淀粉酶联合CRP和SAA检测对急性胰腺炎诊断价值的评价

目的 探讨淀粉酶、C反应蛋白(C-reactive protein,CRP)及血清淀粉样物质A(serumamyloid A,SAA)的变化对AP诊断的临床意义.方法 测定MAP和SAP患者发病24 h内、48 h、72 h及第7天的血、尿淀粉酶和CRP、SAA水平.结果 发病24 h内SAP患者的血淀粉酶、尿淀粉酶、CRP和SAA水平分别为(904.5±402.2)U/L、(2280.3±1270.3)U/L、(155.6±36.2)mg/L和(521.9±109.4)mg/L,均明显高于MAP患者的(598.3±400.4)U/L、(1304.9±868.7)U/L、(51.9 4±38.0)mg/L和(158.6±187.6)mg/L(P＜0.05或P＜0.001);血淀粉酶高峰出现于发病后24 h内,而尿淀粉酶、CRP和SAA高峰出现在发病48 h,分别为(2173.5±1110.6)U/L、(185.3±41.4)mg/L和(717.5±144.2)mg/L.MAP和SAP患者血、尿淀粉酶水平在第7天均明显降低(P＜0.05),MAP患者CRP、SAA在第7天也明显降低(P＜0.05),但SAP患者CRP、SAA在第7大无明显降低(P＞0.05).CRP、SAA和病变发展相平行,CRP和SAA呈正相关(r=0.761,P＜0.05).结论 淀粉酶联合CRP、SAA水平的检测能够早期诊断AP,CRP和SAA可作为早期诊断SAP的参考指标.

The diagnostic value of serum amylase, C-reactive protein and amyloid A in patients with acute pancreatitis

Objective To investigate the clinical significance of changes of serum amylase, CRP and SAA in the diagnosis of acute pancreatitis. Methods The levels of serum and urine amylase, CRP and SAA in patients of mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) at 24 h, 48 h, 72 h and the seventh day after the onset of pancreatitis were measured. Results The levels of serum, urine amylase, CRP and SAA in SAP patients at 24h were (904.5±402.2)U/L, (2280.3±1207.3)U/L, (155.6±36.2) mg/L, (521.9±109.4)mg/L, respectively, and significantly higher than those of MAP patients (P＜0.05 or P＜0.001). The peak value of serum amylase appeared at 24h, however, the peak value of urine amylase, CRP and SAA appeared at 48 h, and the corresponding values were (2173.5±1110.6) U/L, (185.3±41.4) mg/L and (717.5±144.2)mg/L, respectively. The levels of serum and urine amylase significantly decreases in MAP and SAP patients at the seventh day (P＜0.05). The levels of serum CRP and SAA significantly decreased in MAP patients at the seventh day (P＜0.05), however, the levels of serum CRP and SAA did not significantly decrease in SAP patients at the seventh day (P＞0.05). Serum levels of CRP and SAA were related to the severity of acute pancreatitis. Meanwhile CRP showed a positive correlation with SAA (r = 0.761, P＜0.05). Conclusions The change of serum levels of amylase, CRP and SAA can help early diagnose acute pancreatitis; CRP and SAA may predict the development of SAP at early stage.