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急性胰腺炎(acute pancreatitis, AP)是一种迅速发作的胰腺炎症,可导致轻微到严重的、甚至危及生命的状况;由于多种病因(胆道疾病、胰管阻塞、酗酒、暴饮暴食、感染、手术、药物等)引起的胰腺及其周围组织被胰腺分泌的消化酶自身消化所产生的急性化学性炎症,使胰腺发生水肿、出血甚至坏死的一种炎症反应[1-2]。鉴于AP的临床症状(急性腹痛、按压痛、反跳痛等)与急腹症难以鉴别区分,且AP发病凶险,病死率高(20%~30%)的特点[3],因此,早期做出明确诊断就显得尤为重要。本研究收集了我院2017年7月至2021年3月70例收治的AP病人,采用干化学法检测血清脂肪酶(LPS)、淀粉酶(AMS)及C反应蛋白(CRP)水平,探讨它们在AP诊断中的价值。现作报道。
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AP组病人血清LPS、AMS阳性检出率分别为78.57%和77.14%,明显高于非AP组阳性检出率。而2组CRP差异无统计学意义(P>0.05)(见表 1)。
分组 n LPS阳性率 AMS阳性率 CRP阳性率 AP组 70 78.57(55/70) 77.14(54/70) 81.43(57/70) 非AP组 30 23.33(7/30) 13.33(4/30) 70.00(21/30) χ2 — 27.20 35.10 1.60 P — < 0.01 < 0.01 >0.05 表 1 2组血清LPS、AMS及CRP的阳性率比较(%)
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70例AP组的血清LPS、AMS及CRP水平均高于非AP组(P < 0.01)(见表 2)。
分组 n LPS/(U/L) AMS/(U/L) CRP/(mg/L) AP组 70 1135.8±105.4 525.4±63.8 62.43±4.9 非AP组 30 204.4±23.9 86.7±7.9 18.3±0.4 t — 69.86* 56.53* 74.77* P — < 0.01 < 0.01 < 0.01 *示t′值 表 2 2组血清LPS、AMS及CRP水平比较(x±s)
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两项指标联合检测的灵敏度和特异性较单项检测都有不同程度的增高,当AMS、LPS、CRP三项指标联合检测时,其诊断的灵敏度达到95.7%,特异度为98.0%,联合检测在诊断AP价值最大(见表 3)。
指标 AMS LPS CRP AMS+LPS AMS+CRP LPS+CRP AMS+LPS+CRP 灵敏度 77.14 78.57 81.43 90.04 88.66 91.46 95.75 特异度 75.50 73.60 38.82 96.76 88.91 85.60 98.04 表 3 AMS、LPS、CRP水平及联合检测在AP诊断上的灵敏度和特异度(%)
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通过ROC曲线分析发现,在AP的诊断上LPS、AMS准确性明显高于CRP,其中LPS的曲线下面积(AUC)最大,为0.823;其次为AMS的0.785,LPS略微优于AMS,三者联合检测的AUC为0.844,说明LPS、AMS在AP的诊断和检测上要明显优于CRP(见图 1、表 4)。
指标 AUC(95%CI) P 约登指数 cut-off值 LPS 0.823(0.756~0.890) < 0.01 0.562 183.5 AMS 0.785(0.710~0.860) < 0.01 0.592 115.5 CRP 0.564(0.470~0.659) >0.05 0.142 72.88 联合 0.844(0.780~0.907) < 0.01 0.619 — 表 4 AMS、LPS、CRP水平诊断AP效能的比较
血清脂肪酶、淀粉酶及C反应蛋白联合检测对急性胰腺炎诊断的意义
Significance of combined determination of serum lipase, amylase and C-reactive protein in the diagnosis of acute pancreatitis
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摘要:
目的探讨血清脂肪酶(LPS)、淀粉酶(AMS)及C反应蛋白(CRP)对急性胰腺炎(AP)临床诊断的意义。 方法采用强生干化学分析仪(VITROS 5600)检测70例AP和30例非AP病人的血清LPS、AMS及CRP水平,对2组数据进行比较分析。 结果AP组血清LPS、AMS及CRP水平均高于非AP组(P < 0.01),两项指标联合检测的灵敏度和特异度较单项检测都有不同程度的增高,当AMS、LPS、CRP三项指标联合检测时,其诊断的灵敏度达到95.7%,特异度为98.0%,ROC曲线中血清LPS、AMS曲线下面积较高。 结论血清LPS、AMS及CRP三项联合检测可以有效提高AP的诊断效果,具有很好的临床应用价值。 Abstract:ObjectiveTo explore the significance of lipase(LPS), amylase(AMS) and C-reactive protein(CRP) in the diagnosis of acute pancreatitis(AP). MethodsThe levels of peripheral blood LPS, AMS and CRP in 70 AP patients and 30 non-AP patients were detected using dry chemical analyzer(VITROS 5600), and the data in two groups were analyzed. ResultsThe serum levels of LPS, AMS and CRP in AP group were higher than those in control group(P < 0.01).The sensitivity and specificity of the combined detection of the two indicators were higher than that of the single detection.When the three indicators of AMS, LPS and CRP were combined, the diagnostic sensitivity and specificity of which reached 95.7% and 98.0%, and the area under the ROC curve of serum LPS and AMS was relatively high. ConclusionsThe combined detection of serum LPS, AMS and CRP can effectively improve the diagnostic effects of AP, and which is worthy of clinical application. -
Key words:
- acute panereatitis /
- amylase /
- lipase /
- C-reactive protein
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表 1 2组血清LPS、AMS及CRP的阳性率比较(%)
分组 n LPS阳性率 AMS阳性率 CRP阳性率 AP组 70 78.57(55/70) 77.14(54/70) 81.43(57/70) 非AP组 30 23.33(7/30) 13.33(4/30) 70.00(21/30) χ2 — 27.20 35.10 1.60 P — < 0.01 < 0.01 >0.05 表 2 2组血清LPS、AMS及CRP水平比较(x±s)
分组 n LPS/(U/L) AMS/(U/L) CRP/(mg/L) AP组 70 1135.8±105.4 525.4±63.8 62.43±4.9 非AP组 30 204.4±23.9 86.7±7.9 18.3±0.4 t — 69.86* 56.53* 74.77* P — < 0.01 < 0.01 < 0.01 *示t′值 表 3 AMS、LPS、CRP水平及联合检测在AP诊断上的灵敏度和特异度(%)
指标 AMS LPS CRP AMS+LPS AMS+CRP LPS+CRP AMS+LPS+CRP 灵敏度 77.14 78.57 81.43 90.04 88.66 91.46 95.75 特异度 75.50 73.60 38.82 96.76 88.91 85.60 98.04 表 4 AMS、LPS、CRP水平诊断AP效能的比较
指标 AUC(95%CI) P 约登指数 cut-off值 LPS 0.823(0.756~0.890) < 0.01 0.562 183.5 AMS 0.785(0.710~0.860) < 0.01 0.592 115.5 CRP 0.564(0.470~0.659) >0.05 0.142 72.88 联合 0.844(0.780~0.907) < 0.01 0.619 — -
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