Comparison of copeptin, C-reactive protein and D-dimer levels before and after endoscopic retrograde cholangiopancreatography surgery in acute biliary pancreatitis
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摘要:
目的 探讨经内镜逆行性胰胆管造影术(ERCP)治疗急性胆源性胰腺炎前后和肽素(CPT)、C-反应蛋白(CRP)及D-二聚体(D-D)水平变化。 方法 选取2018年5月~2020年3月在我院住院治疗的95例急性胆源性胰腺炎患者为研究对象，按照随机数字表法将患者分为对照组(n=47)和观察组(n=48)，对照组采用传统开腹手术治疗，观察组采用ERCP手术治疗。比较两组患者临床疗效、临床症状恢复时间及并发症情况，观察治疗前后CPT、CRP、D-D水平变化情况。 结果 与对照组比较，观察组治疗总有效率更高(97.92% vs 87.23%，P < 0.05)。手术后1 d、4 d的CPT、CRP、D-D水平较手术前均有下降，且观察组下降幅度较对照组大(P < 0.05)。与对照组相比，观察组腹部疼痛缓解时间、胃肠功能及肝功能恢复时间均较短(P < 0.05)。与对照组相比，观察组住院时间较短，住院费用也较低，且并发症发生率较低(P < 0.05)。 结论 ERCP手术治疗急性胆源性胰腺炎有较好的治疗效果，术后CPT、CRP及D-D水平及临床症状均明显改善，且并发症少，安全性较高。 Abstract:Objective To investigate the changes of copeptin (CPT), C- reactive protein (CRP) and D- dimer (D- D) levelsbefore and after the treatment of acute biliary pancreatitis by endoscopic retrograde cholangiopancreatography (ERCP). Methods Ninety- five patients with acute biliary pancreatitis in our hospital from May 2018 to March 2020 were selected and divided into control group (n=47) and observation group (n=48) according to the random number table method . The control group was treated with traditional open surgery, and theobservation group was treated with ERCP. The clinicalefficacy, clinical symptoms recovery time and complications of the two groups were compared, and changes in CPT, CRP, and D-D levels were observed before and after treatment. Results Compared with the control group (87.23%), the total effective rate of observation group (97.92%) was significantly higher (P < 0.05). The levels of CPT, CRP, and D-D at 1 d and 4 d after the operation were lower than before the operation, and the decrease in the observation group was larger than that of the control group (P < 0.05). Compared with the control group, the observation group had shorter abdominal pain relief time, gastrointestinal function and liver function recovery time (P < 0.05). Compared with the control group, the observation group had shorter hospital stays and lower hospitalization costs, lower complication rate (P < 0.05). Conclusion ERCP surgery has a good effect in the treatment of acute biliarypancreatitis. Postoperative CPT, CRP and D-D levels and clinical symptomsare significantly improved, with fewercomplications and high safety. -
图 1 患者男，53岁，因急性胆源性胰腺炎接受ERCP治疗
A: 手术前; B: 手术1月后.
Figure 1. A 53-year-old male patient received ERCP for acute biliary pancreatitis.
表 1 两组患者临床疗效比较
Table 1. Comparison of clinical efficacy between the two groups[n(%)]
组别 显效 有效 无效 总有效率 对照组(n=47) 31(65.96) 10(21.28) 6(12.77) 41(87.23) 观察组(n=48) 38(79.17) 9(18.75) 1(2.08) 47(97.92) χ2 3.970 P 0.046 
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表 2 两组患者治疗前后CPT、CRP及D-D水平比较
Table 2. Comparison of CPT, CRP and D-D levels between the two groups before and after treatment (Mean± SD)
时间 组别 CPT(pg/mL) CRP(mg/L) D-D(mg/L) 术前 对照组(n=47) 198.37±35.60 95.45±23.38 3.45±1.20 观察组(n=48) 200.15±35.45 96.07±23.50 3.51±1.28 t 0.244 0.128 0.235 P 0.807 0.897 0.814 术后1 d 对照组(n=47) 121.60±26.16 91.57±18.59 2.95±0.96 观察组(n=48) 110.27±25.34 82.65±19.90 2.52±0.93 t 2.144 2.256 2.217 P 0.034 0.026 0.029 术后4 d 对照组(n=47) 98.17±22.40 52.56±11.23 1.75±0.60 观察组(n=48) 85.35±21.34 37.80±10.56 1.18±0.49 t 2.856 6.600 5.076 P 0.005 < 0.001 < 0.001 CPT: 肽素; CRP: C反应蛋白; D-D: D-二聚体.
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表 3 两组患者临床症状恢复时间比较
Table 3. Comparison of recovery time of clinical symptoms between the two groups (d, Mean±SD)
组别 腹部疼痛缓解时间 胃肠功能恢复时间 肝功能恢复时间 对照组(n=47) 3.52±1.15 8.28±2.14 10.62±2.30 观察组(n=48) 1.55±1.08 4.50±1.80 7.40±1.77 t 8.608 10.133 7.656 P < 0.001 < 0.001 < 0.001
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表 4 两组患者住院时间、住院费用及术后并发症比较
Table 4. Comparison of hospital stay, hospitalization cost and postoperative complications between the two groups (Mean±SD)
组别 住院时间(d) 住院费用(万元) 并发症[n(%)] 对照组(n=47) 18.75±3.48 2.62±0.51 4(8.51) 观察组(n=48) 10.78±2.87 1.47±0.46 1(2.08) t 12.189 11.545 1.967 p < 0.001 < 0.001 0.160
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