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1、凝血功能異常在急性胰腺炎患者病情和預(yù)后評(píng)估中的意義臨床內(nèi)科雜志2011年6月第28卷第6期JClinInternMed,June2011,Vol,28,No.6血功能異常在急性胰腺炎患者情和預(yù)后評(píng)估中的意義鄭盛肖瓊怡殷芳朱為梅郭致平王建剛楊蘭艷劉海[中圖分類號(hào)]R576[文獻(xiàn)標(biāo)識(shí)碼]A[DOI]10.3969/j.issn.1001—9057.2011.06.010[摘要]目的研究急性胰腺炎(AP)患者凝血功能的改變及其對(duì)病情嚴(yán)重程度和預(yù)后判斷的意義.方法人院24小時(shí)內(nèi)對(duì)313例AP患者進(jìn)行APACHEm評(píng)分,同時(shí)抽取靜脈血
2、測(cè)定部分凝血活酶活化時(shí)間(APr丌),凝血酶原時(shí)間(PT),凝血酶時(shí)問(wèn)(TT),D一二聚體(D—dimer),纖維蛋白原(FIB),抗凝血酶一m(AT—m)以及血小板(PLT)水平.結(jié)果(1)APTr,PT,D—dimer與APACHEⅢ評(píng)分之間呈正相關(guān)(P<0.05);AT—Ill,PLT與APACHEm評(píng)分之間呈負(fù)相關(guān)(P<0.05).(2)多因素Logistic回歸分析發(fā)現(xiàn),PT,D—dimer對(duì)全身炎癥反應(yīng)綜合征(SIRS)的發(fā)生及死亡預(yù)后具有獨(dú)立預(yù)測(cè)意義,將PT,D—dimer引入APACHEm評(píng)分進(jìn)行
3、聯(lián)合評(píng)分(PDA評(píng)分).APACHEm評(píng)分與PDA評(píng)分進(jìn)行預(yù)測(cè)價(jià)值比較,PDA評(píng)分對(duì)SIRS的預(yù)測(cè)靈敏度和特異度較APACHEm評(píng)分高,PDA評(píng)分對(duì)AP患者死亡預(yù)后的預(yù)測(cè)靈敏度和特異度較APACHEm評(píng)分高,差異均有顯著性.結(jié)論AP患者凝血功能出現(xiàn)明顯異常,凝血,抗凝,纖溶指標(biāo)的紊亂程度與AP患者病情嚴(yán)重程度相關(guān).將Frf,D—dimer與APACHEllt評(píng)分進(jìn)行聯(lián)合評(píng)分,可以提高AP患者病情早期評(píng)估及預(yù)后預(yù)測(cè)的準(zhǔn)確性.[關(guān)鍵詞]凝血;急性生理及慢性健康狀況評(píng)分m;急性胰腺炎;預(yù)后Thesignificanceofcoag
4、ulationfunctionabnormalityinassessingtheseverityandprognosisofacutepancreatitispatientszHENGSheng,XIAoQiongyi,Y1NFang,eta1.DepartmentofGastroen—terology.YunnanThirdPeople'sHospital,Kunming650011,China[Abstract]ObjectiveToexplorethechangesofcoagulationfunctionsinacu
5、tepancreatitispa—tientsandassessingitssignificanceintheseverityandprognosisofacutepancreatitis.MethodsChronichealthevaluationm(APACHEⅢ)scoresweredeterminedin313acutepancreatitispatientsadmittedtothehospitalwithin24hours.Theactivityofpartialthromboplastintime(AP1),p
6、rothrombintime(PT),thrombintime(Tr),D—dimer(D—dimer),fibrinogen(FIB),anti—coagulationenzyme一Ⅲ(ATUI)andplatelet(PLT)weremeasured.Results(1)APrr,,D—dimerwaspositivelycorrelatedwithAPACHEmscore(P<0.05);ATⅢ,PIJTwasnegativelycorrelatedwithAPACHEllIscore(P<0.05).(2
7、)Muh—ivariateLogisticregressionanalysisshowedthatPTandD—dimerwereindependentpredictorsonassessingtheoceurrenceanddeathprognosisofSIRS.ThepredictivevalliebetweenAPACHEⅢscoreandPDAscore(CombiningPT.D—dimerwithAPACHEⅢscore)wascompared.ForpredictingSIRS,thesensitivitya
8、ndspecificitywithPDAscoreweresignificantlyhigherthanthosewithAPACHEmscore:ForpredictingthedeathprognosisinAPpatients,thesensitivityandspecificity
