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[1]陈意喆,柯路,李维勤.血栓调节蛋白对于急性胰腺炎患者胰腺坏死及总体预后的早期预测价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(01):15-20.[doi:10.3969/j.issn.1672-271X.2020.01.004]
　CHENYi-zhe,KELu,LIWei-qin.Thrombomodulin is an early indicator of pancreatic necrosis and overall prognosis in acute pancreatitis patients[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(01):15-20.[doi:10.3969/j.issn.1672-271X.2020.01.004]
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血栓调节蛋白对于急性胰腺炎患者胰腺坏死及总体预后的早期预测价值()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年01期
页码:
15-20
栏目:
临床研究
出版日期:
2020-01-06

文章信息/Info

Title:
Thrombomodulin is an early indicator of pancreatic necrosis and overall prognosis in acute pancreatitis patients
作者:
陈意喆; 柯路; 李维勤
作者单位：210002 南京，南京大学医学院附属金陵医院（东部战区总医院）重症医学中心[陈意喆（现在无锡市人民医院重症医学科工作）、柯路、李维勤]
Author(s):
CHEN　Yi-zhe;  KE　Lu;  LI　Wei-qin
（Department of Critical Care Medicine, Jinlin Hospital/General Hospital of Eastern Theater Command，Medical School of Nanjing University， Nanjing 210002， Jiangsu， China）
关键词:
血栓调节蛋白; 血管内皮损伤; 急性胰腺炎; 胰腺坏死
Keywords:
thrombomodulin;  vascular endothelial injury;  acute pancreatitis;  pancreatic necrosis
分类号:
R576
DOI:
10.3969/j.issn.1672-271X.2020.01.004
文献标志码:
A
摘要:
目的　探讨血栓调节蛋白（TM）对于急性胰腺炎（AP）患者并发胰腺坏死及总体预后的早期预测价值。 方法　回顾性分析2016年2月至12月间南京大学医学院附属金陵医院重症医学中心收治的49例18周岁以上AP急性期患者（入院距发病时间<72 h）的临床资料。比较患者的血浆TM、D-二聚体、降钙素原（PCT）、急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、急性胰腺炎严重程度床边指数评分（BISAP）、AP严重度分级、相关并发症[胰腺坏死、胰腺坏死面积、多器官功能障碍综合征（MODS）]等指标。 结果　①49例患者依据AP严重程度分级结果显示: 轻症患者15例（30.6%）、中重症患者22例（44.9%）、重症患者12例（24.5%），共有31例患者（63.3%）发生胰腺坏死。②轻症、中重症和重症AP患者的TM水平比较差异均有统计学意义（P<0.05）。③合并胰腺坏死患者的血浆TM水平显著高于未合并胰腺坏死患者[19.79(16.36～27.29)ng/mL vs 14.55(11.16～17.86)ng/mL，P=0.001]，随着胰腺坏死面积的增加，患者血浆TM水平也出现显著上升（P<0.001），而D-二聚体、PCT、APACHE Ⅱ评分和BISAP评分等传统指标在上述比较中差异亦有统计学意义。④合并MODS患者和未合并MODS患者的TM水平比较差异有统计学意义[30.59(24.22~37.79)ng/mL vs 16.36(12.90~19.22)ng/mL，P<0.001]。⑤TM、D-二聚体、PCT、APACHE Ⅱ评分和BISAP评分预测胰腺坏死的ROC曲线下面积分别为0.786（95%CI:0.657~0.914，P=0.001）、0.694（95%CI:0.541~0.848，P=0.024）、0.739（95%CI:0.589~0.889，P=0.006）、0.680（95%CI:0.527~0.833，P=0.037）及0.723（95%CI:0.569~0.877，P=0.010）。⑥出院后新发糖尿病患者的TM水平显著高于未合并新发糖尿病患者[21.16(16.99~31.68)ng/mL vs 15.06(12.57~17.43)ng/mL，P=0.017]。 结论　TM是一种可早期预测胰腺坏死发生和AP患者总体预后的可靠指标。
Abstract:
Objective　The aim of this study was to investigate the role of thrombomodulin (TM) as an early indicator of pancreatic necrosis and overall prognosis in acute pancreatitis (AP) patients.　Methods　From February 2016 to December 2016, the clinical characteristics of 49 adult AP patients admitted within 72 h of symptom onset in the ICU of Jinlin Hospital were retrospectively reviewed in this study. We retrospectively compared TM, D-dimer, procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and the bedside index of severity in acute pancreatitis (BISAP), the classification of AP and the prognosis (pancreatic necrosis, presence of pancreatic necrosis and multiple organ dysfunction syndrome). 　Results　①According to the severity classification of AP, 15 patients (30.6%) were diagnosed with mild AP, 22 patients (44.9%) developed moderate severe AP, and 12 patients (24.5%) suffered severe AP. Among all the 49 cases, 31 patients developed pancreatic necrosis. ②TM was significantly different in the mild, moderate and severe AP patients (P<0.05). ③The TM level of pancreatic necrosis patients was dramatically higher than that of the patients without pancreatitis necrosis [19.79(16.36～27.29)ng/mL vs 14.55(11.16～17.86)ng/mL, P=0.001]. Moreover, TM also showed significant difference in patients with different extent of pancreatic necrosis. Other traditional indicators such as D-dimer, PCT, APACHE II and BISAP also had statistical significance in the above comparisons. ④Patients with MODS had a significantly higher TM level than that of patients without MODS [30.59(24.22~37.79)ng/mL vs 16.36(12.90~19.22)ng/mL, P<0.001]. ⑤The areas under the ROC of TM, D-dimer, PCT, APACHE II and BISAP for predicting pancreatic necrosis were 0.786(95%CI:0.657~0.914, P=0.001), 0.694(95%CI:0.541~0.848, P=0.024), 0.739(95%CI:0.589~0.889, P=0.006), 0.680(95%CI:0.527~0.833, P=0.037) and 0.723(95%CI:0.569~0.877, P=0.010), respectively. ⑥The TM level of patients with new-onset diabetes was significantly higher than that of the patients without new-onset diabetes [21.16 (16.99~31.68)ng/mL vs 15.06(12.57~17.43)ng/mL, P=0.017].　Conclusion　The measurement of plasma TM is a useful early prognostic indictor of pancreatic necrosis and overall prognosis in AP patients.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81770641）
更新日期/Last Update: 2020-01-06