急性胰腺炎血浆纤维蛋白相关标志物的动态变化及临床意义

表1 有无POF的AP病人的人口统计学和生化指标的比较

变量	POF组 (n = 32)	无POF组 (n = 120)	t (χ2)	P
年龄	50.28 ± 14.13	46.88 ± 14.43	-1.191	0.2351
性别 (男/女)	24/8 (75.0%)	68/52 (56.7%)	3.554	0.0592
病因
高脂血症	12/65 (18.5%)	53/65 (81.5%)	0.47	0.9252
胆源性	13/57 (22.8%)	44/57 (77.2%)
酗酒	1/4 (25.0%)	3/4 (75%)
不明原因	6/26 (23.1%)	20/26 (76.9%)
ALT (U/L)	97.39 ± 169.14	74.56 ± 127.42	0.822	0.4121
AST (U/L)	73.57 ± 92.08	67.04 ± 118.20	0.281	0.7791
总胆 (mg/dL)	29.08 ± 34.31	16.25 ± 11.81	2.05	0.0491
直胆 (mg/dL)	15.58 ± 27.91	6.04 ± 7.75	1.914	0.0651
LDH (U/L)	283.87 ± 82.20	239.43 ± 92.45	2.369	0.0191
淀粉酶 (U/L)	590.18 ± 572.56	635.85 ± 1010.81	-0.229	0.8191
血糖 (mg/dL)	11.26 ± 4.77	8.17 ± 3.99	3.714	0.0001
BUN (mg/dL)	4.70 ± 2.24	6.74 ± 12.95	-0.884	0.3781
Cr (mg/dL)	68.19 ± 27.43	61.87 ± 23.81	1.287	0.2001
白蛋白 (g/L)	39.67 ± 9.16	44.73 ± 7.60	-3.188	0.0021
钙 (mg/dL)	2.54 ± 1.54	2.29 ± 0.40	0.86	0.3971
钠 (mmol/L)	137.31 ± 5.22	138.19 ± 4.78	-0.877	0.3821
CRP (mg/L)	76.03 ± 88.97	46.70 ± 75.41	1.874	0.0631

¹t-检验,

²χ²检验. POF: 伴持续器官功能衰竭; AP: 急性胰腺炎; ALT: 谷丙转氨酶; AST: 谷草转氨酶; LDH: 乳酸脱氢酶; BUN: 血尿素氮; Cr: 肌酐; CRP: C-反应蛋白.

表2 有无PN的AP病人的人口统计学和生化指标的比较

变量	PN组 (n = 44)	无PN组 (n = 108)	t (χ2)	P
年龄 (岁)	47.64 ± 13.26	47.57 ± 14.89	0.024	0.9811
性别 (男/女)	26/18(59.1%)	66/42(61.1%)	0.053	0.8172
病因			0.660	0.8822
高脂血症	19/65(29.2%)	46/65(70.8%)
胆源性	18/57(31.6%)	39/57(68.4%)
酗酒	1/4(25.0%)	3/4(75.0%)
不明原因	6/26(23.1%)	20/26(76.9%)
ALT (U/L)	84.78 ± 152.65	77.17 ± 130.67	0.305	0.7611
AST (U/L)	69.61 ± 98.77	67.87 ± 118.98	0.084	0.9331
TB (μmol/L)	26.82 ± 31.68	15.70 ± 9.54	2.260	0.0291
DB (μmol/L)	14.17 ± 25.73	5.61 ± 5.57	2.160	0.0361
LDH (U/L)	274.62 ± 92.29	237.30 ± 90.06	2.272	0.0251
AMY (U/L)	750.33 ± 705.14	579.00 ± 1005.02	0.938	0.3501
GLu (mmol/L)	10.13 ± 5.19	8.29 ± 3.83	2.406	0.0171
BUN (mmol/L)	4.90 ± 3.22	6.87 ± 13.52	-0.941	0.3481
Cr (μmol/L)	64.85 ± 32.33	62.54 ± 20.81	0.519	0.6051
ALB (g/L)	41.71 ± 8.75	44.45 ± 7.85	-1.877	0.0621
Ca2+ (mmol/L)	2.32 ± 0.69	2.35 ± 0.81	-0.233	0.8161
Na+ (mmol/L)	136.98 ± 6.18	138.45 ± 4.16	-1.684	0.0941
CRP (mg/L)	64.03 ± 94.06	48.52 ± 72.23	1.084	0.2801

¹t-检验,

²χ²检验. PN: 胰腺坏死; AP: 急性胰腺炎; ALT: 谷丙转氨酶; AST: 谷草转氨酶; TB: 总胆红素; LDH: 乳酸脱氢酶; BUN: 血尿素氮; Cr: 肌酐; ALB: 白蛋白; CRP: C-反应蛋白.

