胆石性胰腺炎的实验室诊断

目的：验证生化检测在胆石性胰腺炎诊断中的价值。方法：总结北京协和医院1993年1月－1999年12月182例急性胰腺炎患者，进行回顾性病例对照分析。将性别，年龄，血清谷丙转氨酶（ALT）、总胆红素（TBIL）和血淀粉酶作为研究变量，数据输入SPSS软件包进行χ^2检验，ROC曲线分析。结果：当女性，年龄≥50岁，ALT≥100U／L，TBIL≥2．3mg/dl时，存在显著的统计学差异。ALT≥100U／L时，诊断胆石性胰腺炎的敏感性和特异性分别为47．8％和94．1％，阳性预测值为93％。TBIL≥2．3mg/dl时，诊断胆石性胰腺炎的敏感性和特异性分别为60％和82．4％，阳性预测值为81％。结论：实验室生化检查有助于急性胰腺炎病因的诊断，对于血清ALT≥100U／L，TBIL≥2．3mg/dl，应考虑到急性胆石性胰腺炎的可能。     

刍议胆石性胰腺炎手术治疗的临床注意要点

目的探讨胆石性胰腺炎手术治疗的临床注意要点。方法对80例胆石性胰腺炎患者临床资料进行回顾性分析,将所得资料进行分析后总结胆石性胰腺炎手术治疗注意事项。结果 80例胆石性胰腺炎患者大多实施胆囊切除+胆总管切开取石+T管引流手术治疗(46.25%);95.00%患者经对症治疗后痊愈出院,死亡率仅为5.00%,对比结果具有统计学意义(P<0.05)。结论临床医师应在术前对患者进行详细检查及评估,根据其病情实时给予针对性的手术治疗方案,从而保障患者手术疗效及预后,降低其术后并发症及复发率,确保患者生活质量及生命安全。     

胆管结石的大小及嵌顿部位与胆石性胰腺炎的关系

自１９８４年１０月至１９９６年５月,我院对１８５例因胆管结石嵌顿而引发的急性胆管炎和／或急性胰腺炎,通过内镜进行了详细的观察和治疗,发现结石的大小及其在胆管内嵌顿部位与急性胰腺炎的发生以及严重程度有密切关系,现报告如下。资料和方法一、一般资料：本组１...     

胆石性胰腺炎的一种简易临床分型法

目的 探讨胆石性胰腺炎合理的临床分型方法,以更好地指导临床选择治疗方案.方法 依据胰腺炎的病情严重程度和胆管有无梗阻,将273例胆石性胰腺炎分成4个临床类型:非梗阻性轻型(Ⅰ型)、梗阻性轻型(Ⅱ型)、梗阻性重型(Ⅲ)、非梗阻性重型(Ⅳ型);再依据胆总管内是否存在结石,将每一类型分成a、b两个亚型.然后对临床分型结果、治疗方法、预后进行分析.结果 Ⅰa型34例,Ⅰb型112例;Ⅱa型59例,Ⅱb型11例;Ⅲa型6例,Ⅲb型4例;Ⅳa型3例,Ⅳb型44例.全组总病死率为3.3%(9/273),Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型的病死率分别为0、0、10%(1/10)、17.0%(8/47),组间差别具有统计学意义(P<0.05).早期手术、传统非手术以及早期区域动脉灌注治疗Ⅳ型的病死率分别为30.8%(4/13)、25%(3/12)、4.5%(1/22),区域动脉灌注组病死率显著低于其他两组(P<0.05).结论 4型2分法是一种较为合理的胆石性胰腺炎临床分型法.以临床分型为依据细化胆石性胰腺炎治疗原则,可提高临床疗效.但在治疗过程中还需重视临床类型的转变.     

胆石性胰腺炎治疗及手术时机的选择

自l本世纪韧Opie首次揭示胆石与胰腺炎关系之后，这方面的临床资料不断积累．胆道结石作为胰腺炎的重要原因之一，基本上得到确认。但对胆石性胰腺发病理机制的了解仍较局限，胆石性胰腺病的治疗仍存在分歧。因此．作在上海第一人民医院学习期间，回顾性的收集近几年收治的67例资料进行总结分析．探讨胆石性胰腺炎的治疗和手术时机。     

