DIAGNOSIS OF ACUTE NECROTIZING PANCREATITIS BY PERFUSION CT IN THE ERALY PHASE OF ACUTE PANCREATITIS
DIAGNOSIS OF ACUTE NECROTIZING PANCREATITIS BY PERFUSION CT IN THE ERALY PHASE OF ACUTE PANCREATITIS
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急性胰腺炎早期灌注CT诊断急性坏死性胰腺炎
DOI：
10.1097/01.mpa.0000325590.23357.37
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发表时间：
2008
期刊：
影响因子：
2.9
通讯作者：
A. Sato
中科院分区：
文献类型：
--
作者：
K. Takeda;K. Kimura;A. Sato
一般认为，急性胰腺炎时存在凝血纤溶系统的紊乱。1入院时有凝血功能异常者DIC、MODS发生率高，预后差。2、3本研究旨在探讨重症急性胰腺炎（SAP）患者凝血-纤溶系统的紊乱。根据日本标准（日本严重程度评分; JSS）对急性胰腺炎的严重程度进行诊断和评价。在标准中，SAP被定义为JSSQ 2。研究对象为1990年至2006年我科收治的145例SAP患者。入院时血小板计数、凝血酶原时间国际标准化比值（PT-INR）、抗凝血酶III、凝血酶-抗凝血酶III复合物（达特）、活化蛋白C、纤维蛋白/纤维蛋白原降解产物、D-二聚体、纤溶酶原激活物抑制物-1和血栓调节蛋白的异常率分别为34%、32%、41%、100%、91%、78%、100%、58%、58%，达特和D-二聚体的含量很高。PT-INR（R= 0.404）、达特（R= 0.392）和血小板计数（R= 0. 196)与JSS呈显著相关。3期和4期患者入院时的达特浓度（9 e JSSe 27）（33 T 14 ng/ml）高于2期（2 e JSSe 8）（22 T 4 ng/ml）。死亡组PT-INR和达特（1.4T0.1和43 T17 ng/ml）明显高于存活组（1.1T0.0和19 T4 ng/ml）。PT-INRQ 1患者的死亡率。15例（41%）明显高于PT-INRG 1患者。15人入院（16%）。入院时TATQ <45 ng/ml的患者死亡率（75%）明显高于入院时TATG <45 ng/ml的患者（17%）（图1）。这些结果表明达特可能是SAP严重程度和预后的有用标志物。特别是入院时TATQ <45 ng/ml的患者，应在高度专业化的机构进行重症监护。
It is generally accepted that disorder of coagulation-fibrinolysis system occurs in acute pancreatitis. 1 Patients presenting coagulative abnormalities on admission have high incidence of DIC, MODS and poor prognosis. 2, 3 This study aimed to investigate the disorder of coagulation-fibrinolysis system in patients with severe acute pancreatitis (SAP). Diagnosis and evaluation of the severity of acute pancreatitis were made according to the Japanese criteria (Japanese severity score; JSS). In the criteria, SAP is defined as JSSQ2. The subjects were 145 patients with SAP in our department between 1990 and 2006. On admission, aberrant rates of platelet count, prothrombin timeinternational normalized ratio (PT-INR), antithrombin III, thrombin-antithrombin III complex (TAT), activated protein C, fibrin/fibrinogen degradation products, D-dimer, plasminogen activator inhibitor-1, and thrombomodulin were 34%, 32%, 41%, 100%, 91%, 78%, 100%, 58%, 58%, respectively, and those of TAT and D-dimer were very high. PT-INR (R= 0.404), TAT (R= 0.392), and platelet count (R= j0. 196) had significant correlation with JSS. TAT concentration on admission was higher in patients of Stage 3&4 (9e JSSe 27)(33 T 14 ng/ml) than Stage 2 (2e JSSe 8)(22 T 4 ng/ml). PT-INR and TAT in non-survivors (1.4 T 0.1 and 43 T 17 ng/ml) were significantly higher than those in survivors (1.1 T 0.0 and 19 T 4 ng/ml). Mortality rate in patients with PT-INRQ1. 15 on admission (41%) was significantly higher than that in patients with PT-INRG1. 15 on admission (16%). Mortality rate in patients withTATQ45 ng/ml on admission (75%) was significantly higher than that in patients with TATG45ng/ml on admission (17%)(Fig. 1). These results suggest that TAT may be a useful marker for severity and prognosis in SAP. Particularly in patients with TATQ45 ng/ml on admission, intensive care should be performed in a highly specialized institution.