尿胰蛋白酶原-2在急诊科诊断急性胰腺炎的临床价值

Clinical value of urine trypsinogen-2 test in the diagnosis of acute pancreatitis in the Emergency Department

目的探讨尿胰蛋白酶原-2在急诊科诊断急性胰腺炎的临床应用价值。方法对急诊科就诊的非选择性上腹痛患者,同时进行血、尿淀粉酶和尿胰蛋白酶原-2检测。结果 175例患者中,被确诊为急性胰腺炎62例(32.6)。尿胰蛋白酶原-2对急性胰腺炎的诊断灵敏度、特异性、阳性和阴性预期值均明显低于血、尿淀粉酶(均为P<0.05或0.01);但在腹痛发作时间小于24h的患者中,尿胰蛋白酶原-2的诊断效能与血、尿淀粉酶均无显著差异。结论尿胰蛋白酶原-2对急性胰腺炎的诊断效能低于血、尿淀粉酶。但在急性腹痛早期,尿胰蛋白酶原-2在急诊科仍具有一定的临床应用价值,尤其是其排除诊断价值。

Objective To investigate the clinical value of the urine trypsinogen-2 dipstick test in the diagnosis of acute pancreatitis in the Emergency Department. Methods 175 patients admitting to the Emergency Department due to upper abdominal pain were included in the study. Serum amylase,urine amylase and urine trypsinogen 2 were assayed in all patients. Results 62 patients included in this study had acute pancreatitis diagnosis. Urine trypsinogen 2 was found positive in 57 （32.6%） patients. The sensitivity,specificity,positive predictive value, and negative predictive value of the urine trypsinogen-2 test for all the patients were 66.1%.85.8 %,71.9%, 82.2% ,respectively.These values were significantly lower than serum and urine amylase （P〈0. 05 or 0.01）. However,in the first 24 hours upper abdominal pain occurred, the sensitivity, specificity, positive predictive value,and negative predictive value of the urine trypsinogen-2 test for all the patients were 83.3%,87. 1 %, 76. 9%, 91.0%, respectively, which were not statistically different from serum and urine amylase. Conclusion Although it has lower sensitivity and specificity compared to amylase,we suggest that urine trypsinogen 2 test may be an important diagnostic tool for early diagnosis of acute pancreatitis,especially in excluding the diagnosis of acute pancreatitis.