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1、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临床内科杂志2011年6月第28卷第6期JClinInternMed,June2011,Vol,28,No.6血功能异常在急性胰腺炎患者情和预后评估中的意义郑盛肖琼怡殷芳朱为梅郭致平王建刚杨兰艳刘海[中图分类号]R576[文献标识码]A[DOI]10.3969/j.issn.1001—9057.2011.06.010[摘要]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.方法人院24小时内对313例AP患者进行APACH
2、Em评分,同时抽取静脉血测定部分凝血活酶活化时间(APr丌),凝血酶原时间(PT),凝血酶时问(TT),D一二聚体(D—dimer),纤维蛋白原(FIB),抗凝血酶一m(AT—m)以及血小板(PLT)水平.结果(1)APTr,PT,D—dimer与APACHEⅢ评分之间呈正相关(P<0.05);AT—Ill,PLT与APACHEm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,
3、将PT,D—dimer引入APACHEm评分进行联合评分(PDA评分).APACHEm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APACHEm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APACHEm评分高,差异均有显着性.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Frf,D—dimer与APACHEllt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.[关键词]凝血;急性生理及慢性健
4、康状况评分m;急性胰腺炎;预后ThesignificanceofcoagulationfunctionabnormalityinassessingtheseverityandprognosisofacutepancreatitispatientszHENGSheng,XIAoQiongyi,Y1NFang,eta1.DepartmentofGastroen—terology.YunnanThirdPeople'sHospital,Kunming650011,China[Abstract]Objecti
5、veToexplorethechangesofcoagulationfunctionsinacutepancreatitispa—tientsandassessingitssignificanceintheseverityandprognosisofacutepancreatitis.MethodsChronichealthevaluationm(APACHEⅢ)scoresweredeterminedin313acutepancreatitispatientsadmittedtothehospita
6、lwithin24hours.Theactivityofpartialthromboplastintime(AP1),prothrombintime(PT),thrombintime(Tr),D—dimer(D—dimer),fibrinogen(FIB),anti—coagulationenzyme一Ⅲ(ATUI)andplatelet(PLT)weremeasured.Results(1)APrr,,D—dimerwaspositivelycorrelatedwithAPACHEmscore(P&
7、lt;0.05);ATⅢ,PIJTwasnegativelycorrelatedwithAPACHEllIscore(P<0.05).(2)Muh—ivariateLogisticregressionanalysisshowedthatPTandD—dimerwereindependentpredictorsonassessingtheoceurrenceanddeathprognosisofSIRS.ThepredictivevalliebetweenAPACHEⅢscoreandPDAsco
8、re(CombiningPT.D—dimerwithAPACHEⅢscore)wascompared.ForpredictingSIRS,thesensitivityandspecificitywithPDAscoreweresignificantlyhigherthanthosewithAPACHEmscore:ForpredictingthedeathprognosisinAPpatients,thesensitivityandspecificity
