本文選題：急性胰腺炎 + α-黑色素細(xì)胞刺激素��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的急性胰腺炎(Acute pancreatitis,AP)目前是臨床上一種常見的急腹癥,并逐年呈上升趨勢(shì)。雖然近年來AP的治療逐漸規(guī)范化,但病死率及復(fù)發(fā)率仍居高不下。及時(shí)評(píng)估病情、尋找一種能及時(shí)反映患者病情的臨床指標(biāo)不僅有利于早期的臨床干預(yù),同時(shí)對(duì)患者病情進(jìn)展及治療方案調(diào)整有著重要意義。目前臨床上已有許多評(píng)分及指標(biāo)應(yīng)用于AP的病情評(píng)估,但其所涉及的指標(biāo)過多,測(cè)量步驟繁瑣、花費(fèi)時(shí)間長(zhǎng)或準(zhǔn)確性及靈敏度低。因此,本文旨在通過對(duì)外周血α-黑色素細(xì)胞刺激素(alpha melanocyte stimulation hormone,α-MSH)、胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)、白介素-6(interleukin 6,IL-6)的動(dòng)態(tài)檢測(cè)研究其在評(píng)估AP病情嚴(yán)重度及預(yù)后方面的價(jià)值,并為臨床更早、更準(zhǔn)確的掌握病情,評(píng)估預(yù)后提供依據(jù)。方法選擇我院2015年6月至2016年3月期間收治的97例發(fā)病在24h以內(nèi)的急性胰腺炎(AP)患者作為研究對(duì)象,其中輕癥組56例、重癥組41例。所有患者入院后第1、3、5、7天抽取外周靜脈血,采用酶聯(lián)吸附法定量測(cè)定血清α-MSH、TAP、IL-6水平。重癥組患者入院時(shí)給予一次急性生理及慢性健康狀況評(píng)分(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序貫性器官衰竭評(píng)估評(píng)分(Sequential organ failur assessment,SOFA)及Ranson評(píng)分。然后進(jìn)行數(shù)據(jù)的收集,對(duì)輕癥組與重癥組數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析;再對(duì)重癥組中發(fā)生多器官功能障礙綜合征(MODS)及未發(fā)生多器官功能障礙綜合征(非MODS)進(jìn)行統(tǒng)計(jì)學(xué)比較及ROC回歸曲線分析。結(jié)果通過研究發(fā)現(xiàn),與輕癥組相比,重癥組血清α-MSH水平較低(P0.05),血清IL-6及前3天血清TAP水平明顯高于輕癥組(P0.05)。在病情預(yù)后評(píng)估方面,α-MSH敏感度80.3%、特異度72.0%、曲線下面積0.848;SOFA評(píng)分敏感度80.2%、特異度72.4%、曲線下面積0.819;Ranson評(píng)分敏感度76.7%、特異度72.1%、曲線下面積0.818;APACHE-Ⅱ評(píng)分敏感度80.1%、特異度70.3%、曲線下面積0.789;TAP敏感度62.8%、特異度70.1%、曲線下面積0.675;IL-6敏感度75.3%,特異度60.1%、曲線下面積0.693;α-MSH、TAP及IL-6聯(lián)合敏感度87.0%、特異度75.0%、曲線下面積0.906。結(jié)論外周血α-MSH、TAP、IL-6水平在急性胰腺炎病情嚴(yán)重度評(píng)估上具有一定的臨床價(jià)值,可以用于評(píng)估AP病情嚴(yán)重程度。在評(píng)估患者預(yù)后方面,α-MSH敏感性、特異性及準(zhǔn)確度均高于TAP及IL-6,另外,三者共同檢測(cè)具有更高的敏感性、特異性及準(zhǔn)確度。
[Abstract]:Objective at present, acute pancreatitis (AP) is a common acute abdomen, and it is increasing year by year. Although the treatment of AP is gradually standardized in recent years, the mortality and recurrence rate are still high. Timely evaluation of the patient's condition and finding a clinical index that can reflect the patient's condition in time are not only beneficial to the early clinical intervention, but also of great significance to the progress of the patient's condition and the adjustment of the treatment plan. At present, many clinical scores and indicators have been applied to the assessment of AP's condition, but they involve too many indicators, the measurement steps are tedious, and it takes a long time or low accuracy and sensitivity. Therefore, the purpose of this study was to evaluate the clinical significance of 偽 -melanocyte stimulating hormone (alpha melanocyte stimulation hormone, 偽 -MSH), trypsinogen activated peptide (trypsinogen activation peptidetad tap) and interleukin-6 (interleukin 6 IL-6) in evaluating the severity and prognosis of AP. A more accurate grasp of the disease, evaluation of prognosis to provide the basis. Methods from June 2015 to March 2016, 97 cases of acute pancreatitis (AP) with onset within 24 hours were selected as study subjects, including 56 cases of mild disease group and 41 cases of severe group. Peripheral venous blood was collected from all patients on the 1st day of admission, and the serum level of 偽 -MSHtapine IL-6 was measured by enzyme-linked adsorption assay (Elisa). The patients in the severe group were given once acute physiological and chronic health status score (Acute physiology and chronic health evaluation 鈪，

本文編號(hào)：2060187