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目的了解急性胰腺炎患者早期血浆凝血和纤溶指标的变化规律及其与病情严重程度的关系。方法将通过临床症状、血清酶学、影象学和病理学诊断的42例急性胰腺炎患者分为重症急性胰腺炎(n=21)和轻症急性胰腺炎(n=21)2组,另选择20例健康正常人作为对照组,测定其血浆凝血酶原时间(PT)、部分活化凝血酶原时间(aPTT)、凝血酶原时间国际标准化比率(INR)、纤维蛋白原(Fbg)、血小板(PLT)和D-二聚体(D-D)。记录患者入院后各项实验室指标、48hRanson和24hAPACHEⅡ评分,了解以上指标含量与急性胰腺炎评分是否存在相关性。结果①与轻症急性胰腺炎(MAP)比较,重症急性胰腺炎(SAP)患者白细胞计数、甘油三脂、血糖、肌苷、24hAPACHEⅡ评分和48hRanson评分显著升高(P<0.05);红细胞压积、白蛋白和血钙显著降低(P<0.05)。②与对照组比较,MAP组血浆PT、aPTT、INR和Fbg均升高(P>0.05),D-D升高显著(P<0.05);与MAP组比较,SAP患者血浆PT、aPTT、INR和Fbg均升高(P<0.05),D-D升高显著(P<0.05);与MAP组比较,SAP患者血浆PT、aPTT、INR、Fbg和D-D含量均显著升高(P<0.05)。③血浆PT、aPTT、INR、Fbg和D-D含量与48hRanson和24hAPACHEⅡ分值均呈显著正相关(P<0.05)。结论急性胰腺炎患者凝血纤溶障碍与病情严重程度相关。
Objective To investigate the changes of early blood coagulation and fibrinolysis in patients with acute pancreatitis and its relationship with the severity of the disease. Methods 42 cases of acute pancreatitis diagnosed by clinical symptoms, serum enzymes, imaging and pathology were divided into two groups: severe acute pancreatitis (n = 21) and mild acute pancreatitis (n = 21) Twenty healthy controls were selected as control group, and their plasma prothrombin time (PT), partial activated prothrombin time (aPTT), international normalized ratio of prothrombin time (INR), fibrinogen (Fbg), platelet (PLT) and D-dimer (DD). All patients were recorded after admission to the laboratory indicators, 48hRanson and 24hAPACHE Ⅱ score to understand the above indicators and acute pancreatitis score whether there is a correlation. Results Compared with mild acute pancreatitis (MAP), white blood cell count, triglyceride, blood glucose, inosine, 24hAPACHEⅡscore and 48hRanson score in patients with severe acute pancreatitis (SAP) were significantly increased (P <0.05) , Albumin and serum calcium decreased significantly (P <0.05). Compared with the control group, plasma PT, aPTT, INR and Fbg were significantly increased (P> 0.05) and DD increased significantly in MAP group (P <0.05); Compared with MAP group, plasma PT, aPTT, INR and Fbg (P <0.05), and DD increased significantly (P <0.05). Compared with MAP group, the levels of PT, aPTT, INR, Fbg and DD in SAP patients were significantly increased (P <0.05). ③ Plasma PT, aPTT, INR, Fbg and D-D levels were significantly and positively correlated with 48hRanson and 24hAPACHEⅡscores (P <0.05). Conclusion The coagulopathies in patients with acute pancreatitis are related to the severity of the disease.