Dumnicka Paulina, Kuśnierz-Cabala Beata, Sporek Mateusz, Mazur-Laskowska Małgorzata, Gil Krzysztof, Kuźniewski Marek, Ceranowicz Piotr, Warzecha Zygmunt, Dembiński Artur, Bonior Joanna, Drożdż Ryszard
Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland.
Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kopernika 15A, 31-501 Kraków, Poland.
Int J Mol Sci. 2017 Apr 2;18(4):753. doi: 10.3390/ijms18040753.
In severe acute pancreatitis (SAP), systemic inflammation leads to endothelial dysfunction and activation of coagulation. Thrombotic disorders in acute pancreatitis (AP) include disseminated intravascular coagulation (DIC). Recently, angiopoietin-2 and soluble fms-like tyrosine kinase 1 (sFlt-1) were proposed as markers of endothelial dysfunction in acute states. Our aim was to assess the frequency of coagulation abnormalities in the early phase of AP and evaluate the relationships between serum angiopoietin-2 and sFlt-1 and severity of coagulopathy. Sixty-nine adult patients with AP were recruited: five with SAP, 15 with moderately severe AP (MSAP) and 49 with mild AP. Six patients were diagnosed with DIC according to International Society on Thrombosis and Haemostasis (ISTH) score. All patients had at least one abnormal result of routine tests of hemostasis (low platelet count, prolonged clotting times, decreased fibrinogen, and increased D-dimer). The severity of coagulopathy correlated with AP severity according to 2012 Atlanta criteria, bedside index of severity in AP and duration of hospital stay. D-dimers correlated independently with C-reactive protein and studied markers of endothelial dysfunction. Angiopoietin-2, D-dimer, and ISTH score were best predictors of SAP, while sFlt-1 was good predictor of MSAP plus SAP. In clinical practice, routine tests of hemostasis may assist prognosis of AP.
在重症急性胰腺炎（SAP）中，全身炎症会导致内皮功能障碍和凝血激活。急性胰腺炎（AP）中的血栓形成障碍包括弥散性血管内凝血（DIC）。最近，血管生成素-2和可溶性fms样酪氨酸激酶1（sFlt-1）被提议作为急性状态下内皮功能障碍的标志物。我们的目的是评估AP早期凝血异常的发生率，并评估血清血管生成素-2和sFlt-1与凝血病严重程度之间的关系。招募了69例成年AP患者：5例为SAP，15例为中度重症AP（MSAP），49例为轻症AP。根据国际血栓与止血学会（ISTH）评分，6例患者被诊断为DIC。所有患者的常规止血检查至少有一项异常结果（血小板计数低、凝血时间延长、纤维蛋白原降低和D-二聚体升高）。根据2012年亚特兰大标准、AP严重程度床边指数和住院时间，凝血病的严重程度与AP严重程度相关。D-二聚体与C反应蛋白和所研究的内皮功能障碍标志物独立相关。血管生成素-2、D-二聚体和ISTH评分是SAP的最佳预测指标，而sFlt-1是MSAP加SAP的良好预测指标。在临床实践中，常规止血检查可能有助于AP的预后评估。
