尿淀粉酶/尿肌酐及尿胰蛋白酶原-2诊断急性胰腺炎的评价

目的探讨尿淀粉酶/尿肌酐(Uamy/Ucr)及尿胰蛋白酶原2测定对急性胰腺炎的临床诊断价值。方法对79例急性胰腺炎患者、48例非胰腺炎急腹症患者和50例健康对照组人员进行血清淀粉酶(Samy)、尿淀粉酶(Uamy)、尿肌酐(Ucr)及尿胰蛋白酶原2测定。结果急性胰腺炎尿胰蛋白酶原2的诊断特异性最高,其特异性和敏感性分别为97.92%和91.14%,其次Uamy/Ucr特异性为91.67%,敏感性为92.41%(临界值为75U/mmol),而临床常用的诊断指标Samy、Uamy的特异性和敏感性均低于前两者。结论尿淀粉酶/尿肌酐比值及尿胰蛋白酶原2检测是较好的早期诊断急性胰腺炎的指标。     

尿淀粉酶／尿肌酐及尿胰蛋白酶原-2诊断急性胰腺炎的评价

目的探讨尿淀粉酶／尿肌酐(Uamy／Ucr)及尿胰蛋白酶原-2测定对急性胰腺炎的临床诊断价值。方法对79例急性胰腺炎患者、48例非胰腺炎急腹症患者和50例健康对照组人员进行血清淀粉酶(Samy)、尿淀粉酶(Uamy)、尿肌酐(Ucr)及尿胰蛋白酶原-2测定。结果急性胰腺炎尿胰蛋白酶原-2的诊断特异性最高，其特异性和敏感性分别为97．92％和91．14％，其次Uamy／Ucr特异性为91．67％，敏感性为92．41％(临界值为75U／mmol)，而临床常用的诊断指标Samy、Uamy的特异性和敏感性均低于前两者。结论尿淀粉酶／尿肌酐比值及尿胰蛋白酶原-2检测是较好的早期诊断急性胰腺炎的指标。     

尿淀粉酶与肌酐比值在胰腺炎诊断中的应用

目的评价尿淀粉酶与肌酐比值在胰腺炎诊断中的作用。方法对健康人和确诊胰腺炎患者分别在早晨(07:00)、中午(12:00)和傍晚(17:00)留取尿液,测定尿淀粉酶和尿肌酐,比较尿淀粉酶、尿淀粉酶/肌酐两种指标结果变异及与临床的符合性。结果尿淀粉酶值在早晨明显偏高,而中午和傍晚偏低;淀粉酶/肌酐比值相对比较稳定,健康人与胰腺炎患者比较差异有统计学意义。结论淀粉酶/肌酐比值是胰腺炎诊断的良好指标。     

急性胰腺炎几项实验诊断指标的比较

目的为了探讨血、尿淀粉酶,淀粉酶清除率与肌酐清除率比值（ACCR）以及尿胰蛋白酶原-2（Tpg-2）测定对急性胰腺炎（AP）的临床诊断价值。方法对67例急性胰腺炎患者,42例非胰腺炎急腹症患者和60例健康体检人员进行血、尿淀粉酶,血、尿肌酐及尿胰蛋白酶原-2测定。结果急性胰腺炎尿胰蛋白酶原-2诊断特异度和敏感度最高,分别为95．2％、95．5％,其次是淀粉酶清除率与肌酐清除率比值,其特异度和敏感度分别为85．7％、92．5％,血淀粉酶（Samy）特异度和敏感度分别为78．6％、80．6％,尿淀粉酶（Uamy）特异度和敏感度分别为69．0％、73．1％。结论尿胰蛋白酶原-2和淀粉酶清除率与肌酐清除率比值是目前诊断急性胰腺炎较好的早期指标,优于血尿淀粉酶。     

尿淀粉酶及其与肌酐比值的测定与应用评价

目的测定尿淀粉酶/肌酐比值,并将它与单纯的尿淀粉酶进行比较和评价.方法同时测定正常人尿淀粉酶及尿肌酐,建立尿淀粉酶及其与肌酐比值的参考值范围;将该两项指标同时用于43例拟诊胰腺炎病人的诊断之中,进行比较和评价.结果尿淀粉酶的参考值范围为0～595 U/L(x-±2s),尿淀粉酶/肌酐的参考范围为3.2～57.2 U/rmo1(x-±2 s);尿淀粉酶的灵敏度为55.6%,而尿淀粉酶/肌酐的灵敏度为72.2%,特异性分别为57.1%和85.7%,尿淀粉酶/肌酐有效地降低了假阳性率和假阴性率.结论尿淀粉酶/肌酐可消除诸多因素的影响,优于单一的尿淀粉酶.     

