摘要
目的评估早期急性胰腺炎（AP）判定指标的准确性，从而寻找到最佳指标。方法随机选择39例AP患者，其中重症急性胰腺炎（SAP）20例，轻症急性胰腺炎（MAP）19例。分别检测血中性粒细胞弹性蛋白酶（PMN—E）、磷脂酶A2（PLA2）活性、胰源性PLA2（Pan—PLA2）、PLA2催化活性（CA—PLA2）、C-反应蛋白（CRP）、淀粉酶等指标，进行急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，并计算各指标的敏感性、特异性，绘制受试者工作特征曲线（ROC），计算总准确率。结果SAP组患者血中PMN—E、CA—PLA2、CRP水平明显高于MAP组（P均〈0．01）。AP患者中Pan—PLA2、淀粉酶仅在发病时一过性升高，SAP组与MAP组比较差异无显著性。PMN—E预测SAP的敏感性为94．5％、特异性为99．4％、阳性预测值为97．8％、阴性预测值为99．4％，总准确率为98．7％，明显高于其他各指标。CRP预测SAP的总准确率也高达84．0％。结论PMN—E、CA—PLA2、CRP、APACHEⅡ均为判定SAP的指标，PMN—E是最准确的指标，而CRP是最简便、快速的指标。
Objective To assess the accuracy of indexes for predicting severe acute pancreatitis （SAP）. Methods Thirty- nine patients suffering from acute pancreatitis （AP） were randomly selected, including 20 SAP cases and 19 mild acute pancreatitis （MAP） cases. The levels of po[ymorphonuclear leucocyte - elastase （PMN - E）, serum phospholipase A2 （PLA2）, pancreatic PLA2 （Pan - PLA2）, PLA2 catalytic activity （CA- PLA2）, amylase, as well as C- reactive protein （CRP）were determined. Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） was scored in every patient. Sensitivity and specificity of all the parameters were assessed, and receiver operator characteristic curve （ROC） was plotted. Positive predictive value, negative predictive value, and overall accuracy were then analyzed. Results PMN - E, CRP and CA - PLA2 were obviously higher in SAP than in MAP, and were indicative of the severity of the disease （all P〈0.01）. Pan - PLA2 and amylase of AP patients raised at the onset of the disease, and they showed no difference between the SAP groups and MAP groups. When SAP was predicted by PMN -E, sensitivity was 94.5%, specificity was 99.4%, positive predictive value was 97.8%, negative predictive value was 99.4%, overall accuracy was 98.7%, higher than other indexes. When SAP was predicted by CRP, the overall accuracy was also high and reached 84.0%. Conclusion PMN -E, CA - PLA2, CRP, and APACHE Ⅱ are all indexes for the diagnosis of SAP. PMN - E is found to be the best index in predicting SAP.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第8期460-462,共3页
Chinese Critical Care Medicine
基金
天津市科学技术基金资助项目（9200938018）
北京市科技计划重大项目（H020420020031）
关键词
胰腺炎
急性
重症
中性粒细胞弹性蛋白酶
胰源性磷脂酶A2
磷脂酶A2催化活性
severe acute pancreatitis
polymorphonuclear leucocyte -elastase
pancreatic phospholipase A2
phospholipase A2 catalytic activity
