急性胰腺炎的早期实验诊断和严重程度判断  

Early laboratory diagnosis and assessment of severity in acute pancreatitis

作　　者：张平武 张建辉[2] 

机构地区：[1]四川省眉山市第一人民医院检验科,四川眉山620010 [2]四川省绵阳市中心医院检验科,四川绵阳621000

出　　处：《内分泌外科杂志》2007年第3期161-163,157,共4页

摘　　要：目的探索急性胰腺炎早期诊断和病情严重程度的实验室检测指标。方法以82例急性腹痛，其中急性胰腺炎39例（急性重型胰腺炎14例和急性轻型胰腺炎25例）和非胰腺急腹症43例，30例健康者为受试者；测定所有受试者血清淀粉酶（Amy）、脂肪酶（Ljp）、白介素-6（IL-6），白介素-8（IL-8）和C-反应蛋白（CRP）浓度。结果方差分析（F检验）显示5个标记物在所观察的疾病组间均存在明显统计学差异（P=0．000）。ROC曲线分析显示：对急性胰腺炎的早期诊断，Amy（cut off=93U／L）和Lip（cut off=229U／L）有较高的敏感度（Se），均是94．9％，Lip还有较高的特异性（Sp）是82．2％。曲线下的面积（AUC）分别是0．961和0．935，优于其它标记物。对判断急性胰腺炎的严重度，CRP（cut off=12．3mg／L）和IL-6（cut off=6．5μg／L）的敏感度相近，分别是92．9％和92．7％，IL-8（cut off=76．8μg/L）次之，Se为89．6％，但Sp最高为100．0％。IL-6和IL-8之AUC分别是0．931和0．977，优于其它标记物。结论Amy和Lip可能是急性胰腺炎的早期诊断指标，IL一6和IL-8可能是其严重程度的判断指标。联合检测Amy（和／或Lip）和IL-6（和／或IL-8）有利于急性胰腺炎的早期诊断和严重度判断。Objective To find the laboratory markers for both the early diagnosis and the severity of acute pancreatitis. Methods Eighty two patients with acute abdomen were studied. 39 of then were acute pancrestitis patients （14 had severe acute pancrestitis and 25 had mild acute pancrestitis）, and 43 were nonpancrestic acute abdomen patients. In addition, 30 healthy subjects were al- so studies as controls. The concentrations of serum amylase, lipase, intedeukin-6, intedeukin-8, and C-reactive protein were mea- sured in all subjects. Results There were significant difference among observated 5 markers by ANOVA（ F test, all P=0.000）.ROC curves analysis revealed that the sensitivity of both amylase （at cut-off value 93 U/L） and lipase （at cut-off value 229 U/L） to early diagnose acute pancreastitis were 94.9%, and in addition had lipase good specificit（82.2%） as well. Area under the curve （AUC） for amylas（0.961） or lipase（0.935） was significantly greater than those for other markers. The sensitivities of C-reactive pro- tein（cut off=12.3mg/L）and intedeukin-6（cut off=6.8μg/L）to evaluate the severity of acute pancreatitis were similar with C-reactive protein being 92.9%, and intedeukin-6 92.7%, respectively. Intedeukin-8 was 89.6%, it is relatively lower, but the specificity was highest（100%）. AUCs for interleukin-6（0.931） and intedeukin-8（0.977） were significantly greater than those for other nmrkers. Conclusion The results suggest that serum lipase and amylase may be the early diagnostic markers of acute pancreastitis. Interleukin-6 and intedeukin-8 may evaluate the severity of acute pancreatitis. The combined detection of serum lipase （or amylase） and intedeukin-6 （or intedeukin-8） is useful in simultaneously establishing both the early diagnosis and the severity of acute pancreatitis.

关 键 词：急性胰腺炎 淀粉酶 脂肪酶 白介素 C-反应蛋白 

分 类 号：R57[医药卫生—消化系统]