血清脂肪酶、淀粉酶肌酐清除比率及尿胰蛋白酶原-2对急性胰腺炎的诊断价值

目的评价急性胰腺炎(AP)早期诊断的方法,为急诊患者早期治疗提供临床诊断依据。方法对85例怀疑急性胰腺炎的急腹症患者及45例正常人对照同时检测血清脂肪酶(LP)、淀粉酶肌酐清除比率(CAmy/Ccr)、尿胰蛋白原-2、血、尿淀粉酶(BAmy、UAmy)并结合临床与B超检查。结果85例急腹症中其中42例确诊为急性胰腺炎(AP),另43例为其他原因导致的急腹症。各指标对急性胰腺炎检测结果与非急性胰腺炎及正常对照组检测结果之间比较均存在显著性差异,有非常显著的升高,并且各指标在诊断急性胰腺炎时均有较高的特异性与敏感性,但各特异性与敏感性存在一定差异。结论各检测指标对急性胰腺炎的诊断准确率以尿胰蛋白酶原-2最高,淀粉酶肌酐清除比率(CAmy/Ccr)次之,尿淀粉酶(Uamy)最差。     

血清脂肪酶、淀粉酶肌酐清除比率及尿胰蛋白酶原-2对急性胰腺炎的诊断价值

目的评价急性胰腺炎(AP)早期诊断的方法,为急诊患者早期治疗提供临床诊断依据.方法对85例怀疑急性胰腺炎的急腹症患者及45例正常人对照同时检测血清脂肪酶(LP)、淀粉酶肌酐清除比率(CAmy/Ccr)、尿胰蛋白原-2、血、尿淀粉酶(BAmy、UAmy)并结合临床与B超检查.结果85例急腹症中其中42例确诊为急性胰腺炎(AP),另43例为其他原因导致的急腹症.各指标对急性胰腺炎检测结果与非急性胰腺炎及正常对照组检测结果之间比较均存在显著性差异,有非常显著的升高,并且各指标在诊断急性胰腺炎时均有较高的特异性与敏感性,但各特异性与敏感性存在一定差异.结论各检测指标对急性胰腺炎的诊断准确率以尿胰蛋白酶原-2最高,淀粉酶肌酐清除比率(CAmy/Ccr)次之,尿淀粉酶(Uamy)最差.     

尿淀粉酶/尿肌酐比值在急性胰腺炎诊断中的应用

目前临床上对急性胰腺炎的实验室诊断主要有血、尿淀粉酶 ,脂肪酶 ,尿胰蛋白酶原 Ⅱ等 ,特别是尿淀粉酶 ,由于其无创伤性及便于留取 ,更为医生、病人接受。由于生理及治疗等多种因素 ,尿淀粉酶结果波动很大 ,严重影响临床的诊治。根据人体在一定时间内排泄的肌酐量比较恒定的原理 ,我们用尿淀粉酶 /尿肌酐比值作为急性胰腺炎的诊断指标 ,可避免上述不足。1　材料与方法1.1　仪器OlympusAU2 70 0生化分析仪。1.2　试剂　淀粉酶试剂 :加拿大威特曼公司液体双试剂 ,以EPS G7为底物 ,速率法测定 ;肌酐试剂 :日本和光液体双试剂 ,酶法测定。1…     

尿胰蛋白酶原-2在筛查急性胰腺炎临床应用中的评价

目的评价尿胰蛋白酶原-2试纸条在筛查急性胰腺炎中的临床价值.方法收集50例急腹症患者的血清和尿液,按最终诊断分为急性胰腺炎组(22例)和非急性胰腺炎组(28例),分别检测尿胰蛋白酶原-2,血淀粉酶和尿淀粉酶,并将结果进行比较.结果尿胰蛋白酶原-2诊断急性胰腺炎的敏感性、特异性分别为96%、86%;血淀粉酶为73%、82%;尿淀粉酶为82%、86%.结论尿胰蛋白酶原-2的敏感性和阴性预期值均高于血、尿淀粉酶,可以作为急性胰腺炎诊断的筛选指标.     

临床实验室诊断急性胰腺炎的方法评价

目的评价急性胰腺炎(AP)早期诊断的方法,为急诊患者早期治疗提供临床诊断依据.方法正常人50名,AP患者42例,非AP患者58例.同时测定血、尿淀粉酶(AMY)、淀粉酶肌酐清除率(CAMY/CCr%)、尿胰蛋白酶原-2.结果 42例AP患者中尿胰蛋白酶原-2阳性40例、CAMY/CCr%阳性37例、血、尿AMY阳性分别为34和29例.诊断敏感性及特异性以尿胰蛋白酶原-2为最高(95.2%、94.8%),其次为CAMY/CCr%(88.1%、86.2%),血、尿AMY则相对较差,其中又以尿胰蛋白酶原-2持续时间最长,可达7 d.AP组与非AP组上述结果差异有显著性.结论尿胰蛋白酶原-2可作为AP的筛选指标,其敏感性和特异性优于血、尿AMY;在条件不具备的情况下,可采用CAMY/CCr%提高AP诊断正确率.     

