血清C反应蛋白、降钙素原及乳酸在重症急性胰腺炎中的变化及临床意义

目的 探讨血清C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)和乳酸在重症急性胰腺炎(severe acute pancreatitis, SAP)中的变化及其临床意义.方法 选取重症监护病房(ICU)于2013年4月至2016年4月期间收治的SAP患者68例,在患者入院后的第1、4、7天及好转后转出或死亡前分别对患者血清CRP含量、PCT浓度和乳酸水平进行检测评估APACHE-II分值,并根据患者的预后情况分为存活组和死亡组.分别采用免疫比浊法、电化学发光法和化学分析法检测存活组和死亡组血清CRP、PCT和乳酸水平.结果 存活组中,与第1天相比,第4天和第7天及转出前患者的血清CRP水平、PCT浓度、乳酸含量以及APACHE-II评分均显著性降低(P<0.05).在死亡组中,与第1天相比,第4天和第7天及转出前患者的血清CRP水平、PCT浓度、乳酸含量以及APACHE-II评分均显著性增加(P<0.05).与同时期存活组比较,死亡组患者的血清CRP水平、PCT浓度、乳酸含量以及APACHE-II评分均显著性增加(P<0.05).此外,血清CRP浓度、PCT水平和乳酸含量均与APACHE-II评分呈正相关(r=0.813, r=0.726, r=0.652,P<0.05).结论 随着SAP患者的病情发展,血清CRP含量、PCT水平、乳酸浓度以及APACHE-II评分出现不同程度的增加.这表明动态监测SAP患者血清CRP含量、PCT水平、乳酸浓度以及APACHE-II评分的改变有利于判断患者的病情发展方向以及采取有效的治疗手段,最终减少AP患者的死亡率.

The Change of Serum C-reactive Protein,Procalcitonin and Lactic AcidLevels in Patients with Severe Acute Pancreatitis andIts Clinical Significance

Objective To explore the levels of serum C-reactive protein (CRP), procalcitonin (PCT) as well as lactate in patients with severe acute pancreatitis (SAP) and evaluate their clinical values.Methods The clinical data of 68 cases of SAP in ICU from April 2013 to April 2016 were retrospectively reviewed, and divided into survived and non-survival groups on the basis of the outcome of patients.The levels of serum CRP, PCT, and lactate were measured and APACHE-II scores were calculated in both groups on 1, 4 as well as 7 days after admission and at discharge or prior to death.The concentrations of CRP, PCT as well as lactate were measured respectively by immune turbidimetry, electrochemical luminescence method and chemical analysis method.Results In the survival group, with the condition alleviating, the levels of serum CRP, PCT as well as lactate, and APACHE-II scores on 4 days and 7 days after the admission and at discharge were significantly reduced compared with 1 day (P<0.05).In the non-survival group, the level of serum CRP, PCT, lactate and APACHE-II scores on 4 days and 7 days after the admission and prior to death were obviously increased compared with day 1 (P<0.05).In addition, compared with survival group in the same period, the level of serum CRP, PCT as well as lactate and APACHE-II scores in the non-survival group were significantly increased (P<0.05).Furthermore, the levels of serum CRP, PCT as well as lactate were positively correlated with APACHE-II scores (r=0.813, r=0.726, r=0.652, P<0.05).Conclusion The levels of serum CRP, PCT, lactate as well as APACHE-II scores were significantly increased with the progression of SAP.Dynamic monitoring of the levels of serum CRP, PCT, lactate as well as APACHE-II scores should be helpful for judging the condition and prognosis of patients, taking effective treatments and finally decreasing the mortality rate of SAP patients.