夏誉，叶素贞

（温州医科大学附属第一医院，浙江 温州 325015，1.急诊科；2.康复医学科）

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急性胰腺炎凝血功能与疾病预后的关系

夏誉1，叶素贞2

（温州医科大学附属第一医院，浙江 温州 325015，1.急诊科；2.康复医学科）

目的：探讨急性胰腺炎患者凝血功能、D-二聚体（D-dimer）与疾病预后的关系。方法：选取2016年1月至2016年12月温州医科大学附属第一医院急性胰腺炎患者208例，以及健康体检者50例为对照组，将急性胰腺炎患者分为轻症急性胰腺炎组（MAP组）和重症急性胰腺炎组（SAP组）。比较各组凝血指标如凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、纤维蛋白原浓度（FIB）、D-dimer、血小板功能等，分析其与急性生理学与慢性健康状况评分（APACHE I I）和Ca2+的相关性。结果：急性胰腺炎患者的PT和FIB显著高于对照组（P＜0.01）；SAP组的PT、FIB、D-dimer及APACHE I I评分显著高于MAP组（P＜0.01）；凝血功能指标PT、FIB、D-dimer、CRP均与Ca2+呈显著负相关（r=-0.317、-0.249、-0.392、-0.362，P＜0.01）；PT、D-dimer与APACHE I I评分存在显著正相关（r=0.270、0.203，P＜0.01）。结论：急性胰腺炎存在凝血功能障碍，以外源性凝血途径为主，且与疾病预后相关；PT联合D-dimer可以更好地预测疾病的严重程度。

急性胰腺炎；凝血功能；预后

Abstract: Objective:To explore the relationship among coagulation function, D-dimer and prognosis in acute pancreatitis (AP).Methods:Two hundred and eight patients with AP and fifty healthy people (control group) in the First Affliated Hospital of Wenzhou Medical University from January 2016 to December 2016 were enrolled. AP patients were divided into mild group (MAP group) and severe group (SAP group). Prothrombin time (PT), part of the activation of prothrombin time (APTT), concentration of fibrinogen (FIB), D-dimer and platelet functions were compared. The relevance to acute physiology and chronic health evaluation (APACHE II)and Ca2+were analyzed.Results:The PT and FIB in AP patients were significantly higher than that in the control group (P＜0.01). The PT, FIB, D-dimer and APACHE II score in SAP group were significantly higher than that in MAP group (P＜0.01). Pearson correlation analysis showed that PT, FIB, CRP and D-dimer were negative correlation with Ca2+(r=-0.317, -0.249, -0.392, -0.362,P＜0.01), PT and D-dimer were significantly positive correlation with the APACHE II score (r=0.270, 0.203,P＜0.01).Conclusion:There is coagulation dysfunction in AP patients, mainly exogenous coagulation way, it’ s closely associated with the severity and prognosis of diseases.PT plus D-dimer is a better predictive value for AP.

Key words:acute pancreatitis; coagulation function; prognosis

急性胰腺炎（acute pancreatitis，AP）是临床诊疗过程中常见的急腹症，胰腺组织损伤，炎症介质释放，表现为全身炎症反应综合征。其中80%为轻症AP（mild acute pancreatitis，MAP），可以在1～2周内恢复，另外的20%发展为重症AP（severe acute pancreatitis，SAP），若伴发多脏器功能不全，病死率高达40%[1]。AP患者凝血系统受到破坏，胰腺组织释放多种炎症介质和组织因子，激活凝血系统，破坏凝血和抗凝系统的动态平衡，血小板也参与其中，严重者可引起弥散性血管内凝血（disseminated intravascular coagulation，DIC）[2]。通过早期评估AP的凝血功能并加以干预，可以有效地改善预后。……