重症急性胰腺炎患者凝血功能紊乱的临床研究

目的 探讨重症急性胰腺炎(SAP)患者血浆凝血系统的变化、发病机制及临床意义.方法收集北京大学人民医院2005年1月至2008年12月期间收治的207例AP患者,其中SAP组53例,MAP组154例,检测患者血浆凝血指标PT,PTA,PT-INR,APTT,FIB及D-dimmer.结果 与MAP组比较,SAP组PT,PTA,FT-INR,FIB及D-dimmer差异均有统计学意义[MAP组分别为(12.45±1.13)s,(94.01±21.21)%,(1.08±0.14),(4.81±1.86)g/L,340.38 ng/mL;SAP组分别为(13.08±1.47)s,(86.92±17.36)%,(1.14±0.20),(5.49±2.30)g/L,943.82 ng/mL;P<0.05],两组APTT差异无统计学意义(P>0.05).D-dirmner与APACHEⅡ评分,D-dimmer与SIRS评分均存在一定相关性(P<0.05).SAP组并发SIRS的发生率(35.5%)与MAP组(10.4%)比较差异有统计学意义(P<0.05),SAP组病死率(5.6%)与MAP组(0)比较差异有统计学意义(P<0.05).结论SAP患者存在血浆凝血功能紊乱及微循环障碍,检测血浆凝血指标有助于评估AP患者的病情严重度及预后.

Alteration at coagulation function in patients with severe acute pancreatitis

Objective To evaluate the changes of blood coagulation and their clinical significance in pa-tients with severe acute pancreatitis (SAP). Method Two hundred and seven patients with acute pancreatitis ad-mitted from January 2005 to Deeember 2008 in People' s Hospital, Peking University, were recruited in this study. Patients were divided into two groups, severe acute pancreatitis (53 cases) and mild acute pancreatitis (154 cas-es), according to the diagnostic criteria set by the Chinese Medical Association in 2004. Plasma coagulation pa-rameters including prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimmer were redorded. Results Com-pared with MAP group, there were significant differences on PT, PTA, PT-INR, FIB, and D-dimmer in SAP group [in MAP group, (12.45 ± 1.13) s,(94.01±21.21)% ,(1.08±0.14),(4.81±1.86)g/L,340.38 ng/ mL, respectively;in SAP group, (13.08±1.47)s,(86.92±17.36) %, (1.14±0.20), (5.49±2.30)g/L, 943.82 ng/mL, respectively; P <0.05]. There was no significant difference on APTT between the two groups (P > 0.05). D-dimmer was correlated to the APACHE Ⅱ score , and it was also correlated to the SIRS score (P < 0.05). The rate of systemic inflammatory response syndrome (SIRS) and the mortality were higher in patients with SAP patients than those in the MAP patients (in SAP group, 35.5%, 5.6%, respectively; in MAP group, 10.4%, 0, respectively; P < 0.05). Conclusions Disorders of coagulation and microcirculation disturbances were observed in patients with severe acute pancreatitis. These alterations may be useful in the assessment of the disease severity and prognosis of patients with acute pancreatitis.