112例伴腹痛的高脂肪酶血症患者病因分析  

Etiologies Analysis of 112 Cases with Abdominal Pain and Hyperlipasaemia

作　　者：庄则豪[1] 陈群[2] 吴婷[1] 刘奇才[3] 陈玉铃[4] 魏晶晶[1] 

机构地区：[1]福建医科大学附属第一医院消化科,福建福州350005 [2]福建医科大学附属第一医院普外科,福建福州350005 [3]福建医科大学附属第一医院检验科,福建福州350005 [4]福建医科大学附属第一医院血液科,福建福州350005

出　　处：《医学信息（中旬刊）》2011年第2期366-368,共3页Medical Information Operations Sciences Fascicule

基　　金：福建省自然科学基金(C0610007)

摘　　要：目的:分析伴腹痛高脂肪酶(LPS)血症患者的病因构成,探讨血清LPS/淀粉酶(AMS)比值用于病因鉴别诊断的价值。方法:回顾2006年6月-2009年3月我院全部血LPS升高住院患者资料,分析其病因构成及LPS、AMS比值同病因及AP的CT分级的关系。结果:共112例伴腹痛的高LPS血症患者进入研究,血清LPS/AMS0.18～20.4,中位值3.53。84例(75%)临床诊断AP,血LPS、AMS及两者比值与AP的CT分级无关(P>0.05)。AP患者血LPS/AMS>5者占酒精性的75%,胆源性的32.65%,高脂血症性的5.88%,其他的10%。28例(占25%)非AP患者中,非胰腺疾病占50%,胰腺假性囊肿或脓肿、胰腺癌分别占28.57%、21.43%,血LPS/AMS>5者仅见于胰腺癌(83%,5/6)、胰腺假性囊肿或脓肿(75%,6/8)和肺部感染并胸腔积液(28.57%,2/7)。结论:高LPS血症主要见于胰腺疾病,也见于肾功能衰竭、肠梗阻及消化道穿孔,部分肺部感染、甲状腺疾病及白血病患者出现高LPS血症原因未明。血清LPS/AMS>5主要见于酒精性AP、胰腺癌、胰腺假性囊肿或脓肿,但以此进行病因判断的敏感性及特异性均低。Objective ：To analyze the causes of hyperlipasaemia and to investigate the ushfulness of lipase/amylase （L/A） ratio in differential diagnosis of pancreatic diseases. Methods： One hundred and twelve patients with abdominal pain and hyperlipasaemia were retrospectively analyzed. Results ：The median value of L/A ratio was 3.53 （0.18 -20.4）. The major etiologies of AP （84/112,75%） were biliary disease （58.33%） ,hyperlipidemia （20.24%） and alcohol （9.52%）. The median values of amylase and lipase in AP patients were 263 U/L （40 -3439U/L） and 668U/L （300 -4380U/L） ,respectively. Those with more than 3 -fold elevated enzymes levels were 35 cases （41.67%） for amylase and 30 cases （35.71%） for lipase. No correlation was found between Bahhazar CT scores and any of lipase levels,amylase levels and L/A ratio （P 〉 0.05 ）. Among AP patients, L/A ratio 〉 5 was found in 75% of alcoholic ,32.65% of biliary disease,5.88% of hyperlipidemia,and I0% of other etiologies. The median value of lipase in non - AP patients （28 eases） was 801U/L （307 -2664U/L）. The etiologies included pancreatic pseudocysts/abscess （8）, pu]monary infection with parapneumonie effusions （ 7 ）, pancreatic cancer （ 6 ）, renal failure （ 2 ）, intestinal obstruction （ 2 ）, perforated duodenal ulcer（ 1 ）, subacute thyroiditis（ 1 ） and acute monocytie leukemia （ 1 ）. Among non - AP causes, L/A ratio 〉 5 was found in 83% of pancreatic cancer,75% of pancreatic pseudocysts/ abscess, and 28.57% of pulmonary infection with pampneumonie effusions. Conclusions ： Hyperlipasaemia was mainly found in pancreatic diseases, but not only. The L/ A ratio 〉 5 was mainly found in alcoholic- induced pancreatic, pancreatic cancer, pancreatic pscudocysts/abscess, however, it cannot be used as a satisfactory index in etiological assessment of pancreatic diseases.

关 键 词：脂肪酶 淀粉酶 腹痛 病因 

分 类 号：R515.3[医药卫生—内科学]