急性胰腺炎患者实验室指标与疾病严重程度的关系

摘要

目的：探讨急性胰腺炎（AP）患者血钙、尿素氮（BUN）、D-二聚体、C-反应蛋白（CRP）、纤维蛋白原及淀粉酶水平与疾病严重程度的关系。方法114例AP患者中轻度AP（MAP组）70例，中度AP（MSAP组）18例，重度AP （SAP组）26例，比较各组实验室指标水平，并分析各指标与急性生理学与慢性健康评估系统Ⅱ（APACHEⅡ）评分的相关性；ROC曲线分析CRP、D-二聚体、纤维蛋白原诊断SAP的敏感性。结果 MSAP组、SAP组BUN、CRP、D-二聚体、纤维蛋白原和APACHEⅡ评分均高于MAP组，血钙低于MAP组；SAP组APACHEⅡ评分高于MSAP组（P＜0.05）；各组间血淀粉酶差异无统计学意义。APACHEⅡ评分与CRP、D-二聚体、纤维蛋白原呈正相关（r分别是0.407、0.404、0.245，均P＜0.05），与血钙呈负相关（r=-0.333，P＜0.05）。ROC曲线显示CRP诊断SAP曲线下面积最大为0.752（95%CI为0.644～0.860），cut-off值是74.45 mg/L，灵敏度为86.4%，特异度为68.2%。结论联合监测BUN、凝血指标、CRP、血钙等实验室指标，有助于综合评价AP患者的病情，改善患者的预后。%Objective To investigate the relationship between values of blood calcium, serum urea nitrogen (BUN), D-dimer, C-reactive protein (CRP), fibrinogen and amylase with the severity of the disease in patients with acute pancreatitis (AP). Methods There were 70 patients with mild AP (MAP group), 18 patients with moderate AP (MSAP group), 26 pa⁃tients with severe acute pancreatitis (SAP group) in 114 AP patients. The laboratory indexes were compared between these groups. The correlation between indexes and the acute physiology and chronic health evaluation systemⅡ (APACHE Ⅱ) score was analysed. The diagnostic sensitivity of SAP using CRP, D-dimer and fibrinogen was analysed by ROC curves. Re⁃sults Compared with MAP group, values of BUN, CRP, D-dimer,fibrinogen and APACHEⅡscore were significantly increased in SAP group (P<0.05), but serum calcium level was significantly decreased (P<0.05). The APACHEⅡscore were significantly higher in SAP group than that of MSAP group (P<0.05). There were no significant differences in level of amylases between three groups. There was a positive correlation between APACHEⅡscore, CRP, D-dimer and fibrinogen (r=0.407, 0.404 and 0.245, P<0.05). There was a negative correlation between APACHEⅡscore and serum calcium level (r=-0.333, P<0.05). The area under the ROC curve showed a maximum CRP curve for diagnosing SAP 0.752 (95%CI=0.644-0.860). The cut-off value was 74.45 mg/L. The sensitivity was 86.4%. And the specificity was 68.2%. Conclusion Combining with monitoring BUN, blood coagulation index, CRP, serum calcium level and other laboratory parameters was useful to overall evaluate AP patients and improve the prognosis.