胰弹性蛋白酶1评估胰腺外分泌功能不全在慢性胰腺炎临床分期以及预后中的应用价值  

Value of evaluating pancreatic exocrine insufficiency with fecal pancreatic elastase-1 in clinical staging of chronic pancreatitis and prognosis evaluation

作　　者：何丹 孙培芳 李伟 龚鸿鹏 潘杰 He Dan;Sun Peifang;Li Wei;Gong Hongpeng;Pan Jie(Department of Gastroenterology,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China;Endoscopic Center,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China;Physical Examination Center,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市中心医院消化内科,温州325000 [2]温州市中心医院内镜中心,温州325000 [3]温州市中心医院体检中心,温州325000

出　　处：《中国基层医药》2023年第9期1330-1334,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市科研项目(Y20220323)。

摘　　要：目的:探究胰弹性蛋白酶1(FE-1)评估胰腺外分泌功能不全(PEI)在慢性胰腺炎(CP)临床分期以及预后中的应用价值。方法:选取2021年1月至2022年6月温州市中心医院收治的PEI患者100例(病例组)和无PEI人群100例(对照组),采用酶联免疫吸附(ELISA)法检测两组患者粪便中FE-1含量,建立受试者工作特征曲线(ROC曲线)分析FE-1对PEI诊断价值,比较不同临床分期患者FE-1差异,采用logistic回归分析影响CP患者预后的危险因素。结果:病例组粪FE-1含量为(63.28±13.24)μg/g,低于对照组的(768.29±102.59)μg/g(t=68.16,P<0.05);FE-1的诊断PEI的灵敏度、特异度、约登指数、95%CI分别为74.7%、63.5%、0.724、0.740~0.870;纳入的200例受试对象共有CP患者103例,随M-ANNHEIM临床分期增加,CP患者粪FE-1含量逐渐下降(F=182.66,P<0.05);以FE-1<200μg/g为标准评估CP患者的胰腺外分泌功能,重新确定CP患者临床分期为Ⅰ期35例,Ⅱ期40例,Ⅲ期28例,与M-ANNHEIM临床分期比较,差异有统计学意义(χ^(2)=12.46,P=0.002);随访6个月,103例CP患者中有31例预后不良(30.1%),单因素分析显示,不同预后患者发病年龄、体质量指数(BMI)、三酰甘油(TG)、饮酒、FE-1含量差异均有统计学意义(χ^(2)=24.07、4.27、5.43、8.38、4.93,均P<0.05);多因素logistic回归分析显示,发病年龄、BMI、TG、饮酒、FE-1是CP患者预后的独立影响因素OR(95%CI)为4.207(2.741~11.609)、1.870(1.241~2.972)、1.984(1.437~3.113)、2.769(1.827~5.125)、1.951(1.469~3.387),均P<0.05)。结论:FE-1对评估PEI具有较好的诊断价值,且与CP临床分期以及患者预后密切相关,有望成为评估CP进展及预测预后的指标。Objective To investigate the value of evaluating pancreatic exocrine insufficiency with fecal pancreatic elastase-1 in the clinical staging of chronic pancreatitis and prognosis evaluation.Methods A total of 100 patients with pancreatic exocrine insufficiency(patient group)who received treatment in Wenzhou Central Hospital from January 2021 to June 2022 and 100 subjects without pancreatic exocrine insufficiency(control group)were included in this study.Fecal pancreatic elastase-1 content was measured by an enzyme linked immunosorbent assay.The receiver operating characteristic(ROC)curve was plotted to evaluate the value of fecal pancreatic elastase-1 content in the diagnosis of pancreatic exocrine insufficiency.Fecal pancreatic elastase-1 content was compared among patients with different clinical stages of chronic pancreatitis.The factors that affect the prognosis of patients with chronic pancreatitis were analyzed using logistic regression analysis.Results Pancreatic elastase-1 content in the patient group was(63.28±13.24)μg/g,which was significantly lower than(768.29±102.59)μg/g in the control group(t=68.16,P<0.05).The sensitivity,specificity,Youden index,and 95%CI of using pancreatic elastase-1 content to diagnose pancreatic exocrine insufficiency were 74.7%,63.5%,0.724,and 0.740-0.870,respectively.Among the 200 included subjects,103 had chronic pancreatitis.With the increase in M-ANNHEIM clinical stage,fecal pancreatic elastase-1 content in patients with chronic pancreatitis gradually decreased(F=182.66,P<0.05).Pancreatic elastase-1 content<200μg/g was used as a standard to evaluate pancreatic exocrine function.Results showed that 35 patients had stage I chronic pancreatitis,40 patients had stage II chronic pancreatitis,and 28 patients had stage III chronic pancreatitis.There was no significant difference in the number of patients with different stages of chronic pancreatitis between the two clinical stage classification methods(χ^(2)=12.46,P=0.002).Six-month follow-up results showed that among 103 pat

关 键 词：胰腺炎 慢性 胰腺外分泌功能不全 胰弹性蛋白酶 敏感性与特异性 预后 影响因素分析 

分 类 号：R576[医药卫生—消化系统]