【摘要】 背景:急性胰腺炎(AP)发病过程中常伴有胰腺微循环障碍、凝血和纤溶系统改变,血小板参数会发生一定的变化。目的:探讨老年AP患者血小板参数的变化特点以及乌司他丁(UTI)治疗对血小板参数和病情的影响。方法:回顾性收集南京医科大学第一附属医院2009年8月至2013年12月收治的年龄≥60岁的AP患者217例,根据病情严重程度分为轻、中、重度AP(MAP、MSAP和SAP)。比较、分析各组治疗前后的血小板参数(PLT、MPV和PDW)以及常规治疗与UTI治疗组间血小板参数和临床疗效的差异。结果:与MAP组相比,MSAP、SAP组入院时PLT较低(P<0.01),MPV、PDW较高(P<0.05);治疗1周后,MSAP、SAP组PLT显著增高(P<0.01),MPV、PDW显著降低(P<0.05)。与常规治疗相比,MSAP、SAP组UTI治疗后PLT显著增高(P<0.01),MPV、PDW显著降低(P<0.01),总有效率显著提高(MSAP:92.3%对81.2%,P<0.01;SAP:90.0%对80.8%,P<0.01)。结论:老年MSAP、SAP患者的血小板参数变化与MAP患者明显不同,可反映其病情严重程度。UTI可有效降低血小板活性,对老年AP患者有较好的治疗和预防病情恶化作用。更多还原

【Abstract】 Background: The development of acute pancreatitis( AP) is often accompanied by pancreatic microcirculation disturbance and alterations in blood coagulation and fibrinolytic systems, which results in abnormalities of platelet parameters. Aims: To investigate the changes of platelet parameters in elderly AP patients and the effect of ulinastatin( UTI) on platelet parameters and disease status. Methods: Two hundred and seventeen elderly AP patients( ≥ 60 years)were enrolled retrospectively from Aug. 2009 to Dec. 2013 at the First Affiliated Hospital of Nanjing Medical University.According to the severity of the disease,patients were divided into three groups: mild AP( MAP),moderately severe AP( MSAP),and severe AP( SAP). The platelet parameters,including PLT,MPV and PDW before and after treatment,as well as the differences in platelet parameters and clinical efficacy between conventional therapy and UTI therapy were compared and analyzed. Results: In MSAP and SAP groups,PLT at admission was significantly lower( P < 0. 01),while MPV and PDW were significantly higher( P < 0. 05) than those in MAP group. After 1-week treatment,PLT increased significantly( P < 0. 01) and MPV and PDW decreased significantly( P < 0. 05) in MSAP and SAP groups. UTI therapy was superior to conventional therapy in increasing PLT( P < 0. 01),decreasing MPV and PDW( P < 0. 01),and improving the overall efficacy in MSAP and SAP groups( MSAP: 92. 3% vs. 81. 2%,P < 0. 01; SAP: 90. 0% vs.80. 8%,P < 0. 01). Conclusions: Changes of platelet parameters in elderly MSAP and SAP patients are different from those in MAP patients,which might reflect the disease severity. UTI is effective in reducing the activity of platelet and can be used in the treatment and prevention of disease progression in elderly AP patients.更多还原