凝血功能异常在急性胰腺炎患者病情和预后评估中的意义

目的研究急性胰腺炎（AP）患者凝血功能的改变及其对病情严重程度和预后判断的意义。方法入院24小时内对313例AP患者进行APACHEm评分，同时抽取静脉血测定部分凝血活酶活化时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）、D-二聚体（D—dimer）、纤维蛋白原（FIB）、抗凝血酶-III（AT-Ⅲ）以及血小板（PLT）水平。结果（1）APTF、PT、D—dimer与APACHEⅢ评分之间呈正相关（P〈0．05）；AT—III、PLT与APACHE III评分之间呈负相关（P〈0．05）。（2）多因素Logistic回归分析发现，PT、D—dimer对全身炎症反应综合征（SIRS）的发生及死亡预后具有独立预测意义，将PT、D—dimer引入APACHEm评分进行联合评分（PDA评分）。APACHE III评分与PDA评分进行预测价值比较，PDA评分对SIRS的预测灵敏度和特异度较APACHE III评分高，PDA评分对AP患者死亡预后的预测灵敏度和特异度较APACHE III评分高，差异均有显著性。结论AP患者凝血功能出现明显异常，凝血、抗凝、纤溶指标的紊乱程度与AP患者病情严重程度相关。将PT、D—dimer与APACHE III评分进行联合评分，可以提高AP患者病情早期评估及预后预测的准确性。

The significance of coagulation function abnormality in assessing the severity and prognosis of acute pancreatitis patients

Objective To explore the changes of coagulation functions in acute pancreatitis patients and assessing its significance in the severity and prognosis of acute pancreatitis. Methods Chronic health evaluation III （APACHE III ） scores were determined in 313 acute panereatitis patients admitted to the hospital within 24 hours. The activity of partial thromboplastin time（ APTr）, prothrombin time （PT）, thrombin time （ TT ） , D- dimer （D-dimer） , fibrinogen （ FIB ） , anti-coagulation enzyme - III （ AT III ） and platelet（PLT） were measured. Results （1）APTT, PT, D-dimer was positively correlated with APACHE m score （ P 〈 0.05 ） ; AT m, PLT was negatively correlated with APACHE III score （ P 〈 0.05 ）. （ 2 ） Multivariate Logistic regression analysis showed that PT and D-dimer were independent predictors on assessing the occurrence and death prognosis of SIRS. The predictive value between APACHE m score and PDA score（ Combining PT, D-dimer with APACHE III score） was compared. For predicting SIRS,the sensitivity and specificity with PDA score were significantly higher than those with APACHE III score;For predicting the death prognosis in AP patients, the sensitivity and specificity with PDA score were significantly higher than those with APACHE III score（72.8% and 80.5% respectively）. The differences were significant. Conclusion The coagulation function in AP patients changed obviously. The disorder degree of coagulation, anticoagulation and fibrinolysis was correlated with the severity degree of AP patients. PDA score can enhance the accuracy of early assessment and prognosis prediction in AP patients.