术后3h血清淀粉酶检测对ERCP术后胰腺炎的预测价值

The value of serum amylase test 3-hour after ERCP for predicting post-ERCP pancreatitis

目的评估ERCP术后3 h血清淀粉酶值对ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)的预测价值。方法收集2011年10月1日至2014年12月1日我院328例连续行ERCP的患者术后3 h和24 h血清淀粉酶值,并统计PEP的发生情况。将是否发生PEP作为状态变量,两个时间点的血清淀粉酶作为检验变量,采用SPSS13.0系统作ROC曲线,分析术后3 h和24 h血清淀粉酶对PEP的预测价值。结果 328例患者中诊断PEP共17例(5.18%)。术后3 h血清淀粉酶值≤200 U/L共194例(59.15%),其中PEP 2例(1.03%);术后3 h血清淀粉酶值>200 U/L共134例(40.85%),其中PEP 15例(11.19%);两者比较有统计学差异(x2=19.731;P<0.001)。术后3 h血清淀粉酶值ROC曲线下面积为0.845,诊断准确度良好,最佳Cut-off值为280 U/L,灵敏度82.4%,特异度74.3%,阳性预测值14.7%,阴性预测值98.7%,准确度74.4%,Youden指数56.4%。术后24 h血清淀粉酶值≤600 U/L共284例(86.59%),其中PEP 1例(0.35%);术后24 h血清淀粉酶值>600 U/L共44例(13.41%),其中PEP 16例(36.36%);两者比较有统计学差异(x2=93.341;P<0.001)。术后24 h血清淀粉酶值ROC曲线下面积为0.977,诊断价值高,最佳Cut-off值为534.5 U/L,灵敏度100%,特异度89.1%,阳性预测值33.3%,阴性预测值100%,准确度89.6%,Youden指数89.1%。结论 ERCP术后3 h血清淀粉酶值对PEP有较好的早期预测价值,特别是有很好的阴性预测价值;当术后3 h血清淀粉酶值>200 U/L并且有胰管插管时,需高度警惕PEP的发生。

Objective To evaluate the value of serum amylase test 3-hour after endoscopic retrograde cholangiopancreatography（ERCP） for predicting post-ERCP（PEP） pancreatitis. Methods A study of 328 consecutive ERCPs performed at a single centre was conducted from Oct. 1, 2011 to Dec. 1, 2014. The serum amylase level was measured at 3 h and 24 h after ERCP. The patients with PEP were recorded. The data were statistically analyzed with ROC curve. Results PEP occurred in 17 patients（5.18%）. There were 194 patients with the 3 h serum amylase≤200 IU/L, and PEP occurred in 2 patients. 134 patients with the 3 h serum amylase200 IU/L,and PEP occurred in 15 patients. There was statistical difference between two groups（χ2=19.731; P〈0.001）. In the ROC curve of 3 h serum amylase, the area under curve was 0.845, the diagnostic accuracy was good and the optimal cut-off value was 280 U/L. The sensitivity of 3 h serum amylase was 82.4%, specificity 74.3%, positive predictive value 14.7%, negative predictive value 98.7%, accuracy 74.4% and Youden index 56.4%. There were284 patients with the 24 h serum amylase≤600 IU/L, and PEP occurred in 1 patient（0.35%）. 44 patients with the 24 h serum amylase600 IU/L, and PEP occurred in 16 patients. There was statistical difference between two groups（χ2=93.341, P〈0.001）. In the ROC curve of 24 h serum amylase, the area under curve was 0.977, the diagnostic accuracy was excellent and the optimal cut-off value was 534.5 U/L. The sensitivity of 24 h serum amylase was 100%, specificity 89.1%, positive predictive value 33.3%, negative predictive value 100%, accuracy 89.6%and Youden index 89.1%. Conclusion The predictive value of 3 h post-ERCP serum amylase for PEP was good,and the negative predictive value was excellent. When patients have undergone cannula of pancreatic duct and 3h serum amylase level is greater than 200 IU/L, PEP should be concerned.