C反应蛋白在EST术后胰腺炎早期诊断中的意义

摘要

Objective To investigate the implication of C-reactive protein (CRP) in the early diagnosis of post-ERCP pancreatitis. Methods Forty-two consecutive patients with biliary stone confirmed by ultrasonography, CT or MRI (MRCP) were selected. In all patients undergoing ERCP, serum amylase, lipase and CRP in the samples obtained before and 6, 24 and 48 after ERCP were determined; (2) The post-ERCP patients were divied into two groups: postoperative-ERCP pancreatitis group (PEP), and post-ERCP non-pancreatitis (non-PEP). The serum amylase, lipase and CRP levels were compared between two groups. Results There were 5 cases in PEP group, and 37 cases in non-PEP group, respectively. There was no significant difference in serum amylase, lipase, and CRP before ERCP between two groups. In PEP group, amylase and CRP levels from 6th h after ERCP showed significant difference from those before operation, and lipase from 24th h. In non-PEP group, lipase and CRP levels at 6th h, 24th h, and 48th h after ERCP showed no significant difference from those before ERCP, but there was significant difference in amylase level before and 24 h after ERCP. Conclusion CRP can be used as one of the biochemical markers in the early diagnosis of post-ERCP pancreatitis.%目的 探讨C反应蛋白(C-reactive protein,CRP)对内镜下乳头括约肌切开术(EST)术后胰腺炎的早期诊断.方法 选择经B超、CT或MRI(MRCP)证实为胆管结石的病人42例.①所有病人将拟施行ERCP、EST及经内镜取石,分别于术前1h及术后6h、24 h、48h抽取空腹静脉血,同时测定这4个时间点的淀粉酶、脂肪酶及CRP.②将EST术后病人分为EST术后胰腺炎组((post-EST pancreatits,PEP组)和EST术后非胰腺炎组(非PEP组),对两组的淀粉酶、脂肪酶及CRP进行比较.结果 在入选EST术后病人中,PEP组有5例,非PEP组有37例.两组病人术前淀粉酶、脂肪酶和CRP经比较,差异均无统计学意义(P＞0.05).在PEP组,与术前比较,淀粉酶从6h开始差异有统计学意义,脂肪酶从24 h开始差异有统计学意义,CRP在6h时差异有统计学意义.在非PEP组,脂肪酶和CRP在6h、24 h、48 h这3个时间点与术前比较,差异均无统计学意义(P＞0.05)；淀粉酶在术后24 h开始与术前比较,差异有统计学意义(P＜0.05).结论 CRP可与血清淀粉酶、脂肪酶联合测定,作为EST术后急性胰腺炎早期诊断的指标之一.