胰蛋白酶原激活肽对重症急性胰腺炎早期临床诊断价值及与预后的关系

The role of trypsinogen activation peptide in the early diagnosis of severe acute pancreatitis and the prediction of outcome

目的：探讨胰蛋白酶原激活肽（ TAP）对重症急性胰腺炎的早期诊断价值，并观察TAP与重症急性胰腺炎患者预后的关系。方法收集胰腺炎患者89例，其中重症急性胰腺炎患者45例，轻症急性胰腺炎患者44例，32例排除胰腺炎的急腹症患者作为对照组；所有患者在入院6 h内采集血液使用ELISA试剂盒检查TAP值，同时观察胰腺炎患者中出现并发症的例数；采用ROC曲线分析TAP对胰腺炎的诊断价值，同时分析对轻症急性胰腺炎及其并发症的判别价值。结果3组患者的TAP值比较差异有统计学意义（ p〈0.01），以重症急性胰腺炎患者值最大；ROC曲线分析显示，以 TAP 值2.78 nmol/L 作为判别标准，TAP 诊断胰腺炎的灵敏度为88.8%、特异性为100%、准确性为91.7%；以 TAP 值8.55 nmol/L 作为判别轻症与重症急性胰腺炎，灵敏度为92.9%、特异性为95.2%、准确性为88.7%；以TAP值11.20 nmol/L作为并发症的判别，灵敏度为75.0%、特异性为90.4%、准确性为82.2%。结论 TAP在早期可用于诊断胰腺炎，尤其对诊断重症急性胰腺炎具有重要的价值，同时TAP还可用于评价重症急性胰腺炎患者的预后。

Objective To explore the role of trypsinogen activation peptide（ TAP）in the early di-agnosis of severe acute pancreatitis（ AP）and the prediction of outcome. Methods Eighty-nine cases with pancreatitis were collected containing 45 cases of severe AP and 44 of mild AP. 32 cases of non-AP acute abdominal disease were chosen as control group. Blood of all patients was collected within 6h to measure TAP. ROC curve was used to analyze the results. Results The TAP was different among the three groups （p〈0. 01）;the TAP of patients with severe AP was the highest. ROC curve indicated that 2. 78 nmol/L was the best cutoff to define AP and non-AP;the sensitivity,specificity and accuracy was 88. 8%,100%and 91. 5%,respectively. 8. 55 nmol/L was used to define severe AP and mild AP;the sensitivity,speci-ficity and accuracy was 92. 9%,95. 2% and 88. 7%,respectively. 11. 20 nmol/L was used to predict the occurrence of complications;the sensitivity,specificity and accuracy was 75. 0%,90. 4% and 82. 2%,re-spectively. Conclusion The TAP can be used to diagnose AP,especially to identify severe AP. The TAP is also beneficial for predicting the outcome of patients with severe AP.