CAJ | 학술논문

目的：检测急性胰腺炎（ acute pancreatitis，AP）患者血浆组织因子途径抑制剂（ tissue factor pathway inhibi－tor，TFPI）水平，并评价其诊断重症急性胰腺炎（ severe acute pancreatitis，SAP）的临床价值。方法取68名急性胰腺炎患者，包括SAP患者32例，轻型急性胰腺炎（ mild acute pancreatitis，MAP）患者36例；另取同期门诊体检者20例为对照，均入院1 h内抽血样，收集临床及实验室参数，计算APACHEⅡ评分和Ranson评分；采用酶联免疫吸附测定（ELISA）方法检测血浆TFPI水平。结果 MAP组患者血浆TFPI浓度[（3026．81±465．76）pg／ml]较对照组明显升高[（2468．73±262．39）pg／ml]（P＜0．05），SAP患者血浆TFPI浓度[（4274．25±639．83）pg／ml]较MAP组明显升高（ P＜0．05）。相关分析显示，AP患者的血浆TFPI水平与白细胞计数（ WBC）、天冬氨酸转氨酶（ AST）、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、肌酐（Cr）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、降钙素原（PCT）、APACHEⅡ评分和Ranson评分呈显著正相关（P＜0．05），与PLT呈显著负相关（P＜0．05）。 ROC曲线图分析显示，血浆TFPI水平诊断SAP发生的价值AUCSAP ＝0．902，95％CI＝0．845～0．959（P＜0．05），诊断界值为血浆TFPI浓度4028．83 pg／ml时，敏感度为87％，特异度为78％。结论 SAP患者的血浆TFPI水平可较正常人群和MAP患者显著升高，并与胰腺炎危重程度显著相关，可用于诊断SAP。
목적：검측급성이선염（ acute pancreatitis，AP）환자혈장조직인자도경억제제（ tissue factor pathway inhibi－tor，TFPI）수평，병평개기진단중증급성이선염（ severe acute pancreatitis，SAP）적림상개치。방법취68명급성이선염환자，포괄SAP환자32례，경형급성이선염（ mild acute pancreatitis，MAP）환자36례；령취동기문진체검자20례위대조，균입원1 h내추혈양，수집림상급실험실삼수，계산APACHEⅡ평분화Ranson평분；채용매련면역흡부측정（ELISA）방법검측혈장TFPI수평。결과 MAP조환자혈장TFPI농도[（3026．81±465．76）pg／ml]교대조조명현승고[（2468．73±262．39）pg／ml]（P＜0．05），SAP환자혈장TFPI농도[（4274．25±639．83）pg／ml]교MAP조명현승고（ P＜0．05）。상관분석현시，AP환자적혈장TFPI수평여백세포계수（ WBC）、천동안산전안매（ AST）、병안산전안매（ALT）、총담홍소（TBIL）、기항（Cr）、응혈매원시간（PT）、활화부분응혈활매시간（APTT）、강개소원（PCT）、APACHEⅡ평분화Ranson평분정현저정상관（P＜0．05），여PLT정현저부상관（P＜0．05）。 ROC곡선도분석현시，혈장TFPI수평진단SAP발생적개치AUCSAP ＝0．902，95％CI＝0．845～0．959（P＜0．05），진단계치위혈장TFPI농도4028．83 pg／ml시，민감도위87％，특이도위78％。결론 SAP환자적혈장TFPI수평가교정상인군화MAP환자현저승고，병여이선염위중정도현저상관，가용우진단SAP。
Objective To examine the levels of plasma tissue factor pathway inhibitor (TFPI) in patients with acute pancreatitis (AP) to assess the clinical value of diagnosis for severe acute pancreatitis ( SAP).Methods Sixty-eight patients were divided into mild acute pancreatitis (MAP)group (n=36) and SAP group (n=32), and twenty volunteers were chosen into normal group ( n=20 ) .Clinical data of these patients were collected, including APACHEⅡscore and Ranson score.Plasma levels of TFPI were measured by ELISA.Results The plasma levels of TFPI in SAP group, MAP group and control group were (4274.25 ±639.83),(3026.81 ±465.76) and (2468.73 ±262.39)pg/ml, respectively(P<0.05).There were significant positive correlations between TFPI and WBC, AST, ALT, TBIL, Cr, PT, APTT, PCT, APACHEⅡscore and Ranson score (P<0.05).The area under the curve (AUC) of TFPI for SAP was 0.902(95%CI=0.845 -0.959, P<0.05 ) .The cutoff value was 4028.83 pg/ml for plasma TFPI with a sensitivity of 87% and a specificity of 78%.Conclusion Plasma levels of TFPI in patients with SAP are significantly increased, which maybe help diagnose SAP.