【摘要】：背景：急性胰腺炎早期常常發(fā)生凝血指標異常,并且跟病情嚴重度緊密相關。然而,目前尚無研究相關研究闡清早期凝血指標變化與急性胰腺炎分級的關聯(lián)。目的：本研究旨在分析早期凝血指標變化與急性胰腺炎分級之間的關系并分析早期凝血指標在預測胰腺炎患者預后中的價值。方法：研究對象：本研究的研究對象為2008年1月至2012年12月收治南京軍區(qū)南京總醫(yī)院(金陵醫(yī)院)全軍普通外科研究所收治的急性胰腺炎患者。所有的患者符合急性胰腺炎(亞特蘭大標準),并且入院時離發(fā)病時間不超過72小時。排除標準：①患者一周以內(nèi)使用過抗凝、促凝藥物；②原發(fā)性肝功能不全③癌癥④再生功能障礙⑤懷孕⑥入院時小于18歲。分級標準：根據(jù)DBC標準、RAC標準資料收集：基礎數(shù)據(jù)包括入院當天年齡、性別、病因、Sofa評分、Ranson評分(48小時)、APACHE Ⅱ評分及PT、APTT、INR、TT、PLT、FIB和D-dimer等凝血指標。統(tǒng)計方法：本研究統(tǒng)計分析采用SPSS17.0軟件完成。所有檢驗都是雙側檢驗,P0.05為差異有統(tǒng)計學意義。ROC曲線被采用來分析比較凝血指標和傳統(tǒng)評分在對AP患者預后中的診斷價值。Somer's D檢驗用來分析不同指標跟DBC分級、RAC分級的相關性。不同AUC值和不同Somer's D值之間的比較用Sidak's檢驗來控制I類誤差。用z檢驗來比較不同指標與DBC分級、RAC分級及死亡率的相關性。Kruskal Wallis檢驗用來分析凝血指標與DBC分級、RAC分級的相關性,并用均值±標準差表示�？ǚ綑z驗用來分析不同DBC分級、RAC分級的死亡率差異和其他指標差異,并用百分比表示。結果：凝血指標與急性胰腺炎DBC分級、RAC分級顯著相關,其中PT、INR、APTT、 D-dimer和PLT水平有顯著差異(P0.05),TT和FIB不同分級之間沒有顯著的統(tǒng)計學差異(P0.05)。凝血指標與DBC分級、RAC分級的相關性比傳統(tǒng)的APACHE Ⅱ, Ranson和Sofa評分要差(Somer's D,表5,p0.05),但是用PT和INR與Ranson評分相比,ROC曲線下面積更高(0.925和0.920 VS.0.735,P=0.029和P=0.037)。PT和INR用來預測死亡的AUC曲線下面積比APACHE Ⅱ和Sofa評分更高,雖然沒有統(tǒng)計學差異(Table 8, p0.05).14.95s的PT值是最好的臨界值來預測住院死亡率(敏感性,0.875,特異性0.853),1.295 INR值是最好的臨界值來預測住院死亡率(敏感性,0.875,特異性為0.853)。結論：急性胰腺炎早期凝血指標與急性胰腺炎DBC分級、RAC分級顯著相關；雖然APACHE Ⅱ, Ranson和Sofa評分跟DBC分級、RAC分級的相關性更好,但是用PT和INR來預測死亡率其價值比APACHE Ⅱ, Ranson和Sofa更高。
[Abstract]:Background: coagulation abnormalities often occur in the early stage of acute pancreatitis and are closely related to the severity of the disease. However, there are no studies to elucidate the correlation between the changes of coagulation parameters and the grade of acute pancreatitis. Objective: to analyze the relationship between the changes of early coagulation parameters and the grade of acute pancreatitis and to analyze the value of early coagulation indexes in predicting the prognosis of patients with acute pancreatitis. Methods: the subjects of this study were the patients with acute pancreatitis admitted to the General Hospital of Nanjing military region (Jinling Hospital) from January 2008 to December 2012. All patients met acute pancreatitis (Atlanta standard) and were hospitalized within 72 hours of onset. Exclusion criteria: (1) patients had used anticoagulant and procoagulant drugs within one week; (2) primary liver insufficiency 3 cancer 4 regenerative dysfunction 5 pregnancy 6 were less than 18 years of age at admission. Grading standard: according to DBC standard and RAC standard data collection: the basic data included age, sex, etiology, Sofa score, Ranson score (48 hours), APACHE 鈪，

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