表3 入院后第1、2、3和7天, 有无POF的AP病人中FRMs的变化

FM	POF组	无POF组	Z (t)	P
FM1	5.12 (5.00, 13.25)	5.49 (5.00, 8.02)	-0.290	0.7711
FM2	6.80 (5.00, 14.35)	5.22 (5.00, 6.98)	-1.854	0.0641
FM3	5.90 (5.00, 7.21)	5.17 (5.00, 7.60)	-0.643	0.5201
FM7	6.90 (5.00, 12.11)	5.96 (5.00, 8.31)	-0.926	0.3541
D-D1	1.41 (0.66, 4.00)	0.67 (0.39, 1.15)	-3.247	0.0011
D-D2	2.79 (1.39, 4.00)	1.43 (0.69, 2.48)	-2.911	0.0041
D-D3	4.00 (2.51, 4.00)	1.38 (0.82, 2.75)	-4.353	0.0001
D-D7	4.00 (2.01, 4.00)	1.90 (0.81, 3.36)	-3.060	0.0021
FDP1	7.26 (3.01, 25.84)	3.07 (1.73, 5.46)	-3.497	0.0001
FDP2	16.95 (5.20, 27.15)	4.49 (3.23, 8.82)	-3.158	0.0021
FDP3	22.15 (8.66, 27.78)	6.26 (3.47, 13.48)	-4.223	0.0001
FDP7	15.93 (8.33, 31.63)	5.38 (2.91, 11.40)	-3.753	0.0001
FIB1	3.91 ± 1.95	3.70 ± 1.33	0.564	0.5762
FIB2	5.45 ± 2.38	4.72 ± 1.45	1.211	0.2332
FIB3	5.57 ± 1.93	4.96 ± 1.98	1.426	0.1572
FIB7	5.04 ± 1.69	4.29 ± 1.27	2.300	0.0242

¹秩和检验,

²t-检验. POF: 伴持续器官功能衰竭; AP: 急性胰腺炎; FRMs: 纤维蛋白相关标志物; FM: 纤维蛋白单体; D-D: D-二聚体; FDP: 纤维蛋白降解产物; FIB: 纤维蛋白原.

表4 入院后第1、2、3和7天, 有无PN的AP中FRMs的变化

FM	PN组 (44)	无PN组 (108)	Z (t)	P
FM1	6.82 (5.00, 18.09)	5.00 (5.00, 7.69)	-2.026	0.0431
FM2	6.47 (5.00, 12.58)	5.00 (5.00, 6.98)	-2.650	0.0081
FM3	7.11 (5.00, 13.09)	5.00 (5.00, 6.93)	-3.277	0.0011
FM7	7.50 (5.91, 10.68)	5.52 (5.00, 7.60)	-3.030	0.0041
D-D1	0.97 (0.63, 1.83)	0.66 (0.39, 1.30)	-2.276	0.0231
D-D2	1.79 (1.28, 4.00)	1.42 (0.73, 3.56)	-1.163	0.0451
D-D3	4.00 (2.66, 4.00)	1.30 (0.75, 2.49)	-5.676	0.0001
D-D7	4.00 (2.66, 4.00)	1.57 (0.88, 2.93)	-4.115	0.0001
FDP1	3.73 (2.56, 8.41)	3.14 (1.72, 6.17)	-1.803	0.0711
FDP2	9.38 (4.06, 22.24)	4.68 (3.11, 9.85)	-2.324	0.0211
FDP3	20.69 (10.14, 27.65)	5.74 (3.31, 11.26)	-5.392	0.0001
FDP7	17.34 (7.57, 30.90)	4.81 (2.79, 8.42)	-5.207	0.0001
FIB1	3.63 ± 1.62	3.80 ± 1.43	-0.649	0.5172
FIB2	4.82 ± 1.98	5.02 ± 1.6	-0.353	0.7262
FIB3	5.46 ± 2.16	4.95 ± 1.88	1.220	0.2272
FIB7	4.59 ± 1.64	4.42 ± 1.32	0.545	0.5872

¹秩和检验,

²t-检验. PN: 胰腺坏死; AP: 急性胰腺炎; FRMs: 纤维蛋白相关标志物; FM: 纤维蛋白单体; D-D: D-二聚体; FDP: 纤维蛋白降解产物; FIB: 纤维蛋白原.

