全段甲状旁腺素在胆源性急性胰腺炎患者中的变化研究(1)
[摘要] 目的 研究全段甲状旁腺素(i-PTH)在胆源性急性胰腺炎(BAP)患者中的变化。 方法 选择2013年1月～2014年12月首都医科大学附属北京朝阳医院收治的BAP患者62例作为研究对象，根据严重程度将其分为38例轻度急性胰腺炎(MAP)组和24例中度急性胰腺炎(MSAP)组。检测两组血常规、肝肾功能、血糖(Glu)、血钙(尖锐湿疣)和i-PTH。研究两组各项指标的变化及与BAP严重程度的关系。 结果 MSAP组的白细胞计数(WBC)、Glu和i-PTH均明显高于MAP组(P < 0.05)，而尖锐湿疣则明显低于MAP组(P < 0.05)。Ca和白蛋白、前白蛋白及γ-谷氨酰转肽酶均呈正相关(r = 0.300、0.392、0.354，P = 0.018、0.002、0.005)，而和i-PTH呈负相关(r = -0.368，P = 0.003)。WBC和i-PTH升高均是BAP患者出现MSAP的危险因素(OR = 1.252、1.029，P = 0.005、0.030)。 结论 i-PTH在BAP患者中随病情加重而升高。i-PTH和WBC升高均是BAP患者出现MSAP的危险因素。
[关键词] 胆源性急性胰腺炎；全段甲状旁腺素；相关性
[中图分类号] R657.51 [文献标识码] A [文章编号] 1673-7210(2016)08(b)-0149-04
[Abstract] Objective To investigate the changes of intact parathyroid hormone (i-PTH) in patients with biliogenic acute pancreatitis (BAP). Methods From January 2013 to December 2014， total 62 BAP patients admitted to Beijing Chaoyang Hospital， Capital Medical University were enrolled. According to the disease severity， BAP patients were divided into 2 groups： 38 cases of mild acute pancreatitis (MAP) group and 24 cases of moderately severe acute pancreatitis (MSAP) group. The blood routine， function of liver and kidney， blood lipids， glucose (Glu)， calcium (Ca) and i-PTH in the two groups were measured， to find the changes of all indexes and the correlation with disease severity in BAP patients. Results White blood cell (WBC)， Glu and i-PTH in MSAP group were significantly increased compared with MAP group (P < 0.05). On the contrary， serum Ca in MSAP group was significantly decreased compared with MAP group (P < 0.05). Ca had a positive correlation with albumin， prealbumin and γ-glutamyl transferase (r = 0.300， 0.392， 0.354， P = 0.018， 0.002， 0.005) and a negative correlation with i-PTH (r = -0.368， P = 0.003). Increased WBC and i-PTH were risk factors for MSAP (OR = 1.252， 1.029， P = 0.005， 0.030). Conclusion Levels of i-PTH are increased with severity of BAP. Increased i-PTH and WBC are both risk factors for MSAP in patients with BAP.
[Key words] Biliogenic acute pancreatitis； Intact parathyroid hormone； Correlation
急性胰腺炎(acute pancreatitis，AP)是消化系统常见的急腹症之一。AP是指多种病因引起的胰酶激活，继以胰腺自身消化导致局部炎性反应为主，可伴或不伴有其他器官功能改变的疾病。AP的病因包括胆石症、高脂血症等。由胆石症诱发的AP称为胆源性急性胰腺炎(biliogenic acute pancreatitis，BAP)，而目前胆石症仍是我国AP的首要病因，因此BAP也是我国最常见的AP种类[1]。AP患者预后差异明显，绝大多数患者症状轻并且病情具有自限性，但是有20%～25%的AP患者病情复杂，特别是在重度急性胰腺炎(severe acute pancreatitis，SAP)患者中死亡率可以高达30%～50%[2-4]。AP初期胰腺内的胰蛋白酶原被异常激活，继以胰腺自身消化导致局部炎性反应，之后会激活大量炎性介质，如白细胞介素(interleukin，IL)-6、IL-18和肿瘤坏死因子-α等，并发生瀑布样级联反应，诱发凝血功能出现异常，导致多器官功能障碍综合征甚至死亡[5-6]。SAP患者抗凝血酶Ⅲ和血小板(platelet count，PLT)等均会明显异常且并且和病情严重程度相关[7]。早期诊断并治疗SAP可以明显减少死亡率并改善患者预后[8]。因此需要早期准确判断AP严重程度并阻止其向SAP发展。既往研究发现D-二聚体和甲状腺激素等均能较好地预测AP严重程度[9-10]。甲状旁腺素(intact parathyroid hormone，PTH)是由甲状旁腺主细胞合成和分泌的单链多肽类激素。PTH由84个氨基酸组成，可以升高血钙(calcium，Ca)和降低血磷，它和降钙素(calcitonin，CT)等共同调节人体钙磷的代谢。Ca对调节神经、肌肉的传导和兴奋具有重要作用，BAP患者会出现Ca的异常，但是全段甲状旁腺素(intact parathyroid hormone，i-PTH)在其中的变化和与疾病严重程度的关系目前罕见研究。本研究旨在探讨i-PTH在BAP中的变化并研究其与疾病严重程度的关系。 (杨宁 张冬磊)
