慢性胰腺炎1994例临床诊断分析

Diagnostic methods in chronic pancreatitis

目的分析我国慢性胰腺炎（CP）常用的诊断方法及其对CP的诊断敏感性和特异性，棘索简便、易行、准确性高的CP诊断方法。方法采用多中心联合调查方法，回顾分析全国22个分研究中心的CP确诊病例，调查时间为1994年5月至2004年5月。并以同期入院无胰腺疾病患者为对照，采用受试者工作曲线（ROC）分析CP诊断方法的敏感性和特异性。结果共入选CP患者1994例，男性1298例（65．1％），女性696例（34．9％），男女性别比为1．86：1。年龄5—85（48．9±15．0）岁。所有CP患者中，有组织学诊断239例（11．98％）；胰腺外分泌功能-N-苯甲酰-L-酪氨酰-对氨基苯甲酸试验（N—benzoyl—L-tyrosyl—paminobenzoic acid，BT—PABA）261例（13．09％），X线腹部平片416例（20．86％）、腹部B超1424例（71．41％）、计算机断层成像（CT）889例（44．58％）、磁共振成像（MRI）和磁共振胰胆管显影（MRCP）245例（12．29％）、内镜逆行胰胆管造影（ERCP）628例（31．49％）、超声内镜（EUS）258例（12．94％）。各诊断方法的诊断敏感性和特异性分别为EUS（88％和93％）、ERCP（87％和93％）、MRI和MRCP（66％和85％）、CT（61％和85％）、B超（69％和82％）、X线腹部平片（32％和80％）、BT—PABA（83和80％）。结论我国CP诊断方法中，腹部B超应用最为广泛，BT-PABA为常用的胰腺外分泌功能检查方法，EUS对CP且具有较高的敏感性和特异性。

Objective To evaluate the diagnostic methods for chronic pancreatitis （CP） in China. Methods Data were collected from 22 hospitals all over China. The time limit was from May 1994 to May 2004. The data of patients without pancreatic diseases and coming into hospital in the same time also were collected as control. The sensitivity and specificity of all diagnostic methods were analyzed through receiver operating characteristic （ ROC ）. Results There were 1994 patients with 1298 males and 696 females involved into the study. There were 239 patients（ 11.98% ）diagnosed with CP by pathology ,261 patients（ 13.09% ） by BT-PABA ,419 patients（20. 86% ） by X -ray, 1424 patients （71.41%） by abdominal B ultrasonograph, 889 patients （ 44. 58 % ） by CT, 245 patients （ 12. 29 % ） by magnetic resonance imaging （ MRI ） and magnetic resonance cholangiopancreatography （ MRCP）, 628 patients （ 31.49% ） by endoscopy retrograde cholangiopancreatograph （ERCP） , and 258 patients （12. 94% ）by endoscopic ultrosonograph （EUS）. The sensitivity and specificity were EUS （88% and 93% ） ,ERCP（87% and 93% ） ,MRI and MRCP（66% and 85% ） ,CT（61% and 85% ） ,B ultrasonography （69% and 82% ）, X-ray（32% and 80% ） ,and BT-PABA（83 and 80% ）. Conclusion B ultrasonography and BT-PA- BA common diagnostic method and common function test for CP, even though they both have low sensitivity and specificity. EUS has the highest sensitivity and specificity for CP.