随机尿、晨尿与24 h尿生化指标的相关性分析

目的:研究分别用肌酐和渗透压校正随机尿、晨尿中的常规生化指标与24 h尿中对应指标含量的相关性。方法:收集患者同一天内的24 h尿、晨尿和随机尿,分别测定三种不同类型尿液中的蛋白、电解质(钾、钠、氯)、和尿酸UA的含量,其中晨尿和随机尿的结果分别以肌酐比值和渗透压比值表示,用SPSS11.5软件进行数据处理和秩相关分析。结果:随机尿、晨尿尿蛋白/尿肌酐比值和尿蛋白/尿渗透压比值与24 h尿蛋白定量结果相关性良好(P<0.05),相关系数约为0.8;随机尿、晨尿尿电解质/尿肌酐比值和尿电解质/尿渗透压比值与24 h尿电解质的相关性较差;随机尿、晨尿尿酸校正后没有相关性。结论:晨尿和随机尿尿蛋白/尿肌酐比值代替24 h尿蛋白的测定有标本收集方便易行的优势;用肌酐校正随机尿、晨尿尿电解质的临床评价有待进一步的研究;尿酸的测定仍须采用24 h尿标本。而晨尿、随机尿用渗透压做校正效果与肌酐校正一致。     

尿胰蛋白酶原—2测定在急性胰腺炎诊断中的意义

目的：探讨尿胰蛋白酶原－2的测定在急性胰腺炎诊断中的临床意义。方法：收集69例急腹症病人血清和尿液标本，按最终诊断分为急性胰腺炎组（34例）和非急性胰腺炎组（35例），分别测定尿胰蛋白酶原－2，血清脂肪酶和血、尿淀粉酶，并将其结果进行比较。结果：尿胰蛋白酶原－2试纸条检测对急性胰腺炎诊断的敏感性，特异性，准确度分别为85％，83％，84％；血清脂肪酶为82％，60％，71％；血淀粉酶为88％，54％，71％；尿淀粉酶为79％，54％，67％。结论：尿胰蛋白酶原－2检测是诊断急性胰腺炎的一个非常有用的筛选指标，尤其是特异性较高。阴性结果可以在很大程度上排除急性胰腺炎。     

随机尿清蛋白/尿肌酐比率测定在慢性肾病的应用

目的研究随机尿清蛋白/尿肌酐比率测定在慢性肾病的应用。方法以测定24 h尿蛋白定量为金标准,比较56例蛋白尿阳性慢性肾脏疾病患者和33例蛋白尿阴性非慢性肾脏病患者的尿蛋白定性、随机尿蛋白定量、随机尿清蛋白定量、随机尿蛋白/肌酐比率、随机尿清蛋白/肌酐比率的检测结果,评价尿清蛋白/肌酐比率的灵敏度（S）、特异度（Sp）、似然比（LR）等诊断性能。结果与24 h尿蛋白定量结果比较：随机尿蛋白/肌酐比率,S=0.91、Sp=0.91、阴性预测值（NPV）=0.86、阳性预测值（PPV）=0.94、-LR=0.1、＋LR=10.1、准确性（ACC）=0.91;随机尿清蛋白/肌酐比率,S=0.96、Sp=0.88、NPV=0.94、PPV=0.93、-LR=0.045、＋LR=8.0、ACC=0.93。结论随机尿（清）蛋白/肌酐比率测定可作为筛检24 h尿蛋白定量的常规检测项目。     

Comparative evaluation of the diagnosis of acute pancreatitis based on serum and urine enzyme assays

We compared the diagnostic sensitivities of serum amylase, lipase (assayed enzymatically and immunologically), trypsinogen and elastase-1, the 2-h-timed urine amylase excretion and the ratio of amylase and creatinine clearances in the recognition of acute pancreatitis. Serial serum and urine findings from 39 patients with acute pancreatitis, and from 42 patients with non-pancreatic causes of abdominal pain (controls), as well as findings from 24 healthy subjects (normals) were studied. Decision thresholds were established for each parameter using either the control or the normal population, and the resulting diagnostic sensitivities determined. On hospital admission, all serum assays were equally sensitive, but on subsequent days lipase, trypsinogen and elastase-1 assays all significantly surpassed the sensitivity of the serum amylase assay. On the second and subsequent hospitalization days, determination of timed urine amylase excretion offered no advantage over the serum amylase, and the ratio of amylase and creatinine clearances lacked discrimination altogether.     

