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目的考察内镜逆行胰胆管造影(ERCP)术后急性胰腺炎患者血清胰蛋白酶原-2(Tr-2)、淀粉样蛋白A1(AA1)和血小板活化因子(PAF)水平及临床价值。方法收集2014年8月至2016年10月在本院消化内科进行ERCP术的患者205例,根据ERCP术后48h内发生急性胰腺炎及严重程度分为三个组别:对照组(未发生急性胰腺炎)68例,轻症急性胰腺炎(MAP)73例,重症急性胰腺炎(SAP)64例。检测所有患者ERCP术前、术后4h、8h、24h和48h的血清Tr-2、AA1和PAF,及ERCP术的并发症,并进行组间比较。结果三个组别ERCP术前清Tr-2、AA1和PAF无显著差异(P>0.05),ERCP术后均有不同程度地增加,至24h达高峰(P<0.05),48h有所降低,与对照组比,MAP和SAP组的血清Tr-2、AA1和PAF增高(P<0.05),与MAP组比,SAP组的血清Tr-2、AA1和PAF明显增高(P<0.05)。三个组别ERCP术后均发生了不同程度的腹胀、恶心呕吐和发热等不良反应,随着急性胰腺炎的严重程度,各类不良反应的发生例数明显增高(P<0.05),其中对照组发生最少(P<0.05),SAP发生最多(P<0.05)。结论联合检测ERCP术后患者血清Tr-2、AA1和PAF水平有助于判定ERCP术后发生急性胰腺炎及急性胰腺炎的发展程度。
Objective To investigate the levels of serum Trp-2, amyloid A1 (AA1) and platelet-activating factor (PAF) in patients with acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) and their clinical value. Methods Totally 205 patients who underwent ERCP in our department from August 2014 to October 2016 were divided into three groups according to the severity of acute pancreatitis and the severity of acute pancreatitis within 48h after ERCP: control group (no acute 68 cases of pancreatitis, 73 cases of mild acute pancreatitis (MAP) and 64 cases of severe acute pancreatitis (SAP). Serum levels of Tr-2, AA1 and PAF, and ERCP in preoperative, postoperative 4h, 8h, 24h and 48h after ERCP were measured in all patients and compared between groups. Results There was no significant difference in the levels of Tr-2, AA1 and PAF between the three groups before and after ERCP (P> 0.05). After ERCP, the levels of ERCP increased to different degrees after 24h, reached the peak at 24h (P <0.05) Compared with the control group, the levels of Tr-2, AA1 and PAF in MAP and SAP groups were significantly increased (P <0.05). Compared with the MAP group, the levels of Tr-2, AA1 and PAF in SAP group were significantly increased (P <0.05). In the three groups, adverse reactions such as abdominal distension, nausea, vomiting and fever occurred in different degrees. With the severity of acute pancreatitis, the incidence of various types of adverse reactions was significantly increased (P <0.05) Group occurred the least (P <0.05), SAP occurred the most (P <0.05). Conclusions Combined detection of serum levels of Tr-2, AA1 and PAF in patients with ERCP is helpful to determine the development of acute pancreatitis and acute pancreatitis after ERCP.