生化检测指标在急性胰腺炎诊断中的临床意义

Clinical significance of biochemical indicator in diagnosis of acute pancreatitis

目的探讨血淀粉酶(S-Amy)、尿淀粉酶(U-Amy)、胰脂肪酶(LPS)、胰蛋白酶原激活肽(TAP)和C反应蛋白(CRP)等5项生化指标在急性胰腺炎(AP)早期诊断和病情评估中的应用价值。方法将265例急腹症患者分为AP组和非AP组,其中AP组根据病情严重程度分为轻症AP(MAP)和重症AP(SAP),同时选取35例健康体检者作为正常对照组。检测各组5项指标。S-Amy、U-Amy和LPS采用速率法检测,TAP采用双抗体夹心酶联免疫吸附试验(ELISA)检测,CRP采用乳胶增强速率散射比浊法检测。结果 S-Amy、U-Amy和TAP水平由高到低依次为AP组>非AP组>正常对照组,各组间差异均有统计学意义(P<0.01)。AP组LPS水平明显高于非AP组和正常对照组(P<0.01),AP组和非AP组CRP水平均高于正常对照组(P<0.01)。SAP组U-Amy、TAP及CRP水平明显高于MAP组(P<0.01),而S-Amy、LPS水平2组间无差异(P>0.05)。在早期AP的诊断中,血清LPS敏感性为92.1%、特异性为91.6%,明显高于S-Amy、U-Amy、TAP和CRP。结论 LPS的检测有助于AP的早期诊断,而TAP和CRP则有助于病变严重程度的判断以及治疗效果的观察与预后评估。

Objective To investigate the application significance of serum amylase（S-Amy）,urinary amylase（U-Amy）,lipase（LPS）,trypsinogen activation peptides（TAP） and C reactive protein（CRP） in diagnosing acute pancreatitis（AP） and assessing the severity of AP in the early stages.Methods 265 patients with acute abdomen were classified into AP and non-AP groups.AP patients were classified into mild AP group（MAP） and severe AP group（SAP）,and 35 healthy subjects were enrolled as control group.The 5 indicators were detected in these different groups.S-Amy,U-Amy and LPS were determined by rate method,TAP by double antibody sandwich enzyme-linked immunosorbent assay（ELISA） and CRP by particle enhanced nephelometry.Results The concentrations of S-Amy,U-Amy and TAP from high to low were AP groupnon-AP groupcontrol group with statistical significance（P0.01）.The concentration of LPS was higher in AP group than non-AP group（P0.01）.The concentrations of CRP in AP and non-AP groups were higher than that in the control group（P0.01）.The concentrations of U-Amy,TAP and CRP in SAP group were significantly higher than those in MAP group（P0.01）.However,the concentrations of S-Amy and LPS had no difference between SAP group and MAP group（P0.05）.In the diagnosis of early stage AP,the sensitivity and specificity were 92.1% and 91.6% in LPS,and were significantly higher than those in S-Amy,U-Amy,TAP and CRP.Conclusions The measurement of LPS may contribute to the early diagnosis of AP,while TAP and CRP can be used as early predictive indicators of changes in AP,as well as the treatment effect and severity of AP.