尿胰蛋白酶原-2在重症急性胰腺炎预测中的意义

The clinical meaning of rapid measurement of urine trypsinogen-2 in predicting severity of acute pancreatitis

目的探讨尿胰蛋白酶原-2对急性胰腺炎严重程度预测的临床意义。方法将尿液样本稀释40倍,然后用免疫层析法定量检测尿胰蛋白酶原-2,将结果与血清C-反应蛋白(CRP)含量及A-PACHE评分进行对照。结果以2000μg/L为标准,尿胰蛋白酶原-2对于患者刚入院及入院24h后预测SAP的敏感性均为62%,特异性分别为87%和85%,阳性预测值(PPV)分别为62%和65%,阴性预测值(NPV)均为85%,阳性似然比(PLR)分别为4.8%和4.2%;CRP含量对患者刚入院及入院24h后的敏感性分别是38%和83%,特异性分别为90%和70%,PPV分别为59%和52%,NPV分别为79%和91%,PLR分别为3.7%和2.7%;APACHEⅡ评分对患者刚入院及入院24h的敏感性分别为87%和86%,特异性分别为52%和45%,PPV分别为61%和56%,NPV分别为82%和80%,PLR分别为3.6%和3.7%。结论尿胰蛋白酶原-2预测SAP较CRP、APACHEⅡ评分价值高,且检测方便,快速。

Objective To study the clinical meaning urine trypsinogen-2 in predicting the severity of acute pancreatitis. Methods We increased the detection limit of the urinary trypsinogen-2 test strip （Actim Pancreatitis） from 50 μg/L to 2 000 μg/L and evaluated the prognostic value of this test. The results were compared with those obtained with serum C-reactive protein and the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores. Results Sensitivity of urinary trypsinogen 2 （ 〉 2 000 μg/L） for prediction of severe AP, both on admission and 24 h late, was 62%; specificity was 87% and 85%, respectively; positive predictive values（PPV） were 65% and 62%, negative predictive values were 85% and 85%, and the positive likelihood ratio （PLR） was 4.8%, and 4.2%. C-Reactive protein（CRP）had a sensitivity of only 38% on admission, and 83% 24 h late; specificity was 90% and 70%, respectively; PPV were 59% and 52%, NPV were 79% and 91%, respectively, and PLR was 3.7 % and 2.7 %, respectively. APACHE Ⅱ scores had a sensitivity of 87 % on admission, and 86% 24 h late; specificity was 52% and 45%, respectively; PPV were 61% and 56%, NPV were 82% and 80%, respectively, and PLR was 3. 6% and 3. 7%, respectively. Conclusions The urine trypsinogen-2 is a better marck for predicting severe acute pancreatitis them CRP and APACHE Ⅱ.