[1]刘慧晶,李若梅,李　悦,等.红细胞分布宽度与D-二聚体联合检测对急性胰腺炎严重程度的评估价值[J].新乡医学院学报,2019,36(9):842-846.[doi:10.7683/xxyxyxb.2019.09.009]
　LIU Hui-jing,LI Ruo-mei,LI Yue,et al.Estimated value of combined detection of red blood cell distribution width and D-dimer for the severity of acute pancreatitis[J].Journal of Xinxiang Medical University,2019,36(9):842-846.[doi:10.7683/xxyxyxb.2019.09.009]
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红细胞分布宽度与D-二聚体联合检测对急性胰腺炎严重程度的评估价值
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年9
页码:
842-846
栏目:
临床研究
出版日期:
2019-09-05

文章信息/Info

Title:
Estimated value of combined detection of red blood cell distribution width and D-dimer for the severity of acute pancreatitis
作者:
刘慧晶1; 2; 3; 李若梅1; 2; 4; 李　悦1; 2; 杨　硕1; 2; 贺志安1; 2
（1.新乡医学院医学检验学院，河南　新乡　453003；2.河南省免疫与靶向药物重点实验室，河南省分子诊断与医学检验技术协同创新中心，河南　新乡　453003；3.新乡医学院第一附属医院检验科，河南　卫辉　453100；4.新乡医学院医学检验学院科研创新班，河南　新乡　453003）
Author(s):
LIU Hui-jing1; 2; 3; LI Ruo-mei1; 2; 4; LI Yue1; 2; YANG Shuo1; 2; HE Zhi-an1; 2
（1.School of Laboratory Medicine，Xinxiang Medical University；2.Henan Province Key Laboratory of Immunology and Targeted Trugs，Henan Province Collaborative Innovation Center of Molecular Diagnostics and Medicine Laboratory Technology；3.Clinical Laboratory，the First Affiliated Hospital of Xinxiang Medical University；4.Scientific Research Innovation Class of Medical Laboratory College，Xinxiang Medical University）
关键词:
红细胞分布宽度; D-dimer; 凝血功能; 急性胰腺炎; 严重程度评估
Keywords:
red blood cell distribution width; D-dimer; coagulation function; acute pancreatitis; severity assessment
分类号:
R576
DOI:
10.7683/xxyxyxb.2019.09.009
文献标志码:
A
摘要:
目的　探讨联合检测红细胞分布宽度（RDW）及D-二聚体（D-dimer）对急性胰腺炎（AP）严重程度的评估价值。方法　回顾性分析2016年1月至2018年9月新乡医学院第一附属医院收治的209例AP患者为研究对象，根据修订后的亚特兰大分类标准将患者分为轻症急性胰腺炎（MAP）组（n=95）、中度重症急性胰腺炎（MSAP）组（n=73）和重症急性胰腺炎（SAP）组（n=41）；依据是否出现多器官功能障碍综合征（MODS）分为MODS组（n=35）和非MODS组（n=174），另收集同期健康体检者60例作为对照组。收集受试者RDW、D-dimer、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、血清Ca2+、急性生理学和慢性健康评分Ⅱ（APACHE Ⅱ）评分等资料，采用受试者工作特征曲线及曲线下面积（AUC）分析各参数对AP患者病情严重程度的评估价值。结果　SAP组患者RDW、D-dimer、PT、APTT、FIB、APACHEⅡ评分高于对照组、MAP组和MSAP组（P<0.05），血清Ca2+水平低于对照组、MAP组和MSAP组（P<0.05）；MSAP组患者RDW、D-dimer、PT、APTT、FIB、APACHEⅡ评分高于对照组和MAP组（P<0.05），血清Ca2+水平低于对照组和MAP组（P<0.05）；MAP组与对照组患者RDW、D-dimer、PT、APTT、FIB比较差异无统计学意义（P>0.05），MAP组患者血清Ca2+水平低于对照组（P<0.05）。MODS组患者RDW、D-dimer、PT、APTT、FIB、APACHEⅡ评分高于非MODS组（P<0.05），血清Ca2+水平低于非MODS组（P<0.05）。入院时RDW诊断SAP及MODS的最佳截断值分别为16.40%（AUC为0.895，95%可信区间为0.843～0.948，P<0.05）和15.39%（AUC为0.816，95%可信区间为0.737～0.895，P<0.05）；D-dimer诊断SAP及MODS的最佳截断值分别为1.35 mg·L-1（AUC为0.907，95%可信区间为0.862～0.953，P<0.05）和1.48 mg·L-1（AUC为0.835，95%可信区间：0.726～0.943，P<0.05）；RDW联合D-dimer检测诊断SAP及MODS的AUC分别为0.932和0.847。结论　联合检测RDW及D-dimer可作为评估早期AP严重程度的实验室指标。
Abstract:
Objective　To investigate the value of red blood cell distribution width （RDW） and D-dimer in assessing the severity of acute pancreatitis （AP）.Methods　A total of 209 patients with AP admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2016 to September 2018 were selected as the study subjects.According to the revised Atlanta classification standard，the patients were divided into mild acute pancreatitis （MAP) group (n=95），moderately severe acute pancreatitis （MSAP) group (n=73） and severe acute pancreatitis （SAP) group(n=41）.According to the presence or absence of multiple organ dysfunction syndrome （MODS），the patients were divided into MODS group （n=35） and non-MODS group （n=174）.Another 60 health people were collected as control group during the same period.The clinical data of RDW，D-dimer，prothrombin time （PT），activated partial thromboplastin time （APTT），fibrinogen （FIB），serum Ca2+，acute physiology and chronic health score Ⅱ （APACHE Ⅱ） were collected.Subject working characteristic curve and area under curve （AUC） were used to analyze the value of each parameter in evaluating the severity of AP patients.Results　The RDW，D-dimer，PT，APTT，FIB and APACHE Ⅱ scores of patients in the SAP group were higher and the serum Ca2+ was lower than that in the control group，MAP group and MSAP group （P<0.05）；The RDW，D-dimer，PT，APTT，FIB and APACHE Ⅱ scores in the MSAP group were higher than those in the control group and MAP group （P<0.05）,while the serum Ca2+ was lower(P<0.05).There was no significant difference in the RDW，D-dimer，PT，APTT，FIB between the MAP group and the control group （P>0.05），but serum Ca2+ in the MAP group was lower than that in the control group （P<0.05）.The RDW，D-dimer，PT，APTT，FIB，APACHE Ⅱ scores of patients in the MODS group were higher than those in the non-MODS group （P<0.05）,while the serum Ca2+ was lower(P<0.05).The best cut-off values of RDW for diagnosis of SAP and MODS at admission were 16.40% （AUC was 0.895，95% CI：0.843-0.948，P<0.05） and 15.39% （AUC was 0.816，95% CI：0.737-0.895，P<0.05），respectively；the best cut-off values of D-dimer for diagnosis of SAP and MODS were 1.35 mg·L-1 （AUC was 0.907，95% CI：0.862-0.953，P<0.05） and 1.48 mg·L-1 （AUC was 0.835，95% CI：0.726-0.943，P<0.05），respectively；the AUC of RDW combined with D-dimer for diagnosis of SAP and MODS were 0.932 and 0.847，respectively.Conclusion　The combined detection of RDW and D-dimer can be used as an effective laboratory indicator for evaluating the severity of early acute pancreatitis.

