78.
[4] KIM S D, BAKER P, DELAY J, et al. Thrombomodulin expression in tissues from dogs with systemic inflammatory disease[J]. Vet Pathol, 2016, 53(4): 797-802.
[5] EGUCHI T, TSUJI Y, YAMASHITA H, et al. Efficacy of recombinant human soluble thrombomodulin in preventing walled-off necrosis in severe acute pancreatitis patients[J]. Pancreatology, 2015, 15(5): 485-490.
[6] SINGH V K, WU B U, BOLLEN T L, et al. A prospective evaluation of the bedside index for severity in acute pancre atitis score in assessing mortality and intermediate markers of severity in acute pancreatitis[J]. Am J Gastroenterol,2009, 104(4): 966-971.
[7] 潘玉玲, 唐红卫, 李绵洋, 等. 急性胰腺炎患者凝血功能、血小板相关参数的改变及其临床意义[J]. 国际检验医学杂志, 2014, (10): 1280-1281, 1284.
[8] ZHU R, WEI S, WU C, et al. Utility of clot formation and lysis assay to monitor global coagulation state of patientswith severe acute pancreatitis[J]. Dig Dis Sci, 2012, 57(5): 1399-1403.
[9] BADHAL S S, SHARMA S, SARAYA A, et al. Prognostic significance of D-dimer, natural anticoagulants and routine coagulation parameters in acute pancreatitis[J]. Trop Gastro enterol, 2012, 33(3): 193-199.
[10] 张冬磊, 杨宁, 郝建宇. 蛋白C和D-二聚体在58例高脂血症性急性胰腺炎中的变化[J]. 中华消化杂志, 2015, (6):415-418.
[11] 张冬磊, 杨宁, 郝建宇. 胆源性急性胰腺炎凝血指标与D-二聚体和蛋白C水平变化及其预测疾病严重程度价值[J].中华实用诊断与治疗杂志, 2016, 30(11): 1103-1105.
[12] LU J, LIAO L M, GENG Y X, et al. A double-blind, randomized, controlled study to explore the efficacy of rFVIIa on intraoperative blood loss and mortality in patients withsevere acute pancreatitis[J]. Thromb Res, 2014, 133(4): 574-578.
[13] LINDSTRÖM O K, TUKIAINEN E M, KYLÄNPÄÄ M L, et al. Thrombin generation in vitro and in vivo, and disturbed tissue factor regulation in patients with acute pancreatitis[J]. Pancreatology, 2011, 11(6): 557-566.
[14] KE L, NI H B, TONG Z H, et al. Efficacy of continuous regional arterial infusion with low-molecular-weight heparin for severe acute pancreatitis in a porcine model[J]. Shock, 2014, 41(5): 443-448.