论文部分内容阅读
目的检测急性胰腺炎(acute pancreatitis,AP)患者血浆组织因子途径抑制剂(tissue factor pathway inhibitor,TFPI)水平,并评价其诊断重症急性胰腺炎(severe acute pancreatitis,SAP)的临床价值。方法取68名急性胰腺炎患者,包括SAP患者32例,轻型急性胰腺炎(mild acute pancreatitis,MAP)患者36例;另取同期门诊体检者20例为对照,均入院1 h内抽血样,收集临床及实验室参数,计算APACHEⅡ评分和Ranson评分;采用酶联免疫吸附测定(ELISA)方法检测血浆TFPI水平。结果 MAP组患者血浆TFPI浓度[(3026.81±465.76)pg/ml]较对照组明显升高[(2468.73±262.39)pg/ml](P<0.05),SAP患者血浆TFPI浓度[(4274.25±639.83)pg/ml]较MAP组明显升高(P<0.05)。相关分析显示,AP患者的血浆TFPI水平与白细胞计数(WBC)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、肌酐(Cr)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、降钙素原(PCT)、APACHEⅡ评分和Ranson评分呈显著正相关(P<0.05),与PLT呈显著负相关(P<0.05)。ROC曲线图分析显示,血浆TFPI水平诊断SAP发生的价值AUCSAP=0.902,95%CI=0.845~0.959(P<0.05),诊断界值为血浆TFPI浓度4028.83 pg/ml时,敏感度为87%,特异度为78%。结论 SAP患者的血浆TFPI水平可较正常人群和MAP患者显著升高,并与胰腺炎危重程度显著相关,可用于诊断SAP。
Objective To investigate the plasma level of tissue factor pathway inhibitor (TFPI) in patients with acute pancreatitis (AP) and evaluate its clinical value in the diagnosis of severe acute pancreatitis (SAP). Methods Sixty-eight patients with acute pancreatitis, including 32 SAP patients and 36 patients with mild acute pancreatitis (MAP), were enrolled in this study. Twenty patients in the same period were enrolled in the study. The clinical and laboratory parameters were collected and the APACHEⅡscore and Ranson score were calculated. The plasma TFPI level was detected by enzyme linked immunosorbent assay (ELISA). Results Compared with the control group, the plasma TFPI concentration in MAP group [(3026.81 ± 465.76) pg / ml] was significantly higher than that in control group [(2468.73 ± 262.39) pg / ml], and the plasma TFPI concentration in SAP group was (4274.25 ± 639.83) pg / ml] was significantly higher than MAP group (P <0.05). Correlation analysis showed that plasma TFPI levels in patients with AP correlated with WBC, AST, ALT, TBIL, Cr and prothrombin PT, APTT, PCT, APACHEⅡscore and Ranson score were significantly correlated (P <0.05), and negatively correlated with PLT (P <0.05). ROC curve analysis showed that the diagnostic value of plasma TFPI level for diagnosis of SAP was AUCSAP = 0.902, 95% CI = 0.845-0.959 (P <0.05), and the diagnostic limit was 87% when the plasma TFPI concentration was 4028.83 pg / The specificity is 78%. Conclusions Plasma TFPI levels in patients with SAP may be significantly higher than those in normal subjects and MAP patients and may be associated with the severity of pancreatitis.