联合检测CRP及PCT水平及急性胰腺炎预后评估.doc

联合检测CRP及PCT水平及急性胰腺炎预后评估 　【摘要】 目的 探讨血清C-反应蛋白（CRP）、降钙素原（PCT）水平的变化对急性胰腺炎 ( AP) 分类及预后评估的指导意义。方法 采用免疫比浊法测定CRP水平，双抗体夹心免疫发光法测定PCT水平。67 例AP患者中，轻型组（MAP）26 例，重型（SAP）无感染组21 例，SAP并感染组20 例。结果 2 个SAP组CRP水平均高于MAP组，高峰出现于第2天，有统计学意义 (Plt;0.01)。SAP并感染组PCT水平高于其他两组，高峰出现于第7天，有统计学意义(Plt;0.01)。PCT水平随着感染的控制而明显下降，有助于判断预后。结论 CRP和PCT的常规检测有助于急性胰腺炎分类、指导治疗及评估预后。 【关键词】 C-反应蛋白 降钙素原 重型急性胰腺炎 继发感染 预后 　　Abstract: Objective To explore the effects of changes of C-reactive protein (CRP) and Procalcitonin (PCT) levels on serum of Acute pancreatitis(AP) differentiation and the significance of its prognosis. Methods CRP levels in serum of 67 Acute pancreatitis patients were measured by Immunolgical turbidity and PCT levels were tested by Double-antibody Sandwich ELISA assay. There were 26 cases in Moderate Acute pancreatitis (MAP) group, 21 cases in Severe Acute pancreatitis （SAP） without infection group and 20 cases in SAP patients with subsequent infection group. Results CRP levels in serum of SAP patients were higher than those in MAP patients. The peak appeared in the 2nd day and had statistic significance (Plt;0.01). PCT levels in serum of SAP with subsequent infection patients were higher than that in SAP patients without infection and the peak appeared on the 7th day with its statistic significance (Plt;0.01). After antibiotic treatment, the levels of PCT were decreased obviously and that will assist in estimating the prognosis. Conclusions Regular test of CRP and PCT assists in differentiaton , guding treatment ,estimatement and prognosis of severe acute pancreatitis. Key words:C-reactive protein；Procalcitonin；Severe Acute pancreatitis；subsequent infection；prognosis 血清淀粉酶和脂肪酶是诊断急性胰腺炎（AP）的重要检测项目，但两者对评估AP严重程度均无价值。目前认为发病24h后动态测定血清C-反应蛋白（CRP）有助于AP早期分型［1］，而动态测定血清降钙素原（Procalcitonin，PCT）有助于早期发现AP的感染并发症［2］。本文分析67例AP患者C-反应蛋白（CRP）及PCT值的变化，探讨其对AP分型、治疗选择及预后评估的意义。 1 临床资料 　　1.1 一般资料 67例AP患者均为本院住院患者，以中华医学会外科学会胰腺学组于1996年制定的AP的临床诊断和分级标准［3］作为判断轻型（MAP）和重型（SAP）的标准。SAP合并感染的诊断标准：(1)临床诊断标准：上腹部两个以