摘要
目的:探讨血浆降钙素原(PCT)、和肽素(Copeptin)及D-二聚体水平对急性胰腺炎(AP)病情严重程度及预后评估的价值。方法:选取2017-01-01—2019-12-31期间三亚中心医院收治的AP患者175例,根据其病情严重程度分为轻度胰腺炎(MAP)组(78例)、中度重型胰腺炎(MSAP)组(50例)和重症胰腺炎(SAP)组(47例)。47例SAP患者根据其预后情况分成存活组(30例)和死亡组(17例)。另选取60例健康体检者作为对照组。比较各组血浆PCT、Copeptin及D-二聚体水平。应用受试者工作特征(ROC)曲线分析血浆PCT、Copeptin及D-二聚体水平对SAP诊断及预后评估的价值。结果:AP组血浆PCT(2.65±0.84 vs.0.03±0.01,ng/mL)、Copeptin(2.37±0.45 vs.0.28±0.03,ng/mL)及D-二聚体(1.31±0.26 vs.0.35±0.04,mg/L)水平明显高于对照组(P<0.05)。SAP组血浆PCT(4.16±1.08 vs.2.73±0.92,1.51±0.36,ng/mL)、Copeptin(3.40±0.72 vs.2.58±0.53,1.40±0.28,ng/mL)及D-二聚体(2.17±0.85 vs.1.48±0.32,0.64±0.11,mg/L)水平均明显高于MSAP组和MAP组(P<0.05)。死亡组血浆PCT(4.82±1.58 vs.3.60±1.02,ng/mL)、Copeptin(4.17±0.95 vs.2.80±0.64,ng/mL)及D-二聚体(2.66±1.04 vs.1.75±0.42,mg/L)水平均明显高于存活组(P<0.05)。ROC曲线显示,PCT、Copeptin及D-二聚体3项联合诊断SAP的曲线下面积(0.894,95%CI:0.836~0.955)最大,其敏感度和特异度为90.4%和83.6%;3项联合预测SAP发生死亡的曲线下面积(0.930,95%CI:0.872~0.993)最大,其敏感度和特异度为95.0%和87.2%。结论:血浆PCT、Copeptin及D-二聚体水平升高与AP患者的病情严重程度相关,3项联合检测对SAP诊断和预后评估具有一定价值。
Objective:To investigate the value of plasma procalcitonin(PCT),Copeptin and D-dimer levels in evaluating the severity and prognosis of acute pancreatitis(AP).Method:One hundred and seventy-five AP patients admitted to Sanya Central Hospital from January 2017 to December 2019 were divided into 78 mild pancreatitis(map)group,50 moderate severe pancreatitis(MSAP)group and 47 severe pancreatitis(SAP)group according to their severity.Forty-seven SAP patients were divided into survival group(n=30)and death group(n=17)according to their prognosis.Sixty healthy examinees were selected as control group.Plasma PCT,Copeptin and D-dimer levels in each group were compared.The value of PCT,copeptin and D-dimer in the diagnosis and prognosis of SAP were analyzed by ROC curve.Result:The levels of PCT(2.65±0.84 vs.0.03±0.01,ng/mL),Copeptin(2.37±0.45 vs.0.28±0.03,ng/mL)and D-dimer(1.31±0.26 vs.0.35±0.04,mg/L)in AP group were significantly higher than those in control group(P<0.05).The levels of PCT(4.16±1.08 vs.2.73±0.92,1.51±0.36,ng/mL),Copeptin(3.40±0.72 vs.2.58±0.53,1.40±0.28,ng/mL)and D-dimer(2.17±0.85 vs.1.48±0.32,0.64±0.11,mg/L)in SAP group were significantly higher than those in MSAP group and MAP group(P<0.05).The PCT(4.82±1.58 vs.3.60±1.02,ng/mL),Copeptin(4.17±0.95 vs.2.80±0.64,ng/mL)and D-dimer(2.66±1.04 vs.1.75±0.42,mg/L)in the dead group were significantly higher than those in the survival group(P<0.05).ROC curve showed that the area under the curve(0.894,95%CI:0.836-0.955)with three combinations of PCT,Copeptin and D-dimer diagnoses of SAP were the largest,with sensitivity and specificity of 90.4%and 83.6%.The area under the curve(0.930,95%CI:0.872-0.993)of the three combined predictors of SAP death was the largest,with sensitivity and specificity of 95.0%and 87.2%.Conclusion:The increase of plasma PCT,Copeptin and D-dimer levels is related to the severity of AP patients.The combined detection of the three has certain value for the diagnosis and prognosis evaluation of SAP.
作者
吴开李
王连臣
符国宏
郑扬慈
WU Kaili;WANG Lianchen;FU Guohong;ZHENG Yangci(Department of General Surgery,Sanya Central Hospital,Sanya,Hainan,572000,China)
出处
《临床急诊杂志》
CAS
2020年第6期499-503,共5页
Journal of Clinical Emergency
基金
海南省医学科研基金资助(No:16A200517)。
