Li Q, Liu C, Ling L, Huang X, Chen S, Zhou J
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2022 Jul 20;42(7):1006-1012. doi: 10.12122/j.issn.1673-4254.2022.07.06.
To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP.
We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed.
We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF: Ag, PT, PC, AT Ⅲ and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Ag, PT, APTT, TT, FIB, D-dimer, PLT, PC, PLG, AT Ⅲ, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF: Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT Ⅲ, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84).
Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF: Ag, PT, PC, AT Ⅲ and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF: Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ and PLG can further increase the predictive value.
探讨凝血功能与急性胰腺炎（AP）严重程度及预后的相关性，寻找早期预测及动态监测AP预后的实验室指标。
回顾性分析2017年12月1日至2018年11月30日我院收治的起病72 h内入院的AP患者的临床资料，分析入院时凝血功能相关指标及其住院期间变化与患者预后的相关性。
依据纳入及排除标准筛选出1260例AP患者资料，最终175例患者纳入本分析，其中52例为重症急性胰腺炎（SAP），12例死亡。Logistic回归分析确定入院时血管性血友病因子抗原（vWF:Ag）、凝血酶原时间（PT）、蛋白C（PC）、抗凝血酶Ⅲ（ATⅢ）及D-二聚体指标为预测SAP及死亡的独立危险因素。动态监测病程中凝血功能相关指标变化对患者预后有较大预测价值，vWF:Ag、PT、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体、血小板计数（PLT）、PC、纤溶酶原（PLG）、ATⅢ及其变化值均为预测SAP及死亡的独立危险因素。ROC分析提示动态监测指标变化，尤其是△vWF:Ag、△PT、△APTT、△FIB、△TT、△D-二聚体、△PLT、△PC、△ATⅢ、△PLG变化，可有效预测患者SAP及死亡情况（曲线下面积范围为0.63 - 0.84）。
AP患者存在血管内皮损伤及凝血功能紊乱。入院时vWF:Ag、PT、PC、ATⅢ及D-二聚体指标为预测SAP及死亡的独立危险因素，动态监测vWF:Ag、PT、APTT、TT、FIB、D-二聚体、PLT、PC、ATⅢ及PLG变化可进一步提高预测价值。
