血清α-淀粉酶、CA242水平与胆管支架置入术后并发胰腺炎的相关性

Study on the correlation between the expressions of serumα-amylase,CA242 and pancreatitis after biliary stent implantation

目的探讨血清α-淀粉酶、糖类抗原242(CA242)水平与胆管支架置入术后并发胰腺炎的相关性。方法选取2016年1月~2020年1月本院收治的因恶性胆道梗阻行胆管支架置入术患者179例,根据术后24 h是否并发胰腺炎将其分为并发胰腺炎组(n=78)和未并发胰腺炎组(n=101)。采用酶速率法检测血清α-淀粉酶水平,采用电化学发光免疫法检测血清CA242表达水平。通过Logistic回归分析胆管支架置入术后并发胰腺炎的影响因素,受试者工作特征曲线(ROC)分析血清α-淀粉酶、CA242对胆管支架置入术后并发胰腺炎的预测价值。结果术后4 h时并发胰腺炎组患者血清α-淀粉酶、CA242、IL-10、CRP表达水平明显升高(P<0.05),并发胰腺炎组术前术后水平差值均明显大于未并发胰腺炎组(P<0.05)。术后1周时两组患者总胆红素、直接胆红素表达水平均明显降低(P<0.05),并发胰腺炎组术前术后总胆红素、直接胆红素水平差值明显小于未并发胰腺炎组(P<0.05)。α-淀粉酶、CA242、IL-10、CRP高水平均是恶性胆道梗阻患者胆管支架置入术后并发胰腺炎的危险因素(P<0.05)。血清α-淀粉酶、CA242联合检测对胆管支架置入术后并发胰腺炎预测的曲线下面积为0.883,明显优于α-淀粉酶、CA242单独检测对其预测的曲线下面积0.824、0.826(Z=2.015、2.127,P<0.05)。结论恶性胆道梗阻患者胆管支架置入术后血清α-淀粉酶、CA242水平升高与并发胰腺炎有关,且二者联合检测对术后并发胰腺炎的诊断价值较高。

Objective To investigate the correlation between the expressions of serumα-amylase,carbohydrate antigen 242(CA242)and pancreatitis after biliary stent implantation.Methods From January 2016 to January 2020,179 patients underwent biliary stent placement due to malignant biliary obstruction were selected and divided into 78 patients with pancreatitis and 101 patients without pancreatitis according to the postoperative complications of pancreatitis.The level of serumα-amylase was measured by enzyme rate method,the expression level of CA242 in serum was detected by electrochemiluminescence immunoassay.Logistic regression was used to analyze the influencing factors of pancreatitis after stent placement,ROC was used to analyze the predictive value of serumα-amylase and CA242 in patients with pancreatitis after biliary stent implantation.Results The levels of serumα-amylase,CA242,IL-10 and CRP in pancreatitis group were significantly increased at 4 hours after operation(P<0.05),and the difference of preoperative and postoperative levels in patients with pancreatitis was significantly higher than that in patients without pancreatitis(P<0.05).The expression levels of total bilirubin,direct bilirubin and indirect bilirubin in the two groups were significantly decreased at 1 week after operation(P<0.05),and the difference of total bilirubin and direct bilirubin before and after operation in patients with pancreatitis was significantly lower than that in patients without pancreatitis(P<0.05).High levels ofα-amylase,CA242,IL-10 and CRP were the risk factors of pancreatitis after biliary stent implantation in patients with malignant biliary obstruction(P<0.05).The area under the curve of pancreatitis after biliary stent implantation predicted by serumα-amylase and CA242 was 0.883,which was significantly better than 0.824,0.826 ofα-amylase and CA242 single detections(z=2.015,2.127,P<0.05).Conclusions The elevated levels of serumα-amylase and CA242 in patients with malignant biliary obstruction after biliary stent implantation are related to pancreatitis,and the combined detection of the two is of high value in the diagnosis of postoperative pancreatitis.