尿羧肽酶B和尿胰蛋白酶原激活肽诊断急性重症胰腺炎的临床价值分析  

Compare the Diagnostic Value of Carboxypeptidase（CAPAP） and the Urinary Trypsinogen（TAP） for Severe Acute Pancreatitis（SAP）

作　　者：刘斌[1] 龙延滨[1] 刘栋[1] 刘倩[2] 

机构地区：[1]陕西省人民医院普外二科,西安710068 [2]陕西省人民医院消化内二科,西安710068

出　　处：《现代检验医学杂志》2015年第5期81-83,共3页Journal of Modern Laboratory Medicine

摘　　要：目的 评估尿液中羧肽酶B激活肽（carboxypeptidase B,CAPAP）水平和尿胰蛋白酶原（trypsinpgen activation peptide,TAP）对急性重症胰腺炎（severe acute pancreatitis,SAP）的临床诊断价值.方法 收集2012年6月～2014年6月因腹痛24～72 h就诊的病人,最终将23例SAP患者和38例急性轻症胰腺炎（mild acute pancreatitis,MAP）患者纳入研究,使用EPS速率法检测血清淀粉酶（amylase,Amy）水平,使用ELISA法检测尿液中TAP水平,使用胶体金法检测尿液中CAPAP水平,分别计算其诊断效能进而确定诊断效能最高的生化指标.结果 研究共纳入61例患者,根据实验结果分析,SAP组尿液中CAPAP和TAP水平较MAP组均明显升高,CAPAP水平SAP组82.61％,MAP组为7.89％（P＜0.05）,TAP水平SAP组为93.62±14.61 nmol/L,MAP组为67.50士6.25 nmol/L,差异有统计学意义（P＜0.01）.血清Amy水平SAP组（744.31±689.64 u/L）与MAP组（549.32±338.33 u/L）差异无统计学意义（P＞0.05）.三项生化指标中,尿CAPAP对SAP最具有诊断价值（敏感度86.4％,特异度89.7％,准确度88.5％,阳性及阴性预测值分别为82.6％和78.8％）.结论 相对于血清Amy和尿TAP,尿CAPAP可作为诊断SAP的一项可靠生化指标,血淀粉酶不适宜作为一项SAP的筛查指标.Objective To assess the usefulness of the activation peptide of carboxypeptidase B （CAPAP） and urinary trypsin- ogen activation peptide （TAP） in the diagnosis of severe acute pancreatitis （SAP）. Methods Patients with acute abdominal pain and hospitalized within 24-72 h after the onset of symptoms were prospectively studied from 2012.6 to 2014.6. They were divided into two groups：SAP （n=23）, MAP （n= 38）. Serum amylase （Amy） was measured using a EPS. Urinary TAP was measured using a quantitative solid-phase ELISA,and urinary CAPAP by a radioimmunoassay method. Then,cal- culated its diagnostic performance to determine the highest diagnostic effectiveness biomarker. Results 61 patients accom- plished this study. Patients with severe acute pancreatitis showed significantly higher median levels of urinary CAPAP and TAP levels,the level of CAPAP in SAP was 82.61%,in MAP was 7.89% （P〈0.05） ,the level of TAP in SAP was 93.62 ±14.61 nmol/L,in MAP was 67.50±6.25 nmol/L （P〈0.01）. There was no significance in serum Amylase （SAP 744.31 ±689.64 u/L,MAP 549.32±338.33 u/L,P〉0.05）. Urinary CAPAP was the most reliable test for the diagnosis of SAP （sensitivity 86.4 %, specificity 89.7 % ,accuracy 88.5%, positive and negative predictive values 82.6 % and 78.8 %, respec- tively）. Conclusion In patients with SAP,CAPAP in urine are reliable diagnostic markers. Amylase is not a useful screening test for the diagnosis of SAP.

关 键 词：急性重症胰腺炎 尿羧肽酶 尿胰蛋白酶原 

分 类 号：R576[医药卫生—消化系统] R446.112[医药卫生—内科学]