The Value On Dynamic Detection Of Acute Pancreatitis Patient's Blood Serum C-reactive Protein

Objective:More and more evidences indicated that C-reactive protein(CRP) is an important identification marker of inflammation, infection, tissue damage, necrosis and malignant tumor[1]. The concertration of CRP is very low in healthy crowd. A high concentration of the CRP cues many events occurrence such as inflammation and infection [2]. The detection of CRP play an important role in bacterial infection, inflammation process, tissue necrosis, tissue damage and the screening, monitoring, pathogenetic condition appraisal, the curative effect in the recovery period [3]. When the other clinical parameters could not identify the diagnosis, CRP detection would indicate the inflammation and the tissue damage in the early stage, with the high sensitive and specificity showed its great significant in clinical medicine[4].To estimate the value of CRP on the diagnose , pathogenetic condition appraisal and prognosis of acute pancreatitis(AP).The blood serum CRP in disease's clinical practice provides evidence based medicine (EBM).Methods:92 AP patients in the gastroenterology of the first affiliated hospital of Nanchang University were classified according to the 2004 China Guidelines for the Management of Acute Pancreatitis. There are three groups, mild acute pancreatitis (MAP)group (n=36), severe acute pancreatitis (SAP)group (n=56), and physical control group (n=40). The CRP concentration in serum were measured respectively on day l, 3, 5, 7 after admission and the day before discharge. Rate nephelometry was used to measure the serum CRP concentration. Measure the patient's routine blood test, the erythrocyte sedimentation rate(ESR) simultaneously.All patients underwent abdominal CT examination. Patient's clinical datas (the laboratory inspection, the imageology material,the pathology material and so on) were analyzed by SPSS16.0 for windows.Results:1. analysis the data of the CRP in blood serum in the seclected cases during the four periods, which are the first day, three day, 5th day, the 7th day. The physical control group average concentration is (2.10±1.21)mg/L, MAP group average concentration is (69.08±30.61)mg/L, SAP group average concentration is (134.56±22.23)mg/L, Pancreatic necrosis group average concentration is (277.87±94.62)mg/L, Pancreatic non-necrosis group average concentration is (171.70±95.28)mg/L . The acute pancreatitis mild case group and the severe group's blood serum CRP concentration is higher than the physical control group(P<0.01), the severe group's blood serum CRP concentration is higher than the mild case group(P<0.01), The pancreatic necrosis group's blood serum CRP concentration is higher than the pancreatic non-necrosis group(P<0.01).2. The positive predictive value of the Ranson score, the APACHEII score and blood serum CRP are 94.44%, 83.61%, 78.33%, respectively.3. The area under the ROC curve (AUC) showed the concertration of the CRP in blood serum during each peirod, which would indicate the occurrence of pancreatic necrosis. The AUC of the three day is 0.707. The accuracy of the predict of pancreatic diagnosis is acceptable.4. The blood serum CRP concentration, the white blood cell counting(WBC), the neutrophile percentage (N%), ESR and the pancreatic gland necrosis degree (necrosis grading) carries on the Spearman rank correlation analysis. The result demonstrated WBC, N% and the blood serum CRP concentration present relation between them (P<0.05); ESR, the pancreatic gland necrosis degree (necrosis grading) and the blood serum CRP concentration didn't show relation among them (P>0.05).Conclusions:1.The acute pancreatitis patient's blood serum CRP concentration after having gets sick the 1st day obviously to elevate, the 3rd day of patient blood serum CRP concentration may present a peak.2.Whether there is blood serum does CRP and pancreatic gland necrosis have the certainly auxiliary function regarding judgment acute pancreatitis' mild or severe, has the value to the severe acute pancreatitis' condition monitor.3.Sole application blood serum CRP is limited to the acute pancreatitis condition appraisal's value, compares the Ranson score system and APACHEII score system's low, cannot substitute the above score system, studies has certain reference value to the clinical practice.