胰型淀粉酶、脂肪酶在急性胰腺炎中的临床应用

Clinical application of pancreatic amylase and lipase in acute pancreatitis

目的为了评价急性胰腺炎中胰型淀粉酶(P-AMY)的临床应用价值,对总淀粉酶(α-AMY)、P-AMY、脂肪酶(lipase,LPS)进行方法学评价。方法选择急性胰腺炎患者126例、其他疾病患者对照组105例、健康对照组95例,用日立7600全自动生化分析仪测定α-AMY、P-AMY、LPS。本实验室临界值定为α-AMY216U/L、P-AMY115U/L、LPS200U/L。结果α-AMY、P-AMY、LPS灵敏度分别为73.1%、88.5%、92.3%,特异性分别为70.5%、81.9%、82.9%,ROC工作曲线下α-AMY、P-AMY、LPS灵敏度分别为65.4%、88.5%、88.5%,特异性分别为86.7%、80.9%、89.5%,α-AMY和P-AMY之间差异有统计学意义(P=0.045),P-AMY和LPS之间差异无统计学意义(P=0.613)。结论P-AMY检测比α-AMY更敏感、更特异性地反映急性胰腺炎。LPS也同样在急性胰腺炎中具有高灵敏度和特异性,临床上应同时检测P-AMY和LPS作为诊断急性胰腺炎的指标,具有更重要意义。

Objective To investigate the clinical value of pancreatic amylase （P-AMY） in acute pancreatitis, and perform methodical evaluation on total amylase （α-AMY）, P AMY and lipase. Methods 126 cases of patients with acute pancreatitis, 105 cases of disease controls and 95 healthy controls were invoiced in the investigation. Hitachi7600 automatic biochemical analyzer was applying to measuring α-AMY, P AMY and lipase. The upper limit of the reference range of the total amylase, pancreatic amylase and lipase was 216 U/L, 115 U/L and 200 U/L respectively in our laboratory. Results The sensitivity of total amylase, pancreatic amylase, and lipase for the diagnosis of acute pancreatitis was 73. 1%, 88. 5% and 92. 3% respectively; and while the specificity was 70. 5%.81. 9% and 82.9% respectively. The diagnostic accuracy, determined as the area under the curve, was 0. 795 for total amylase, 0. 868 for pancreatic amylase, and 0. 886 for lipase. There was a significant difference between the total amylase and pancreatic amylase （P=0. 045）, but no significant difference was found between the pancreatic amylase and lipase （P=0. 613） by ROC curve. Conclusion Pancreatic amylase has a higher sensitivity, specificity and diagnostic accuracy than α-AMY in acute pancreatitis, and shows a similar diagnostic performance as lipase. Therefore, P-AMY and lipase should be measured in combination in the diagnosis of acute pancreatitis.