早期肝功能损害对急性胰腺炎病因判定的临床价值  

Clinical value of early liver dysfunction in diagnosis of etiology of acute pancreatitis

作　　者：陈勇[1,2] 曾艳凌[1,2] 林志辉[1,2] 

机构地区：[1]福建医科大学省立临床医学院 [2]福建省立医院消化内科,福建省福州市350001

出　　处：《世界华人消化杂志》2012年第34期3390-3393,共4页World Chinese Journal of Digestology

摘　　要：目的:观察急性胰腺炎(acute pancreatitis,AP)患者发病48h内肝功能改变,探讨早期肝功能损害对AP病因判定的临床意义.方法:对153例AP患者临床资料回顾性分析,按病因分为胆源性、非胆源性及不明原因3组.胆源性组(n=80);非胆源性组(n=44);不明原因组(n=29).早期肝功能检测指标:胆源性组(n=61);非胆源性组(n=33).比较胆源性组和非胆源性组早期肝功能指标血清丙氨酸氨基转氨酶(amino transaminase,ALT)、门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)、直接胆红(direct bilirubin,DBIL)、谷氨酰转移酶(glutamyl transferase,GGT)、碱性磷酸酶(alkaline phosphatase,AKP),观察其早期肝功能损害的临床类型,并计算胆源性组早期肝功能损害的敏感性和特异性.结果:胆源性组患者早期肝功能损害较非胆源性组严重,ALT(214.16U/L±146.92U/Lvs30.82U/L±25.59U/L),AST(212.72U/L±210.50U/Lvs28.24U/L±22.16U/L),GGT(438.34U/L±286.69U/Lvs60.48U/L±68.32U/L),AKP(202.81U/L±147.77U/Lvs72.06U/L±36.70U/L),TBIL(56.52μmol/L±46.01μmol/Lvs18.25μmol/L±9.56μmol/L),DBIL(36.81μmol/L±32.50μmol/Lvs5.17μmol/L±4.65μmol/L,均P<0.001);早期肝功能损害临床类型以ALT、AST、GGT、AKP、TBIL及DBIL混合损害为主,占88.6%;其敏感性为95.1%,特异性为90.9%.结论:早期肝功能损害可预测AP病因为胆石(源)性.早期肝功能检测应作为急诊的常规实验室检查项目,更适合于基层医院.AIM： To investigate the clinical significance of early liver dysfunction in diagnosis of the etiol- ogy of acute pancreatitis. METHODS： The clinical data for 153 patients with acute pancreatitis were retrospectively analyzed. These patients were divided into three group based on the etiology of the disease： bili- ary pancreatitis （n = 80）, non-biliary pancreatitis （n = 44） and unexplained pancreatitis （n = 29）. The markers of early liver function were com- pared between the biliary pancreatitis group （n -- 61） and non-biliary pancreatitis group （n -- 33）, including serum alanine amino transaminase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, direct bilirubin （DBIL）, gamma- glutamyl transferase （GGT）, alkaline phospha- tase （AKP）. The sensitivity and specificity of early liver dysfunction in the diagnosis of biliary pancreatitis were calculated.RESULTS： Early liver dysfunction in patients with biliary pancreatitis was more serious than that in patients with non-biliary pancreatitis （ALT： 214.16 U/L ＋ 146.92 U/L vs 30.82 U/L ＋ 25.59 U/L; AST： 212.72 U/L ＋ 210.50 U/L vs 28.24 U/L ＋ 22.16 U/L; GGT： 438.34 U/L ＋ 286.69 U/L vs 60.48 U/L ＋ 68.32 U/L; AKP： 202.81 U/L ＋ 147.77 U/L vs 72.06 U/L ＋ 36.70 U/L; TBIL： 56.52 μmol/L ＋ 46.01μmol/L vs 18.25 μmol/L ＋ 9.56μmol/L; DBIL： 36.81 μmol/ L ＋ 32.50 μmol/L vs 5.17μmol/L ＋ 4.65 μmol/L; all P 〈 0.001）. Early liver dysfunction manifested mainly as abnormal ALT, AST, GGT, AKP, TBIL, DBIL, or a combination of several of them. The sensitivity and specificity of early liver dysfunc- tion in the diagnosis of biliary pancreatitis were 95.1% and 90.9%, respectively. CONCLUSION： Early liver dysfunction can be used to predict the etiology of acute pancreatitis. Early liver function tests should be included in routine emergency laboratory tests.

关 键 词：早期肝功能损害 急性胰腺炎 病因 肝功 能检测指标 实验室检查 

分 类 号：R576[医药卫生—消化系统]