急性胰腺炎病程中反应性血小板增多的临床意义。
Clinical significance of reactive thrombocytosis in the course of acute pancreatitis.
机构信息
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-Ku, Tokyo, 173-8610, Japan.
出版信息
BMC Gastroenterol. 2023 Jun 13;23(1):206. doi: 10.1186/s12876-023-02837-w.
BACKGROUND
Reactive thrombocytosis occurs secondary to systemic infections, inflammatory, and other conditions. The relationship between thrombocytosis and acute pancreatitis (AP) in inflammatory diseases is uncertain. This study aimed to evaluate the clinical significance of thrombocytosis in AP patients during hospitalization.
METHODS
Subjects within 48 h of AP onset were consecutively enrolled over 6 years. Platelet counts of ≥ 450,000/µL were defined as thrombocytosis, < 100,000/µL as thrombocytopenia, and other counts as normal. We compared clinical characteristics, including the rate of severe AP (SAP) assessed by the Japanese Severity Score; blood markers, including hematologic and inflammatory factors and pancreatic enzymes during hospitalization; and pancreatic complications and outcomes in the three groups.
RESULTS
A total of 108 patients were enrolled. Although, SAP was more common in patients with thrombocytosis and thrombocytopenia (87.9% and 100%, respectively), the differences in lymphocytes and C-reactive protein, lactase dehydrogenase, and antithrombin levels, which are factors of the systemic inflammatory response, and the mean platelet volume, an indicator of platelet activation, were observed among patients with thrombocytosis and thrombocytopenia during hospitalization. Regarding pancreatic complications and outcomes, patients with thrombocytosis and thrombocytopenia had higher acute necrotic collection (ANC), pancreatic necrosis, intestinal paralysis, respiratory dysfunction, and pancreatic-related infection levels than patients with normal platelet levels. The relationship between pancreatic complications and thrombocytosis was assessed by multivariate logistic regression; the odds ratios for development of ANC, pancreatic necrosis and pancreatic-related infections were 7.360, 3.735 and 9.815, respectively.
CONCLUSIONS
Thrombocytosis during hospitalization for AP suggests development of local pancreatic complications and pancreatic-related infections.
背景
反应性血小板增多症继发于全身感染、炎症和其他情况。血小板增多症与炎症性疾病中急性胰腺炎（AP）之间的关系尚不确定。本研究旨在评估 AP 患者住院期间血小板增多的临床意义。
方法
在发病后 48 小时内，连续纳入 6 年来的患者。血小板计数≥450,000/μL 定义为血小板增多症，＜100,000/μL 定义为血小板减少症，其他计数定义为正常。我们比较了三组患者的临床特征，包括日本严重程度评分评估的 SAP 发生率；血液标志物，包括住院期间的血液学和炎症因子和胰腺酶；以及胰腺并发症和结局。
结果
共纳入 108 例患者。尽管血小板增多症和血小板减少症患者 SAP 更为常见（分别为 87.9%和 100%），但血小板增多症和血小板减少症患者的淋巴细胞和 C 反应蛋白、乳酸脱氢酶和抗凝血酶水平（全身炎症反应的因素）和血小板平均体积（血小板激活的指标）存在差异。关于胰腺并发症和结局，血小板增多症和血小板减少症患者的急性坏死性积聚（ANC）、胰腺坏死、肠麻痹、呼吸功能障碍和胰腺相关感染发生率高于血小板正常水平患者。通过多变量逻辑回归评估胰腺并发症与血小板增多症的关系；ANC、胰腺坏死和胰腺相关感染的发生比值比分别为 7.360、3.735 和 9.815。
结论
AP 住院期间的血小板增多提示局部胰腺并发症和胰腺相关感染的发生。
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