[关键词] 胆源性急性胰腺炎；全段甲状旁腺素；相关性
[中图分类号] R657.51 [文献标识码] A [文章编号] 1673-7210(2016)08(b)-0149-04
[Abstract] Objective To investigate the changes of intact parathyroid hormone (i-PTH) in patients with biliogenic acute pancreatitis (BAP). Methods From January 2013 to December 2014， total 62 BAP patients admitted to Beijing Chaoyang Hospital， Capital Medical University were enrolled. According to the disease severity， BAP patients were divided into 2 groups： 38 cases of mild acute pancreatitis (MAP) group and 24 cases of moderately severe acute pancreatitis (MSAP) group. The blood routine， function of liver and kidney， blood lipids， glucose (Glu)， calcium (Ca) and i-PTH in the two groups were measured， to find the changes of all indexes and the correlation with disease severity in BAP patients. Results White blood cell (WBC)， Glu and i-PTH in MSAP group were significantly increased compared with MAP group (P < 0.05). On the contrary， serum Ca in MSAP group was significantly decreased compared with MAP group (P < 0.05). Ca had a positive correlation with albumin， prealbumin and γ-glutamyl transferase (r = 0.300， 0.392， 0.354， P = 0.018， 0.002， 0.005) and a negative correlation with i-PTH (r = -0.368， P = 0.003). Increased WBC and i-PTH were risk factors for MSAP (OR = 1.252， 1.029， P = 0.005， 0.030). Conclusion Levels of i-PTH are increased with severity of BAP. Increased i-PTH and WBC are both risk factors for MSAP in patients with BAP.
[Key words] Biliogenic acute pancreatitis； Intact parathyroid hormone； Correlation
急性胰腺炎(acute pancreatitis，AP)是消化系统常见的急腹症之一。AP是指多种病因引起的胰酶激活，继以胰腺自身消化导致局部炎性反应为主，可伴或不伴有其他器官功能改变的疾病。AP的病因包括胆石症、高脂血症等。由胆石症诱发的AP称为胆源性急性胰腺炎(biliogenic acute pancreatitis，BAP)，而目前胆石症仍是我国AP的首要病因，因此BAP也是我国最常见的AP种类[1]。AP患者预后差异明显，绝大多数患者症状轻并且病情具有自限性，但是有20%～25%的AP患者病情复杂，特别是在重度急性胰腺炎(severe acute pancreatitis，SAP)患者中死亡率可以高达30%～50%[2-4]。AP初期胰腺内的胰蛋白酶原被异常激活，继以胰腺自身消化导致局部炎性反应，之后会激活大量炎性介质，如白细胞介素(interleukin，IL)-6、IL-18和肿瘤坏死因子-α等，并发生瀑布样级联反应，诱发凝血功能出现异常，导致多器官功能障碍综合征甚至死亡[5-6]。SAP患者抗凝血酶Ⅲ和血小板(platelet count，PLT)等均会明显异常且并且和病情严重程度相关[7]。早期诊断并治疗SAP可以明显减少死亡率并改善患者预后[8]。因此需要早期准确判断AP严重程度并阻止其向SAP发展。既往研究发现D-二聚体和甲状腺激素等均能较好地预测AP严重程度[9-10]。甲状旁腺素(intact parathyroid hormone，PTH)是由甲状旁腺主细胞合成和分泌的单链多肽类激素。PTH由84个氨基酸组成，可以升高血钙(calcium，Ca)和降低血磷，它和降钙素(calcitonin，CT)等共同调节人体钙磷的代谢。Ca对调节神经、肌肉的传导和兴奋具有重要作用，BAP患者会出现Ca的异常，但是全段甲状旁腺素(intact parathyroid hormone，i-PTH)在其中的变化和与疾病严重程度的关系目前罕见研究。本研究旨在探讨i-PTH在BAP中的变化并研究其与疾病严重程度的关系。 (杨宁 张冬磊)