李世思 郭志唐 陈章彬 滕毅山

[摘要]目的探討 D-二聚体（DD）、白细胞介素-6（IL-6）、C-反应蛋白（CRP）、降钙素原（PCT）对急性胰腺炎（AP）病情严重性的诊断价值。方法回顾性分析2018年1月至2020年5月昆明医科大学第二附属医院就诊的160例 AP 患者的临床资料，并根据病情分为轻症急性胰腺炎（MAP）组80例、重症急性胰腺炎（SAP）组80例，所有患者均在入院24 h 内抽血，分析患者的一般资料（性别、年龄）、住院时间和实验室相关指标[DD、IL-6、CRP、PCT、白细胞（WBC）、血小板（PLT）、丙氨酸氨基转移酶（ALT）、淀粉酶（AMY）]。结果 SAP 组患者入院24 h 内血清 DD、IL-6、CRP、PCT 水平显著高于 MAP 组，差异有统计学意义（ P <0.05）;两组患者血清 WBC、AMY、PLT、ALT 水平比较，差异无统计学意义（ P >0.05）;使用 DD、IL-6、CRP、PCT 四个指标单独检测诊断 SAP 的曲线下面积（AUC）分别为0.877、0.920、0.938、0.958，灵敏度分别为85.00%、77.50%、96.30%、92.50%，特异度分别为75.00%、93.75%、82.50%、91.25%;各项指标联合检测诊断 SAP 的 AUC 为0.998，灵敏度为98.80%，特异度为98.75%。结论血清 DD、IL-6、CRP、PCT 各指标分析检测均可用于预测早期胰腺炎患者是否向 SAP 发展，而各项指标联合检测诊断率更高，临床上可将其作为诊断 SAP 新的参考依据。

[关键词]急性胰腺炎; D-二聚体;白细胞介素-6; C-反应蛋白;降钙素原

[中图分类号] R659  [文献标识码] A   [文章编号]2095-0616（2021）23-0155-04

Diagnostic value of serum D-dimer， interleukin-6， C-reactive protein and procalcitonin testing for severe acute pancreatitis

LI  Shisi    GUO  Zhitang    CHEN  Zhangbin    TENG  Yishan

Department of Hepatobiliary and Pancreatic Surgery， the Second Affiliated Hospital of Kunming Medical University， Yunnan， Kunming 650101， China

[Abstract] Objective To explore the diagnostic value of D-dimer （DD）， interleukin-6（IL-6）， C-reactive protein （CRP） and procalcitonin （PCT） for the severity of acute pancreatitis （AP）. Methods The clinical data of 160 AP patients treated in The Second Affiliated Hospital of Kunming Medical University from January 2018 to May 2020 were analyzed retrospectively， and they were divided into 80 cases in the group of mild acute pancreatitis （MAP） and 80 cases in the group of severe acute pancreatitis （SAP） according to the disease condition. All the patients had their blood drawn within 24 h of admission. Their general information （gender and age）， hospitalization time and laboratory related indicators including DD， IL-6， CRP， PCT， white blood cells （WBC）， platelets （PLT）， alanine aminotransferase （ALT） and amylase （AMY） were analyzed. Results The serum DD， IL-6， CRP and PCT levels within 24 h of admission of the patients of the SAP group were significantly higher than those of the MAP group， with all the differences being statistically significant （P <0.05）. When serum WBC， AMY， PLT and ALT levels were compared between the two groups of patients， the differences were statistically insignificant （P >0.05）. When the four indices of DD， IL-6， CRP and PCT were respectively used alone to test and diagnosis of SAP， the area under curve （AUC） was respectively 0.877， 0.920， 0.938 and 0.958， the sensitivity was respectively 85.00%， 77.50%， 96.30% and 92.50%， and the specificity was respectively 75.00%， 93.75%， 82.50% and 91.25%. When the indices were jointly used for the test and diagnosis of SAP， the AUC was 0.998， the sensitivity was 98.80%， and the specificity was 98.75%. Conclusion The analysis and test of serum DD， IL-6， CRP and PCT indices respectively can be used to predict the development of SAP in the patients with early pancreatitis， and the combined test of all these indices can improve the diagnostic rate to a greater extent. It can be taken as a new reference for the diagnosis of SAP in clinical practice.

[Key words] Acute pancreatitis; D-dimer; Interleukin-6; C-reactive protein; Procalcitonin

急性胰腺炎（acute pancreatitis， AP）是多种病因致使胰酶在胰腺内被过早激活，导致胰腺及其周围组织发生自我消化、水肿、出血甚至坏死的炎症反应，临床上常表现为急性上腹痛、恶心、呕吐、和血胰酶增高[1]。根据疾病的严重程度，AP 可分为轻症急性胰腺炎（mild acute pancreatitis group，MAP）和重症急性胰腺炎（severe acute pancreatitis group， SAP）[2]。AP 的严重程度差异性较大，MAP 患者可逐渐康复，而 SAP 患者病情进展迅速，多数患者可出现全身性的炎症反应、多器官衰竭，甚至病死[3]。因此早期预测患者是否进展为 SAP，尽早给予针对性处理，对改善患者预后、降低病死率有重要意义。……