Urine protein excretion in acute pancreatitis

The mechanism of the increased renal clearance of amylase and the amylase to creatinine clearance ratio (CAM/CCR) in acute pancreatitis remains controversial with both renal tubular dysfunction and altered glomerular permeability being invoked as explanations. To differentiate between these mechanisms, we investigated the quantity and character of protein excretion in 10 patients with pancreatitis. For a short period of time, seven of 10 patients had mild proteinuria with a mean protein excretion rate of 230 +/- 154 mg/24 hr. Proteinuria decreased in 9/9 survivors to 17 +/- 18 mg/24 hr. Albumin excretion rate initially was minimally increased in 10/10 patients with a mean of 61 +/- 40 mg/24 hr, decreasing during recovery in 8/9 survivors to 10.9 +/- 10.4 mg/24 hr (P less than 0.01). Electrophoresis of urine obtained during the acute phase consistently showed a low molecular weight proteinuria pattern that cleared with recovery. Twenty-one of 22 urinary samples with an elevated CAM/CCR had a low molecular weight protein pattern. All the above findings can be explained by alterations in renal tubular reabsorption of proteins without changes in glomerular permeability. In 2/4 patients a low molecular weight protein was present in urine specimens from the acute phase that was not present in highly concentrated urine specimens from the recovery period. This raises the possibility that an abnormal low molecular weight protein enters the serum in acute pancreatitis, which, after glomerular filtration, produces the renal tubular malfunction found in acute pancreatitis.     

Point-of-care Urine Trypsinogen Testing for the Diagnosis of Pancreatitis

Objectives
To assess a point-of-care (POC) urine trypsinogen (UT) test for the diagnosis of pancreatitis in the emergency department (ED).
Methods
This was a prospective cohort study of a convenience sample of patients presenting to the ED with abdominal pain or symptoms suggestive of pancreatitis. A 3-minute POC UT test (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) was compared with plasma lipase and amylase measurements, imaging results when performed, and final discharge diagnoses. The criterion standard was a final discharge diagnosis of acute pancreatitis.
Results
Of 191 patients included in this study, 17 patients were diagnosed with either acute or acute-on-chronic pancreatitis. The sensitivity and specificity of UT for acute pancreatitis were, respectively, 100% (95% confidence interval [CI] = 77% to 100%) and 96% (95% CI = 92% to 98%). Seven of the 17 patients with pancreatitis (41%) had diagnostic findings on CT and positive UT tests but had nondiagnostic plasma lipase and amylase levels.
Conclusions
A POC UT screening test for pancreatitis in the ED compared favorably with plasma lipase and amylase levels. Future studies should be performed to explore whether this test in the ED setting has better clinical utility than plasma lipase or amylase.     

Use of a Urine Dipstick and Brief Clinical Questionnaire to Predict an Abnormal Serum Creatinine in the Emergency Department

Objectives:  Prior data demonstrated that a urine dipstick used alone was a sensitive predictor of abnormal creatinine, but not sufficiently enough to forego screening of serum creatinine prior to administration of contrast for diagnostic studies. The authors hypothesized that a brief historical questionnaire coupled with a urine dipstick would have high sensitivity for renal dysfunction, potentially eliminating the need for a serum creatinine prior to contrast administration.
Methods:  This was a prospective study of a convenience sample of patients at two academic tertiary-care emergency departments (EDs) during 2006–2007. Subjects included patients who had both a serum creatinine result reported by the laboratory and a urine dipstick result reported in the medical record. Data included triage vital signs, basic demographic data, 14 medical history items, dipstick urinalysis, and serum creatinine results. The main outcome measure was an abnormal serum creatinine, defined as greater than 1.5 mg/dL.
Results:  Complete data sets were collected on 1,354 patient visits. Of these, there were 161 (12%) with a serum creatinine of >1.5 mg/dL. Logistic regression analysis identified the following independent predictors associated with elevated creatinine: age greater than 60 years, known renal insufficiency, diabetes, hypertension, diuretic use, vomiting, and proteinuria. Nearly all patients with abnormal creatinine (98%) had at least one of these seven predictors. A decision tool combining these predictors would have identified 158 of 161 patients with an abnormal creatinine (sensitivity, 98.1%; 95% confidence interval [CI] = 95.8% to 99.9%) and a specificity of 21.2% (95% CI = 18.8% to 23.2%).
Conclusions:  The absence of six historical factors and absence of proteinuria can be safely used to identify patients who are unlikely to have an abnormal creatinine.