急性胰腺炎患者血浆D-二聚体变化与病情相关性研究

目的 了解急性胰腺炎(AP)患者早期血浆D-二聚体变化与病情严重程度的关系.方法 通过临床症状、血清酶学、影像学和病理学诊断的61例AP患者分为重症AP(30例)和轻症AP(31例)两组,另选择30例健康正常人作为对照组,测定血浆D-二聚体.记录患者入院后各项实验室指标、48 h Ranson和24 h APACHEⅡ评分,了解D-二聚体含量与各项实验室指标、评分是否存在相关性.结果 (1)轻症AP和重症AP组血浆D-二聚体分别为(0.21±0.21)mg/L和(0.69±0.32)mg/L,与正常对照组(0.08±0.13)mg/L比较均显著升高(P值分别为0.029、0.000);重症AP组血浆D-二聚体水平高于轻症AP组(P=0.000).(2)AP患者血浆D-二聚体水平与48 h Ranson评分、24 hAPACHEⅡ评分均呈显著正相关(P值均为0.000).(3)AP患者血浆D-二聚体含量与白细胞计数、血糖、血肌酐、PT、APTT均呈显著正相关(P＜0.05);与红细胞压积、血白蛋白和血钙水平均呈显著负相关(P＜0.05).结论 AP患者血浆D-二聚体升高,D-二聚体含量和胰腺炎病情严重程度明显相关.

Serum D-dimer changes and prognostic implication in acute pancreatitis

OBJECTIVE: To investigate the role of D-dimer in human acute pancreatitis (AP) and its relation to the severity of the disease. METHODS: Plasma concentration of D-dimer was measured in 31 patients with mild AP (MAP), 30 patients with severe AP (SAP) and 30 normal people as a control group. The results of routine laboratory tests, 48-hour Ranson and 24-hour APACHE II scores were all recorded. We attempted to find a relationship between D-dimer level and the results of routine laboratory tests, 48-hour Ranson scores and 24-hour APACHE II scores. RESULTS: (1) As compared with the control group, the plasma concentration of D-dimer was much higher in MAP (0.21 +/- 0.21) mg/L (P = 0.029) and SAP patients (0.69 +/- 0.32) mg/L (P = 0.000). The D-dimer level in the SAP group was higher than that in the MAP group (P = 0.000). (2) The rise in the D-dimer level was directly related to 48-hour Ranson (P = 0.000) and 24-hour APACHE II scores (P = 0.000). (3) The rise in the D-dimer level was directly related to leukocyte count, blood glucose, creatinine, prothrombin time and partial thromboplastin time (P < 0.05) and inversely related to hematocrit, albumin and calcium (P < 0.05). CONCLUSIONS: Plasma concentration of the D-dimer rises in AP patients; D-dimer level is related to the disease severity.