肝功指标判断汉坦病毒所致肝损害的临床价值

目的探讨常用肝功能指标判断汉坦病毒所致肝损害的临床价值。方法回顾性分析367例肾综合征出血热(HFRS)患者肝功能指标、病情及治疗结局的关系。结果HFRS患者ALT、AST、TBIL及白蛋白异常分别占73.84%(271/367)、79.84%(293/367)、13.35%(49/367)和44.41%(163/367)。HFRS不同临床型间ALT、AST和TBIL差异有统计学意义(P<0.001),而白蛋白各型间差异无统计学意义(P>0.05)。结论汉坦病毒易于引起肝脏损害,肝损害程度与病情、预后有关;ALT、AST及TBIL是反映肝脏损害程度的重要指标;而白蛋白不能作为汉坦病毒肝损害程度的判断指标。     

胆石性胰腺炎早期内镜和保守治疗的疗效对照分析

目的 探讨早期内镜治疗对急性胆石性胰腺炎的治疗价值.方法 103例胆石性胰腺炎患者随机接受了内镜下的十二指肠乳头切开取石治疗(EEI组,n=51)和保守治疗(ECM组,n=52).观察器官衰竭评分、CT严重程度指数、局部并发症、发病率、病死率.结果 2组患者器官衰竭评分、CT严重程度评分、局部并发症发生率、发病率及病死率无统计学差异(P均＞0.05),但重型胰腺炎患者EEI组的上述指标低于ECM组(P均＜0.05).结论 早期进行内镜治疗并不能有效地减少轻型急性胆石性胰腺炎和胆胰管梗阻患者的全身和局部炎症,在排除了急性胆管炎的前题下,早期的内镜治疗不是一项必要的措施.重型急性胆源性胰腺炎病情严重,发展迅速,早期内镜介入治疗可以在直视下迅速解除梗阻和其他病因,诊断明确,治疗效果确切.     

鲜葱白提取物对实验性非酒精性脂肪肝的药效作用

目的 观察鲜葱白提取物在防治大鼠非酒精性脂肪肝形成中对血脂和肝功能的作用.方法 SD大鼠40只,随机分为4组,每组10只,分别为:正常组、模型组、鲜葱白提取物组和易善复组.实验4周后观察各组大鼠一般情况,以及病理组织学的特点,并对血浆中TC、TG、HDL-C和GPT、GOT的水平进行检测.结果 与模型组比较,鲜葱白提取物组大鼠血浆中的TC、TG、GPT、GOT含量明显降低(P<0.01),且作用优于易善复组,但对HDL-C的作用不明显.结论 鲜葱白提取物可降低脂肪肝大鼠的血脂,保护肝功能,从而起到预防大鼠非酒精性脂肪肝形成的作用.     

血液灌流联合连续性静脉-静脉血液滤过治疗高脂血症性胰腺炎的疗效

目的探讨血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)技术治疗高脂血症性胰腺炎(HLP)的临床疗效。方法将19例HLP患者随机分为两组,联合治疗组10例采用HP+CVVH治疗,对照组9例采用常规CVVH治疗,比较两组治疗前后甘油三酯(TG);肿瘤坏死因子(TNF)-α、白介素(IL)-1、IL-6等细胞因子水平及急性生理与慢性健康评分(APACHE)Ⅱ和存活率。结果联合治疗组治疗7 d后TG、TNF-α、IL-1、IL-6及APACHEⅡ评分均呈下降趋势,与对照组比较差异显著(P0.05);联合治疗组存活率7/10(70%)明显高于对照组5/9(55.6%)。结论 HP联合CVVH治疗能迅速降低血脂,有效调整炎症因子水平,改善HLP患者预后,提高存活率。     

梗阻性黄疸大鼠NF-κB的变化及其对免疫应答的影响

目的:探讨梗阻性黄疸(obstructive jaundice,OJ)时NF-KB的变化及其对免疫应答的影响.方法:60只Wistar♂大鼠随机分成3组:假手术组(SHAM组)、梗阻性黄疸组(CBDL组)和梗阻性黄疸+NF-kB抑制剂脯氨酸二硫化氨基甲酸酯(PDTC)组(PDTC组).每组术后7、14 d分批(n=10)检测光镜下肝脏病理组织学,血清总胆红素(TB),谷丙转氨酶(ALT),内毒素(LPS)水平,肝组织促炎因子IL-1β、IL-6,抑炎因子IL-10以及NF-kB蛋白表达.结果:CBDL组7、14 d大鼠均出现肝组织病理损伤,CBDL组较SHAM组血清TB、ALT、LPS增高(7 d:140.14±10.17 vs 7.309±1.04,134.479±10.20 vs 35.79±3.76.189.33±11.05 vs 2.816±0.58;14 d:194.608±12.73 vs 36.142±3.51.217.797±12.37 vs 7.321±1.03.292.816±14.53vs 2.664±0.53,均P＜0.01),肝组织IL-1β,IL-6,IL-10和NF-kB表达增强(均P＜0.01),且14 d较7 d变化更为显著.PDTC组大鼠血清TB、ALT和肝组织IL-1β、IL-6、NF-kB表达在7 d时相点时比CBDL组显著下降(P＜0.01),而到14 d时相点时比较CBDL组无明显变化;LPS和IL-10表达与CBDL组各时相点相比无明显差异.结论:梗阻性黄疸大鼠早期(7 d)通过PDTC抑制NF-kB活化表达,可下调促炎因子的表达,减轻肝损.后期(14 d)作用不明显,其机制可能是通过LPS、IL-10等其他途径所致.     

Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends

OBJECTIVES: We aimed to determine whether early trends in the serum pancreatic enzymes and liver tests of patients with gallstone pancreatitis predict persistent common bile duct (CBD) stones and complications. METHODS: Medical records of patients with gallstone pancreatitis were reviewed retrospectively. Serial serum pancreatic enzymes and liver tests were recorded until the time of cholangiography. Laboratory trends were analyzed by comparing initial results obtained in the emergency department to subsequent results obtained 8-24 h, 24-48 h, and 48-72 h after presentation. RESULTS: Of 154 patients with gallstone pancreatitis, 28 (18%) had persistent CBD stones at cholangiography. Complications and death were more frequent in patients with persistent CBD stones than in those without CBD stones (29% and 11% vs 12% and 1%, respectively; p < 0.05). Laboratory trends predicted both persistent CBD stones and complications of pancreatitis. When any laboratory value rose between admission and 24-48 h of hospitalization, persistent CBD stones were present in 31% of cases, versus 8% of those in whom all laboratory values remained constant or fell (p = 0.001). Likewise, complications occurred in 21% of those with any rising laboratory value, versus 8% of those in whom all values remained constant or fell (p < 0.05). CONCLUSIONS: Patients with gallstone pancreatitis and rising serum chemistries had a 4-fold risk of persistent CBD stones and a nearly 3-fold risk of complications compared to patients in whom all chemistry values remained constant or fell. This simple prediction rule may identify patients with biliary pancreatitis who are most likely to benefit from early interventions to diagnose and remove persistent CBD stones.     

Early endoscopic sphincterotomy in the management of acute gallstone pancreatitis in elderly patients

Eighteen elderly patients with acute attacks of gallstone pancreatitis underwent early endoscopic sphincterotomy of the papilla of Vater. Eleven patients were considered to be at high risk for surgery due to chronic cardiorespiratory or renal problems. The outcome of these patients was compared with that of 20 consecutive elderly patients with gallstone pancreatitis treated at the same time by means other than endoscopic sphincterotomy. Endoscopic sphincterotomy resulted in an immediate clinical improvement in all patients, except in one patient who developed transient cholangitis; there was no mortality. In contrast, there was one death (5%) and 20% morbidity in the controls. Mean hospitalization period was shorter in patients undergoing sphincterotomy (6 compared with 9.5 days), although the patients managed by sphincterotomy were initially more seriously ill than controls. Only two of the 11 high-risk patients underwent elective cholecystectomy; all others were well during a mean follow-up of 22 months. It is concluded that early endoscopic sphincterotomy is highly effective and safe in acute attacks of gallstone pancreatitis in elderly high-risk patients.     

Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis.

BACKGROUND/AIMS: We have compared the effects of glutamine-rich Stresson Multi Fibre and of Nutrison Fibre nutrients on the changes of some immunological parameters of 16 patients with acute pancreatitis. Laboratory parameters included: total protein, albumin, prealbumin, retinol binding protein, IgG, IgA, IgM, IgE, complement components: C3, C4, acute phase proteins: C-reactive protein, transferrin, CD-markers of peripheral lymphocytes and activity of peripheral phagocytes. METHODOLOGY: Nine patients were supplied with Stresson Multi Fibre and 7 patients with Nutrison Fibre, using a nasojejunal tube. The levels of serum proteins were measured with laser nephelometry, the CD markers of lymphocytes with flow cytometry and the phagocytic activity with chemiluminescence. RESULTS: The treatment with glutamine-rich Stresson resulted in significant elevations in the serum levels of IgG, retinol binding protein, compared to the effects of Nutrison Fibre. In addition, the recovery of treated patients was significantly shorter in the Stresson Multi Fibre group than in the Nutrison Fibre group. CONCLUSIONS: The Stresson Multi Fibre nutrient treatment of patients treated for acute pancreatitis seems to have clinical benefit based upon the fast recovery of IgG, IgM proteins which take part in the immunological defense mechanisms.     

