血小板异常评估急性胰腺炎严重程度的临床价值

目的 探讨血小板在急性胰腺炎（AP）患者中的变化及与AP严重程度和预后的关系.方法 比较重症急性胰腺炎（SAP）组和轻症急性胰腺炎（MAP）组血小板的计数变化.SAP组进一步分为血小板降低组和血小板正常组,比较两组局部并发症和多器官功能不全综合征（MODS）的发生率、病死率以及胰腺坏死程度与血小板计数（PLT）之间的关系,并分析差异有无统计学意义.分析血小板与APACHEⅡ评分系统、BISAP评分系统、CT评分系统、Ranson评分系统之间的相关性.结果 AP患者重症组与轻症组相比,PLT下降,血小板平均体积（MPV）升高,两组比较差异有统计学意义（P＜0.05）,PDW及PCT差异无统计学意义（P＞0.05）;SAP患者发病前3d首次PLT计数（＜100×109/L）的比例明显多于MAP组,差异有统计学意义（P＜0.001）;血小板降低组中局部并发症患者、MODS患者及病死率明显高于血小板正常组,两者相比差异有统计学意义（P ＜0.05）;SAP中胰腺坏死程度与血小板计数水平呈负相关性（P＜0.05）;血小板计数水平与CTSI评分标准相关性最强,其次是APACHEⅡ评分系统,而与Ranson评分系统无明显相关性.结论 血小板计数能够比较准确地反映AP的严重程度和预后,尤其在预测SAP局部并发症、MODS、坏死程度中有较高的临床价值.

Clinical value of platelet abnormalities in the assessment of severity of acute pancreatitis

Objective To evaluate the clinical value of the platelet parameters in acute pancreatitis.Methods The patients were divided into MAP group and SAP group.And the changes of platelets in SAP group and MAP group were compared.SAP group was further divided into reduce platelet group and normal platelet group.The local complications,the incidence of MODS,case fatality as well as the relationship between the degree of pancreatic necrosis and the plate-let count in the above two groups were compared.Moreover,the correlations were studied and analyzed among platelet count and four scoring systems-APACHE Ⅱ scoring system,BISAP scoring system,CTSI scoring system and the Ranson scoring system.Results Compared with MAP group,the PLT and MPV had significant difference in SAP group（P ＜0.05）,the PDW and PCT had no statistical difference between the two groups （P ＞ 0.05）.The ratio of platelet count （＜ 100 × 109/L） in SAP group in their first three days prior to the illness onset was obviously higher than that in MAP group（P ＜0.001）.The patients with local complications,MODS and mortality in platelet reduced group were significantly higher than those in platelet normal group （P ＜ 0.05）,the degree of pancreatic necrosis in SAP was negatively correlated with platelet count level（P ＜ 0.05）,platelets counts were closely associated with these three criteria of APACHE Ⅱ scoring system,BISAP scoring system and CTSI scoring system.Among them,the closest correlation with the level of platelet count in patients was CT grading standard and the second was the APACHE Ⅱ scoring system,the level of platelet count was not obviously related with Ranson scoring system.Conclusion The platelet count can more accurately reflect the severity of AP and prognosis,especially has a high clinical value in the prediction of local complications,MODS,the degree of necrosis in SAP.