急性胰腺炎凝血功能與疾病預后的關系

夏譽，葉素貞

（溫州醫科大學附屬第一醫院，浙江 溫州 325015，1.急診科；2.康復醫學科）

·短 篇 論 著·

急性胰腺炎凝血功能與疾病預后的關系

夏譽1，葉素貞2

（溫州醫科大學附屬第一醫院，浙江 溫州 325015，1.急診科；2.康復醫學科）

目的：探討急性胰腺炎患者凝血功能、D-二聚體（D-dimer）與疾病預后的關系。方法：選取2016年1月至2016年12月溫州醫科大學附屬第一醫院急性胰腺炎患者208例，以及健康體檢者50例為對照組，將急性胰腺炎患者分為輕癥急性胰腺炎組（MAP組）和重癥急性胰腺炎組（SAP組）。比較各組凝血指標如凝血酶原時間（PT）、部分活化凝血酶原時間（APTT）、纖維蛋白原濃度（FIB）、D-dimer、血小板功能等，分析其與急性生理學與慢性健康狀況評分（APACHE I I）和Ca2+的相關性。結果：急性胰腺炎患者的PT和FIB顯著高于對照組（P＜0.01）；SAP組的PT、FIB、D-dimer及APACHE I I評分顯著高于MAP組（P＜0.01）；凝血功能指標PT、FIB、D-dimer、CRP均與Ca2+呈顯著負相關（r=-0.317、-0.249、-0.392、-0.362，P＜0.01）；PT、D-dimer與APACHE I I評分存在顯著正相關（r=0.270、0.203，P＜0.01）。結論：急性胰腺炎存在凝血功能障礙，以外源性凝血途徑為主，且與疾病預后相關；PT聯合D-dimer可以更好地預測疾病的嚴重程度。

急性胰腺炎；凝血功能；預后

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

急性胰腺炎（acute pancreatitis，AP）是臨床診療過程中常見的急腹癥，胰腺組織損傷，炎癥介質釋放，表現為全身炎癥反應綜合征。其中80%為輕癥AP（mild acute pancreatitis，MAP），可以在1～2周內恢復，另外的20%發展為重癥AP（severe acute pancreatitis，SAP），若伴發多臟器功能不全，病死率高達40%[1]。AP患者凝血系統受到破壞，胰腺組織釋放多種炎癥介質和組織因子，激活凝血系統，破壞凝血和抗凝系統的動態平衡，血小板也參與其中，嚴重者可引起彌散性血管內凝血（disseminated intravascular coagulation，DIC）[2]。通過早期評估AP的凝血功能并加以干預，可以有效地改善預后。……