Radenkovic Dejan, Bajec Djordje, Ivancevic Nenad, Milic Natasa, Bumbasirevic Vesna, Jeremic Vasilije, Djukic Vladimir, Stefanovic Branislava, Stefanovic Branislav, Milosevic-Zbutega Gorica, Gregoric Pavle
Center for Emergency Surgery, School of Medicine, Surgical Department, University of Belgrade, Belgrade, Serbia.
Pancreas. 2009 Aug;38(6):655-60. doi: 10.1097/MPA.0b013e3181a66860.
Studies on the clinical value of parameters of hemostasis in predicting pancreatitis-associated complications are still scarce. The aim of this prospective study was to identify the useful hemostatic markers for accurate determination of the subsequent development of organ failure (OF) during the very early course of acute pancreatitis (AP).
In 91 consecutive primarily admitted patients with AP, prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin III, protein C, plasminogen activator inhibitor 1, D-dimer, and plasminogen were measured in plasma within the first 24 hours of admission and 24 hours thereafter. Two study groups comprising 24 patients with OF and 67 patients without OF were compared.
Levels of prothrombin time, fibrinogen, and D-dimer on admission were significantly different between the OF and non-OF groups, and all these parameters plus antithrombin III were significantly different 24 hours later. A D-dimer value of 414.00 microg/L on admission was the best cutoff value in predicting the development of OF with sensitivity, specificity, and positive and negative predictive values of 90%, 89%, 75%, and 96%, respectively.
Measurement of plasma levels of D-dimer on the admission is an accurate method for the identification of patients who will develop OF in the further course of AP.
关于止血参数在预测胰腺炎相关并发症临床价值的研究仍然较少。这项前瞻性研究的目的是确定在急性胰腺炎（AP）极早期过程中用于准确判定随后是否发生器官衰竭（OF）的有用止血标志物。
对91例连续首次入院的AP患者，在入院后24小时内及之后24小时检测血浆中的凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、抗凝血酶III、蛋白C、纤溶酶原激活物抑制剂1、D-二聚体和纤溶酶原。比较包括24例发生OF的患者和67例未发生OF的患者的两个研究组。
入院时OF组和非OF组的凝血酶原时间、纤维蛋白原和D-二聚体水平有显著差异，24小时后所有这些参数加上抗凝血酶III也有显著差异。入院时D-二聚体值为414.00μg/L是预测OF发生的最佳临界值，其敏感性、特异性、阳性预测值和阴性预测值分别为90%、89%、75%和96%。
入院时检测血浆D-二聚体水平是识别AP后续过程中会发生OF患者的准确方法。
