血清淀粉酶监测对ERCP术后胰腺炎的预测

Significance of serum amylase in predicting post-ERCP pancreatitis

目的探讨为预测ERCP术后急性胰腺炎或持续重度高淀粉酶血症发生而测定血清淀粉酶的最佳时间。方法对198例行ERCP术的患者分别测定术前即刻和术后2h、4h、8h、24h的血清淀粉酶值,将2h、4h、8h的血清淀粉酶值分别与24h的血清淀粉酶值及最终临床结果比较。结果198例患者中15例在ERCP术后24h的血清淀粉酶水平仍高于正常值上限的5倍(>575IU/L),与其他淀粉酶水平较低的患者比较,在所有时间点上淀粉酶值都有显著性差异。虽然8h点的血清淀粉酶水平判断术后胰腺炎的敏感性最高,但考虑实用价值可将4h点作为一可靠预测指标。结论ERCP术后4h血清淀粉酶水平是有利于随访、具有经济效益、预测术后胰腺炎或重度高淀粉酶血症发生的指标。

Objective To predict post-ERCP pancreatitis or persistent severe hyperamylasemia by detecting peak time of serum amylase. Methods Serum amylase activity was measured in 198 patients after ERCP, immediately before ERCP, and 2, 4, 8 and 24 h after ERCP. The data at 2, 4 and 8 h were compared with those at 24 and with the outcome. Results 24 h after ERCP, serum amylase was still more than five times the upper normal limit in 15 patients. There was a significant difference at all sampling times between the 15 patients with 24 h severe hyperamylasemia （ 〉 575 IU/L） and those with the lower levels. Although the sensitivity of serum amylase measurement in detecting pancreatitis was highest at 8 h, the 4 h assessment appeared to be a more reliable predictor. Conclusions Serum amylase assessment at 4 h after ERCP was a reliable, cost-effective follow-up predictor in predicting post-ERCP pancreatitis.