65例急性梗阻型胆源性胰腺炎外科治疗分析

目的 探讨急性梗阻型胆源性胰腺炎(AOGP)外科治疗的有关问题.方法 对65例梗阻型AGP患者的临床资料进行回顾性分析,轻症急性梗阻型胆源性胰腺炎(MAOGP)42例,保守治疗38例,急诊后期手术4例;重症急性梗阻性胆源性胰腺炎(SAOGP)23例,均行早期或急诊手术.结果 本组病例痊愈64例, 1例因伴心脏病、糖尿病、多器官功能衰竭及腹腔感染术后2周内死亡.结论 对伴有化脓性胆管炎的AOGP者早期宜行急诊手术,轻型梗阻性AGP早期积极非手术治疗,胰腺炎治愈后2～4周内择期手术治疗胆石病,可以降低复发率、并发症发生率和病死率.     

Diagnostic value of various laboratory parameters in acute pancreatitis]

In 427 samples of serum and urine, collected during their stay at hospital from 40 patients affected with acute pancreatitis, the sensitivity and the specifity of total amylase and lipase in serum, total amylase and pancreas isoamylase in urine, as well as the amylase-/creatinine clearance were determined. The pancreas isoamylase in serum was used as reference value. It appeared that the sensitivity of the lipase was next to that of the pancreas isoamylase in serum, even in limit ranges. Usually the lipase stayed pathological the longest and could therefore be used to identify in the best way even an easing-off pancreatitis. The diagnostic accuracy of the total amylase in serum and urine, of the pancreatic isoamylase in urine and of the amylase-/creatinine clearance was found to be obviously less reliable. The specifity of all examined tests was reduced in patients with renal insufficiency, liver disease, alcohol abuse and in patients with abdominal pains of non pancreatic origin. Concluding form our results and with regard to the expenditure of laboratory technique and to the time required by the methods of determination, we found that of all the examined parameters, the lipase was the most convenient for both emergency and routine diagnose of an acute pancreatitis.     

Factors associated with prior acute pancreatitis episodes among patients with chronic pancreatitis

BackgroundThe relationship between chronic pancreatitis (CP) and acute pancreatitis (AP) is complex and not well understood. CP could be preceded by antecedent episodes of AP.AimsThe aim of this study was to explore both genetic and environmental factors associated with AP episodes before the diagnosis of CP.MethodsThis was a cross-sectional study including 1022 patients. Detailed demographic, genetic, and clinical data were collected. Based on the presence of AP episode(s) before diagnosis of CP, patients were divided into AP group (further classified into single episode of AP group and recurrent AP group) and non-AP group. Related factors among these groups were assessed using multivariate logistic regression model.ResultsBefore diagnosis of CP, 737 patients (72.1%) had a history of AP. Smoking(P = 0.005) and heavy alcohol consumption(P = 0.002) were risk factors for AP while age at CP onset(P < 0.001), harboring the SPINK1 mutation(P < 0.001), diabetes(P < 0.001) and steatorrhea(P < 0.001) were protective factors. Further, alcoholic CP(P = 0.019) was the only independent risk factor for recurrent AP attacks while age at onset of CP(P < 0.001), pancreatic stones(P = 0.024). and pseudocysts(P = 0.018) served as protective factors.ConclusionsSPINK1 mutations served as protective factor for AP episodes, suggesting SPINK1 mutation might play a pathogenic role in CP occurrence with occult clinical manifestations.     

影响重症胰腺炎预后的早期危险因素分析

目的探讨影响重症急性胰腺炎（severe acute pancreatitis,SAP）预后的早期危险因素。方法回顾性分析2000年1月至2010年12月间我院收治的SAP患者90例,按预后分为死亡组（37例）和生存组（53例）。分析比较两组患者临床资料及人院24h内实验室检查指标的差异,并通过Logistic回归分析筛选与预后有关的危险因素。结果死亡组患者年龄、血糖显著高于生存组（JP〈0．05）。死亡组患者动脉血氧分压、血钙、血清白蛋白显著低于生存组（P〈0．05）。高龄（OR=1．589．95％CI：1．195～2．114,P〈0．05）,动脉血氧分压（OR=0．055,95％CI：0．004—0．700,P〈0．05）、血清白蛋白（OR=0．850,95％CI：0．752～0．960,P〈0．05）是影响SAP预后的早期因素。结论高龄、低动脉血氧分压、低血清白蛋白可能是影响SAP预后的早期危险因素。