血清生化指标在胆源性重症急性胰腺炎诊治中的临床价值

目的探讨总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、总胆汁酸(TBA)、γ-谷氨酰转肽酶(GGT)各血清生化指标在胆源性急性胰腺炎鉴别诊断及严重程度评估中的临床价值。方法共筛选急性胰腺炎患者583例,根据其疾病严重程度分为急性胰腺炎组(406例)和重症急性胰腺组(177例),同时将重症急性胰腺炎患者根据其病因分为胆源性急性胰腺炎组(71例)和非胆源性急性胰腺炎组(106例),回顾性统计分析所有患者入院24 h内TBIL、DBIL、ALT、ALP、TBA、GGT等血清生化指标在急性胰腺炎严重程度及病因判断中的临床价值。结果重症急性胰腺组TBIL、DBIL、ALT、ALP、TBA、GGT血清水平显著高于急性胰腺炎组(P0.01),上述指标ROC曲线下面积(AUC)分别为0.688、0.677、0.577、0.628、0.618、0.633;胆源性重症胰腺炎组TBIL、DBIL、ALT、ALP、TBA、GGT血清水平显著高于非胆源性重症胰腺炎组(P0.01),上述指标ROC曲线下面积(AUC)分别为0.786、0.765、0.695、0.805、0.786、0.816。结论血清TBIL、DBIL、ALT、ALP、TBA、GGT有助于胆源性急性胰腺炎的鉴别诊断及严重程度的早期评估。

Clinical value of serum biochemical markers in diagnosis and treatment of severe acute biliary pancreatitis

Objective To explore the clinical significance of serum biochemical markers, including total bilirubin （TBIL）, di- rect bilirubin （DBIL）, alkaline phosphatase （ALP）, total bile acid （TBA） and gamma glutarnyl transpeptidase （GGT）, in the differential diagnosis and severity assessment of biliary acute pancreatitis. Methods A total of 583 patients with acute pancre- atitis were screened and divided into acute pancreatitis group （n = 406） and severe acute pancreatitis group （n = 177） according to the severity of the disease. Based on the etiology, the patients of severe acute pancreatitis group were divided into acute biliary panereatitis group （n = 71 ） and acute non - biliary pancreatitis group （n = 106）. We retrospectively reviewed all patients＇ serum biochemical parameters within 24 hours of the admission, such as TBIL, DBIL, ALT, ALP, TBA and GGT, and then statistically analyzed the clinical value of the parameters in judging the severity and etiology of acute panereatitis. Results The serum levels of TBIL, DBIL, ALT, ALP, TBA and GGT were significantly higher in severe acute pancreatitis group than in acute pancreatitis group （P〈0.01）, and the area under curves （AUCs） of above- mentioned parameters were 0. 688, 0. 677, 0. 577, 0. 628, 0. 618 and 0. 633, respectively. The serum levels of TBIL, DBIL, ALT, ALP, TBA and GGT were significantly higher in severe biliary pancreatitis group than in severe non- biliary pancreatitis group （P〈 0.01 ）, and the area under curves （AUCs） of above - mentioned parameters were 0. 786, 0. 765, 0. 695, 0. 805, 0. 786 and 0. 816, respectively. Conclusions Serum TBIL, DBIL, ALT, ALP, TBA and GGT are helpful in the differential diagnosis and early assessment of severity of biliary acute pancreatitis.