表5 入院后第1、2和3天FRMs其他生化指标对AP伴POF的预测

	Cut-offvalue	AUC	95%CI	Sn (%)	Sp (%)	PPV (%)	NPV (%)	Z	P
D-D1	1.18	0.693	(0.611, 0.767)	60.00	76.99	40.91	87.88	3.247	0.0012
FDP1	4.63	0.711	(0.629, 0.784)	65.52	70.80	36.53	88.89	3.725	0.0002
LDH1	218.72	0.672	(0.590, 0.747)	82.76	49.58	28.57	92.19	3.528	0.0004
GLU1	8.6	0.720	(0.640, 0.790)	71.87	75.21	42.24	90.72	3.913	0.0001
A1	40.58	0.661	(0.579, 0.737)	53.13	81.90	44.74	86.37	2.725	0.0064
CRP1	84	0.615	(0.532, 0.694)	34.38	86.32	40.74	82.78	2.022	0.0431
D-D2	2.07	0.731	(0.604, 0.836)	73.68	74.42	56.01	86.48	3.357	0.0008
FDP2	10.69	0.755	(0.632, 0.854)	61.11	82.61	57.89	84.21	3.881	0.0001
AT-Ⅲ2	55	0.584	(0.498, 0.666)	25.00	98.25	77.82	84.21	1.330	0.1836
LDH2	261.59	0.761	(0.684, 0.828)	54.84	87.93	54.84	87.93	5.156	<0.0001
CRP2	74.05	0.718	(0.684, 0.828)	83.33	51.72	30.86	92.30	4.446	<0.0001
D-D3	1.94	0.776	(0.687, 0.849)	88.90	61.90	42.85	94.55	5.651	<0.0001
FDP3	15.51	0.769	(0.682, 0.843)	66.67	80.68	51.43	88.75	4.997	<0.0001
AT-Ⅲ3	95	0.664	(0.581, 0.740)	93.33	37.39	28.00	95.55	2.930	0.0034
LDH3	233.64	0.731	(0.651, 0.801)	55.17	82.91	44.45	88.18	4.363	<0.0001
CRP3	203	0.777	(0.506, 0.680)	45.16	95.65	73.67	86.62	6.151	<0.0001

FRMs: 纤维蛋白相关标志物; POF: 伴持续器官功能衰竭; AP: 急性胰腺炎; D-D: D-二聚体; LDH: 乳酸脱氢酶; CRP: C-反应蛋白; FDP: 纤维蛋白降解产物.

表6 入院后第1、2、3和7天FRMs及其他生化指标对PN的预测

	Cut-offvalue	AUC	95%CI	Sn (%)	Sp (%)	PPV (%)	NPV (%)	Z	P
FM1	5.58	0.595	(0.506, 0.680)	62.50	58.70	39.68	78.26	1.810	0.0703
D-D1	0.86	0.622	(0.537, 0.702)	63.41	62.75	40.62	81.01	2.354	0.0186
LDH1	240.66	0.635	(0.552, 0.712)	66.44	64.76	43.93	82.93	2.620	0.0088
GLU1	8.2	0.629	(0.546, 0.706)	56.82	68.57	40.68	79.42	2.483	0.0130
ALB1	43.15	0.607	(0.523,0.686)	61.36	62.50	40.91	79.27	2.064	0.0390
CRP1	78	0.545	(0.462, 0.627)	27.91	83.96	41.38	74.17	0.854	0.3931
FM2	5.94	0.639	(0.549, 0.723)	60.98	69.41	49.02	78.67	2.711	0.0067
D-D2	1.42	0.590	(0.458, 0.713)	76.19	51.22	44.44	80.77	1.212	0.2256
FDP2	6.23	0.676	(0.548, 0.788)	68.18	66.67	51.73	80.00	2.489	0.0128
LDH2	278.31	0.633	(0.550, 0.711)	31.82	91.26	60.86	75.81	2.569	0.0102
CRP2	102	0.614	(0.530, 0.694)	53.49	68.93	41.81	78.02	2.186	0.0288
FM3	5.87	0.683	(0.590, 0.766)	65.71	67.50	46.93	81.82	3.339	0.0008
D-D3	2.63	0.832	(0.749, 0.896)	77.14	81.58	65.85	88.57	8.422	<0.0001
FDP3	14.09	0.814	(0.731, 0.881)	69.44	83.54	65.78	85.71	7.502	<0.0001
AT-Ⅲ3	81	0.635	(0.551, 0.713)	59.09	68.32	44.82	79.31	2.613	0.0090
LDH3	160.89	0.639	(0.556, 0.717)	88.10	37.50	36.27	88.64	2.754	0.0059
CRP3	105.03	0.706	(0.625, 0.779)	65.91	76.47	54.72	83.37	4.072	<0.0001
FM7	5.87	0.698	(0.596, 0.788)	88.46	52.17	41.07	92.31	3.574	0.0004
D-D7	3.87	0.761	(0.664, 0.841)	65.52	86.96	67.86	85.72	4.371	<0.0001
FDP7	8.79	0.825	(0.735, 0.894)	75.00	82.09	66.66	87.30	6.610	<0.0001
AT-Ⅲ7	94	0.639	(0.552, 0.720)	78.05	45.26	38.10	82.69	2.679	0.0074
LDH7	177.12	0.661	(0.575, 0.740)	78.57	50.00	41.25	83.93	3.182	0.0015
CRP7	42	0.708	(0.624, 0.783)	60.98	81.91	59.52	82.80	3.934	0.0001

FRMs: 纤维蛋白相关标志物; PN: 胰腺坏死; FM: 纤维蛋白单体; D-D: D-二聚体; FDP: 纤维蛋白降解产物; LDH: 乳酸脱氢酶; CRP: C-反应蛋白.