南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (7): 1006-1012.doi: 10.12122/j.issn.1673-4254.2022.07.06

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凝血相关的实验室指标对急性胰腺炎患者的病情和预后有较高预测价值

李 勤，刘超男，凌莉琴，黄珣钡，陈 思，周 静   

  1. 四川大学华西医院实验医学科，四川 成都 610041
  • 出版日期:2022-07-20 发布日期:2022-07-15

Association between coagulation function and prognosis in patients with acute pancreatitis

LI Qin, LIU Chaonan, LING Liqin, HUANG Xunbei, CHEN Si, ZHOU Jing   

  1. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
  • Online:2022-07-20 Published:2022-07-15

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摘要： 目的 探讨凝血功能相关指标与急性胰腺炎患者病情严重程度和预后相关性，寻找可以用于早期预测和/或动态监测急性胰腺炎预后的实验室指标。方法 回顾分析2017年12月1日~2018年11月30日在四川大学华西医院就诊的急性胰腺炎患者（入院距发病时间<72 h）的临床资料，分析患者入院时和住院期间的凝血功能相关指标的变化与急性胰腺炎预后的相关性。结果 共收录1260例急性胰腺炎患者，根据纳入和排除标准，最终有175例纳入本研究，其中52例为重症急性胰腺炎，12例患者死亡。Logistic回归分析提示，入院时检测vWF:Ag、PT、PC、AT Ⅲ和D-dimer指标可作为预测重症急性胰腺炎和/或死亡的独立危险因素；但是动态监测病程中的各指标能提高预测价值，尤其是vWF: Agmax、PTmax、APTTmax、TTmax、FIBmin、D-dimermax、PLTmin、PCmin、PLGmin、AT Ⅲmin以及以上各指标的变化值（△）是预测重症急性胰腺炎和/或死亡的独立危险因素。ROC分析提示，动态监测各指标的变化值，尤其是△vWF:Ag、△PT、△APTT、△FIB、△TT、△D-dimer、△PLT、△PC、△AT Ⅲ、△PLG可作为预测重症急性胰腺炎和/或死亡的有效实验室指标（AUC0.63-0.84）。结论 急性胰腺炎患者存在血管内皮损伤、凝血功能紊乱。入院时检测vWF:Ag、PT、PC、AT Ⅲ和D-dimer指标可作为预测重症急性胰腺炎和/或死亡的独立危险因素，在患者病情中动态监测vWF:Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ、PLG以及各指标的变化情况会进一步提高预测价值。

关键词: 急性胰腺炎；凝血功能；重症急性胰腺炎；死亡

Abstract: Objective To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP. Methods We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed. Results We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF:Ag, PT, PC, AT III and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Agmax, PTmax, APTTmax, TTmax, FIBmin, D-dimermax, PLTmin, PCmin, PLGmin, AT IIImin, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF:Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT III, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84). Conclusion Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF:Ag, PT, PC, AT III and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF:Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT III and PLG can further increase the predictive value.

Key words: acute pancreatitis; coagulation; severe acute pancreatitis; death