淀粉酶测定法对误吸的诊断价值

Diagnostic value of amylase assay in patients with aspiration

目的探讨淀粉酶测定法对误吸的诊断价值及其缺陷。方法选择2018年1月至2020年11月本院住院患者及门诊人群共184例,根据有否误吸分为实验组(误吸组)与对照组。误吸组:121例,男89例,女32例,29~84岁,平均62.36±11.96岁;入选标准:内镜见支气管腔内有食物残渣。对照组:63例,男46例,女17例,23~83岁,平均59.68±12.87岁;入选标准:体检身体健康的正常人11例,无消化系统疾病病史的肺部微小结节者52例。两组均行支气管镜检查获取下呼吸道分泌物,标本采取淀粉酶测定法测定。记录两组基本资料、操作时间及比较两组的诊断率。结果误吸组和阴性对照组,性别和年龄无显著性差异。淀粉酶测定法敏感性88.43%,特异性98.39%,假阳性率1.61%,假阴性率11.57%。工作曲线(ROC):淀粉酶测定法的ROC曲线下面积为0.955。淀粉酶检测+标本处理平均时间约202.68±38.62min。结论淀粉酶测定法对误吸的诊断方法特异性好,阳性预测值高,有较好的敏感性。但其标本处理时间长、灌洗位置及浓度不规范,限制了临床应用。

Objective To explore the diagnostic value of amylase assay for aspiration and analyze its disadvantage.Methods A total of 184 inpatients and outpatients treated in our hospital from January 2018 to November 2020 were selected and divided into experimental group(aspiration group)and control group according to whether the occurrence of aspiration.Aspiration group:121 patients,including 89 males and 32 females with ages ranging between 29 and 84 years old,average age 62.36±11.96 years old.Inclusion criteria:endoscopically-proven food residue in bronchial lumen.Control group:63 patients,including 46 males and 17 females with ages ranging between 23 and 83 years old,average age 59.68±12.87 years old.Inclusion criteria:11 healthy subjects and 52 patients with pulmonary nodules and without a history of digestive diseases.The lower respiratory secretions were obtained by bronchoscopy in both groups,and the samples were determined by amylase assay.The basic data,operation time,and diagnosis rate of the two groups were recorded.Results There was no significant difference in sex and age between aspiration group and negative control group.Amylase assay showed that the sensitivity was 88.43%,the specificity was 98.39%,the false-positive rate was 1.61%,and the false-negative rate was 11.57%.Receiver operating characteristic curve(ROC):The area under ROC of amylase assay was 0.955.Amylase detection time and sample treatment averaged about 202.68±38.62 min.Conclusion Amylase assay has good specificity,high positive predictive value and good sensitivity for the diagnosis of aspiration.However,the long processing time,irregular lavage location and concentration limit its clinical application.