D-二聚体在预测小儿急性胰腺炎病程及预后中的作用。

The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis.

作者信息

Boskovic Aleksandra, Pasic Srdjan, Soldatovic Ivan, Milinic Nikola, Stankovic Ivica

机构信息

Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia.

Department of Immunology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia.

出版信息

Pancreatology. 2014 Sep-Oct;14(5):330-4. doi: 10.1016/j.pan.2014.07.015. Epub 2014 Aug 8.

DOI:10.1016/j.pan.2014.07.015

PMID:25163808

Abstract

BACKGROUND

Current predictive severity scores for pediatric acute pancreatitis are either extrapolated from adult studies or difficult to use in practice. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity and outcome in pediatric AP.

METHODS

36 patients (aged 1-17 yrs) with AP were included in the study. Levels of D-dimer and other routine laboratory parameters for AP were determined on admission. The Pediatric Acute Pancreatitis Severity Score was used to assess disease severity. The development of systemic and local complications was also recorded.

RESULTS

D-dimer level was significantly higher in a group of patients with complications, median 1189.5 (271-4800) vs 172.5 (105-1086) in a group of patients without complications (p < 0.001). D-dimer showed high precision in the prediction of acute necrotic collection, with the optimal cut-off values of 442.5 μg/L, Sensitivity (Sn) 100%, Specificity (Sp) 62.1% and in the prediction of multiple organ failure with optimal cut-off value 1189 μg/L, Sn 100% and Sp 87.5%. According to the areas under the curve (AUCs) of each parameter, D-dimer seemed to have predictive power similar to PAPS score and higher than C-reactive protein and Lactate dehydrogenase level.

CONCLUSION

D-dimer level may be a simple clinical predictor of severity in pediatric acute pancreatitis.

摘要

背景

目前用于小儿急性胰腺炎的预测严重程度评分要么是从成人研究中推断而来，要么在实际应用中难以使用。本研究的目的是评估血浆D - 二聚体水平作为小儿急性胰腺炎严重程度和预后标志物的价值。

方法

36例年龄在1 - 17岁的急性胰腺炎患者纳入本研究。入院时测定急性胰腺炎患者的D - 二聚体水平和其他常规实验室参数。采用小儿急性胰腺炎严重程度评分来评估疾病严重程度。同时记录全身和局部并发症的发生情况。

结果

有并发症的患者组D - 二聚体水平显著更高，有并发症组的中位数为1189.5（271 - 4800），无并发症组为172.5（105 - 1086）（p < 0.001）。D - 二聚体在预测急性坏死性积液方面显示出高准确性，最佳截断值为442.5μg/L，灵敏度（Sn）100%，特异度（Sp）62.1%；在预测多器官功能衰竭方面，最佳截断值为1189μg/L，Sn 100%，Sp 87.5%。根据各参数的曲线下面积（AUC），D - 二聚体似乎具有与小儿急性胰腺炎严重程度评分（PAPS）相似的预测能力，且高于C反应蛋白和乳酸脱氢酶水平。