血清脂肪酶测定对急性胰腺炎的诊断价值

目的探讨血清脂肪酶(LPS)在急性腹痛时对急性胰腺炎(AP)的鉴别诊断价值。方法将598例急性腹痛患者分为AP组192例和非AP(NAP,包括胆结石30例、肠梗阻15例、急性胆囊炎10例、腹部外伤9例、胰腺恶性肿瘤6例、不明原因腹痛299例、糖尿病6例、上消化道疾病11例、肺部疾病9例、急性肾功能衰竭11例)组406例,同时测定血清LPS和淀粉酶(AMY)。绘制受试者工作特征(ROC)曲线,计算LPS和AMY诊断AP的敏感性、特异性、阳性预测值、阴性预测值。结果 AP组血清AMY和LPS水平明显高于NAP组(P<0.01)。LPS和AMY均以正常参考范围上限的3倍(180、300 U/L)为临界值时,其灵敏度、特异性、阳性预测值和阴性预测值分别为87.5%、62.5%,89.4%、95.3%,80.0%、86.3%和94.7%、88.2%;血清LPS和AMY诊断AP的ROC曲线下面积分别为0.959和0.921,二者测定结果之间呈正相关(r=0.90)。结论血清LPS对AP的诊断性能优于AMY,对AP的诊断具有重要的临床意义。

Diagnosis significance of serum lipase for acute pancreatitis

Objective To investigate the differential diagnosis significance of serum lipase （LPS） for acute pancreatitis （AP） in patients with acute abdominal pain. Methods A total of 598 patients with acute abdominal pain were classified into AP group （ 192 cases） and non-AP （NAP） group （406 cases）, including cholecystolithiasis （30 cases）, intestinal obstruction （ 15 cases ）, acute cholecystitis （ 10 cases ）, abdominal trauma （ 9 cases ）, pancreas malignancy （6 cases ） , special abdominal pain （ 299 cases）, diabetes mellitus （ 6 cases）, upper digestive tract disease （ 11 cases） , pulmonary disease （ 9 cases） and acute renal failure （ 11 cases）. Receiver operating characteristic （ ROC ） curve was set up, and the sensitivity, specificity, positive and negative predictive values were analyzed for LPS and serum amylase （AMY）. Results Serum AMY and LPS levels in AP group were significantly higher than those in NAP group（P 〈0.01 ）. When the cut-off values of LPS and AMY were both set to 3 times of upper limit of normal reference range （ 180 and 300U/L）, the sensitivities were 87.5% and 62.5%, the specificities were 89.4% and 95.3%, the positive predictive values were 80. 0% and 86. 3% , the negative predictive values were 94. 7% and 88. 2%, respectively. The areas under ROC curve for LPS and AMY were 0. 959 and 0. 921. There was positive correlation between serum AMY and LPS levels （ r = 0.90）. Conclusions Serum LPS has clinical significance in AP diagnosis, and is a better marker than AMY.