【作者】 舒金勇；

【导师】 孙维佳；

【作者基本信息】 中南大学 ， 普通外科学， 2010， 硕士

【摘要】 目的：结合APACHEⅡ评分及SOFA评分,评价血清降钙素原(procalcitonin, PCT)评估急性胰腺炎严重程度和判断预后的价值,探讨血清降钙素原浓度与急性胰腺炎患者发生重症急性胰腺炎及死亡之间的关系。方法：选取2009年5月-2010年3月在湘雅医院住院的急性胰腺炎患者41例,根据2008年美国急性胰腺炎临床指南将其分为轻症急性胰腺炎组(17例),重症急性胰腺炎组(24例),并随机选取正常健康志愿者15例作为对照组。同时将41例急性胰腺炎患者按照PCT浓度正常为<0.5ng/ml;轻度升高为0.5ng/ml≤PCT浓度<2.0ng/ml；明显升高为2.0ng/ml;为标准分为正常组,轻度升高组和明显升高组。对急性胰腺炎患者在入院后24小时内进行SOFA(Sepsis-related organ failure assessmen, SOFA)评分及APACHEⅡ(Acute physiology and chronic health evaluation, APACHEⅡ)评分,并抽取急性胰腺炎患者及健康志愿者外周静脉血用于PCT检测。密切追踪观察患者直至其出院,并记录住院期间的死亡病例数。将PCT浓度、APACHEⅡ评分、SOFA评分、病死率之间的关系进行分析。结果：1.血清PCT浓度重症急性胰腺炎组显著高于轻症急性胰腺炎组(p<0.001)和正常对照组(p<0.001)；轻症急性胰腺炎组显著高于正常对照组(p<0.001)2.将PCT浓度与APACHEⅡ评分及SOFA评分进行非参数等级相关分析,结果显示PCT浓度与APACHEⅡ评分(r=0.668,P<0.001)及SOFA评分(r=0.722,P<0.001)呈明显正相关。3.PCT浓度明显升高组的病死率大于PCT浓度轻度升高组的病死率(P=0.022)和PCT浓度正常组的病死率(P=0.006); PCT浓度轻度升高组的病死率与PCT浓度正常组的病死率差异无统计学意义(P=0.528)。4.采用logistic回归分析结果显示PCT是急性胰腺炎患者发生重症急性胰腺炎的危险因素。5.进一步采用logistic回归分析结果显示SOFA评分是急性胰腺炎患者死亡的危险因素。结论：1.检测血清PCT浓度可以客观判断急性胰腺炎患者病情的严重程度。2.PCT浓度越高,急性胰腺炎患者为重症急性胰腺炎的风险越大。3.PCT在低浓度时对急性胰腺炎患者的病死率没有影响；高浓度时,急性胰腺炎患者的病死率可能增大,但PCT不是急性胰腺炎患者死亡的危险因素。更多还原

【Abstract】 Objective:To assess the diagnostic and prognostic value of procalcitonin(PCT) and discuss the relations among PCT concentrations, severe acute pancreatitis and death in patients with acute pancreatitis by combining with APACHEⅡscore and SOFA score.Methods:The method adopted was to select a sample of 41 patients with acute pancreatitis from May 2009 to March 2010 in Xiangya Hospital.These patients were classified into mild acute pancreatitis group(17 cases), severe acute pancreatitis group (24 cases) according to the definition of Diagnosis and treatment guidelines for acute pancreatitis of USA in 2008. And 15 healthy volunteers were also chosen as a control group. Meanwhile,41 patients were divided into PCT concentrations normal groups,mild rise group and obvious rise group according to the normal PCT concentrations<0.5ng/ml,mild rise of 0.5ng/ml≤PCT concentrations<2.0ng/ml and obvious rise of PCT concentrations≥2.0ng/ml.SOFA score, APACHEⅡscore and blood samples were obtained with in 24 hours after admission. Blood samples were used to detect the concentrations of PCT.Through follow-up visit to the patients with acute pancreatitis,and record of the number of deaths, their relations were analyzed.Results:1. Procalcitonin concentrations was significantly higher in patients with severe acute pancreatitis than in patients with mild acute pancreatitis (▲p<0.001) and the control group(p<0.001).It was also found that the procalcitonin concentrations was much higher in patients with mild acute pancreatitis than that of the control group(p<0.001).2.PCT concentrations were positively correlated with the severity of acute pancreatitis. Spearman’s correlation coefficient between PCT concentrations and APACHEⅡscore was 0.668(p<0.001);and the Spearman’s correlation coefficient between PCT concentrations and SOFA score was 0.722(p<0.001).3.It was concluded that the case-fatality rate of the PCT concentrations obvious rise group was significantly higher than the group of PCT concentrations mild rise group (p=0.022) and that of PCT concentrations normal group(p=0.006). However,there was no statistic difference between PCT concentrations mild rise group and PCT concentrations normal group(p=0.528)4.Binary Logistic regression analysis confirmed that PCT concentrations was obviously correlated with severe acute pancreatitis when eliminating confusion factors including age,sex and SOFA score.5. SOFA score was found highly correlated with death in patients with acute pancreatitis by using binary Logistic regression analysis without considering confusion factors including age,sex,PCT and APACHEⅡscore.Conclusion:1. PCT concentrations detecting could be used to juge the severity of acute pancreatitis.2.Higher concentrations of PCT increases the risk of developing severe acute pancreatitis in patients with acute pancreatitis.3. When the PCT concentrations was at a lower level,it had no influence on the Fatality rate.If it was at a higher level, the Fatality rate might be rise up. But it was not the risk factor that leading to death in patients with acute pancreatitis.更多还原