以3倍正常上限值为cut off值评价血清脂肪酶和淀粉酶对急性胰腺炎的诊断价值

目的通过比较血清淀粉酶(AMY)和脂肪酶(LPS)的敏感性和特异性以探讨诊断急性胰腺炎(AP)的首选实验室指标。方法选取2013年1月至2014年6月该院收治的急腹症患者381例,其中急性胰腺炎患者128例,其他急腹症患者253例,另外选取2013年该院体检的80例健康者作对照。采用强生Vitros 350干式生化分析仪检测血清AMY和LPS水平,以3倍正常上限值为cut off值分别评价两者单项和联合检测诊断急性胰腺炎的敏感性和特异性。结果血清AMY和LPS特异性相似,分别为92.9%和93.3%,差异无统计学意义(P0.05);而LPS敏感性远高于AMY,分别为91.4%和60.2%,差异有统计学意义(P0.05);两者联合检测敏感性为93.8%,和LPS单项检测的敏感性(91.4%)比较,差异无统计学意义(P0.05)。结论血清LPS诊断急性胰腺炎的敏感性和特异性均较高,优于AMY单项检测,也优于两者联合检测,是诊断急性胰腺炎的首选实验室检测。可降低对昂贵的影像学检查的依赖,减少患者辐射,节约费用。

The value of lipase and amylase in diagnosising the acute pancreatitis by using 3 times normal upper limit for the cut off value

Objective To explore the preferred laboratory index for acute pancreatitis by comparing the sensi‐tivity and specificity of serum lipase and amylase .Methods From January 2013 to June 2014 in our hospital ,data were collected on 381 patients with acute generalised or upper abdominal pain and initial raised serum lipase and/or amylase values .253 cases of patients(66 .4% ) presented with abdominal conditions other than AP and 128 had AP .In addition ,80 cases of healthy people were selected as control group .Sensitivity and specificity for both enzymes for the diagnosis of AP were calculated using the cut‐off of three times the upper limit of normal .The analytes were meas‐ured using a Johnson Vitros 350 system .Results Lipase displayed a sensitivity of 91 .4% for AP ,against 60 .2% for amylase .Specificity was 93 .3% for lipase and 92 .9% for amylase .Combined detection with lipase and amylase had a sensitivity of 93 .8% and there were no significant difference between it and the single detection of LPS that sensitivi‐ty was 91 .4% .Conclusion Serum Lipase was the first selective method for laboratory examination of acute pancrea‐titis that was better than the single detection of serum amylase and combined detection and had higher sensitivity and Specificity .Morever ,it could reduce the dependence of expensive imaging examination and radiation .