参考文献/References:

［1］　王春友，李非，赵玉沛，等.急性胰腺炎诊治指南（2014）［J］.临床肝胆病杂志，2015，31（1）：17-20.
［2］　WANG D，YANG J，ZHANG J，et al.Red cell distribution width predicts deaths in patients with acute pancreatitis［J］.J Res Med Sci，2015，20（5）：424-428.
［3］　GRAVITOSOARES M，GRAVITOSOARES E，GOMES D，et al.Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis［J］.BMC Gastroenterol，2018，18（1）：108.
［4］　CUTHBERTSON C M，CHRISTOPHI C.Disturbances of the micro-circulation in acute pancreatitis［J］.Br J Surg，2006，93（5）：518-530.
［5］　董文会.急性胰腺炎凝血功能变化及临床意义［J］.中国现代医生，2015，53（21）：21-23.
［6］　田玉玲，雷力民，黄婵娟，等.急性胰腺炎患者血浆凝血功能与病情关系的研究［J］.临床消化病杂志，2013，25（3）：183-185.
［7］　HSIEH Y P，CHANG C C，KOR C T，et al.The predictive role of red cell distribution width in mortality among chronic kidney disease patients［J］.PLoS One，2016，11（12）：e0162025.
［8］　CETINKAYA E，SENOL K，SAYLAM B.Red cell distribution width to platelet ratio：new and promising prognostic marker in acute pancreatitis［J］.World J Gastroenterol，2014，20（39）：14450-14454.
［9］　GULEN B，SONMEZ E，YAYLACI S，et al.Effect of harmless acute pancreatitis score，red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department［J］.World J Emerg Med，2015，6（1）：29-33.
［10］　何文华，吕农华.亚特兰大急性胰腺炎分类国际共识2012年修订解读［J］.中国实用内科杂志，2013，33（9）：708-711.
［11］　冯小萌，王原.急性胰腺炎发病机制及治疗研究进展［J］.世界最新医学信息文摘，2017，17（40）：26-30.
［12］　RARATY M G，CONNOR S，CRIDDLE D N，et al.Acute pan-creatitis and organ failure：pathophysiology，natural history and management strategies［J］.Curr Gastroenterol Rep，2004，6（2）：99-103.
［13］　SALOMONE T，TOSI P，PALARETI G，et al.Coagulative disorders in human acute pancreatitis：role for the D-dimer［J］.Pancreas，2003，26（2）：111-116.
［14］　LIU S，WANG P，SHEN P P，et al.Predictive values of red blood cell distribution width in assessing severity of chronic heart failure［J］.Med Sci Monit，2016，22：2119-2125.
［15］　HU Z，SUN Y，WANG Q，et al.Red blood cell distribution width is a potential prognostic index for liver disease［J］.Clin Chem Lab Med，2013，51（7）：1403-1408.
［16］　YALIN M S，TAS A，KARA B，et al.New predictor of acute necrotizing pancreatitis：red cell distribution width［J］.Adv Clin Exp Med，2018，27（2）：225-228.
［17］　OH H J，PARK J T，KIM J K，et al.Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy［J］.Nephrol Dial Transplant，2012，27（2）：589-594.

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更新日期/Last Update: 2019-09-05