尿中胰蛋白酶原激活肽对重症急性胰腺炎的早期预测价值

目的　评估尿中胰蛋白酶原激活肽（TAP）对重症急性胰腺炎（SAP）患者的早期预测价值。方法　出现首发症状后48h内入院的急性胰腺炎（AP）患者41例（轻型29例、重症12例）及对照组11例，在入院时、24h、48h及72h取尿样测定TAP浓度，同时对每个患者在入院后48h进行APACHEⅡ评分。结果　入院时重症组尿TAP值（95nmol/L)高于轻型组（20nmol/L，P＜0.005)及对照组(15nmol/L，P＜0.005)。入院时尿中TAP值≥35nmol/L预测SAP的特异性和敏感性分别为89.7%和91.7%，而APACHEⅡ≥9诊断SAP的特异性和敏感性仅为72.7%和75.0%。90%的患者可通过TAP预测AP的严重程度，而APACHEⅡ评分仅能对73%的患者进行正确评价。结论　首发症状出现后48h内入院的AP患者尿中TAP浓度可早期预测SAP。

Urinary trypsinogen activation peptide assay for the early prediction of s evere acute pancreatitis

Objective To investigate the value of TAP in t he earlyprediction of severe acute pancreatitis (SAP) and to compare it with ac ute physiology and chronic health evalutionⅡ (APACHEⅡ). Methods We observed the association between TAP concen tration and the severity of acute pancreatitis with competitive enzyme-linked i mmunosorbent assay(ELISA). Urine samples were collected for the measurement of T AP concentration at admission, 24,48,and 72h after from 41 patients with acute pancreatitis (AP) (12 severe cases, and 29 mild) who presented within 48h of the onset of symptoms and from 11 control patients, while APACHEⅡ scores were r ecorded at 48h after admission. Results The TAP at admission of SAP (95nmol/L) was signficantly higher than t hat of mild (20nmol/L; P＜0.005) and control (15nmol/L;P＜0.005 ).The sensitivity and specificity of adimission urinary TAP≥35nmol/L for SAP were 89.7% and 91.7%,whereas that of 48 h APACHEⅡ score were 75% and 72.7%. TAP concentration correlated with subsequent disease severity in 90%, whereas AP ACHEⅡ at 48h was correct in 73%. Conclusions Urinary TAP at the first 48h of the onset of symptoms can predi ct SAP. TAP assay helps to identify patients who will progress to the severe acute disease.