胰脂肪酶、CRP 及血淀粉酶联合相关肝功能指标检测诊断 AP 的临床应用研究

摘要

目的：研究分析胰脂肪酶（LPS）、C 反应蛋白（CRP）及血淀粉酶（S - AMY）联合相关肝功能指标检测诊断急性胰腺炎（AP）的临床应用价值。方法将2013年1月至2013年12月收治的193例急腹症患者分为 AP 组106例和非 AP 组87例，其中 AP 组根据病因情况和病情严重程度分为胆源组（n =64）和非胆源组（n =42）；轻症组（MAP，n =69）和重症组（SAP，n =37）。另外选择90例健康体检者作为对照组。检测患者的相关指标。结果 AP 组的 S - AMY水平显著高于非 AP 组和对照组，且非 AP 组较对照组水平高，各组间比较差异均有统计学意义（ P ﹤0.05）；AP 组 LPS指标也显著高于非 AP 组和对照组（ P ﹤0.05），非 AP 组和对照组相比差异无统计学意义（ P ﹥0.05）；AP 组和非 AP 组CRP 水平较对照组高（ P ﹤0.05）；与 MAP 相比，SAP 组 CRP 水平明显增高（ P ﹤0.05），S - AMY 和 LPS 两组相比差异无统计学意义（ P ﹥0.05）；肝功能指标检测发现，胆源性 AP 组 TB、ALT、AST 三者指标水平高于非胆源性 AP 组（ P ﹤0.05）；胆源性 AP 组 DB 水平高于非胆源性 AP 组，但两组差异无统计学意义（ P ﹥0.05）；血清 LPS 指标特异度90.5％，敏感度91.2％，高于 S - AMY 和 CRP；S - AMY 与 LPS 联合检测特异度94.1％，敏感度92.9％，高于单个指标的诊断结果。结论 S - AMY 与 LPS 联合检测有助于 AP 的诊断，CRP 则更适用于评估 AP 的严重程度，监测病情和预后情况；血清中 TB、DB、AST、ALT 等相关肝功能指标对于临床上区分胆源性 AP 和非胆源性 AP 上具有一定的参考价值，有利于提高胆源性 AP 的诊断。%Objective To explore the diagnostic significance of pancreatic lipase,CRP,serum amylase and liver function detection in A-cute pancreatitis. Methods From January 2013 to December 2013 in our hospital,193 acute abdomen cases were divided into AP group 106 ca-ses and non - AP group 87 cases,according to the cause and severity of the situation. The patients of AP group was divided into bile source group (n = 64)and non - biliary source group(n = 42);mild group(MAP,n = 69)and severe group(SAP,n = 37). Also we selected 90 healthy volunteers as a control group,to detect relevant indicators of the patient. Results S - AMY in AP group was significantly higher than non - AP group and the control group. The non - AP group was higher than the control group. The difference was statistically significant( P ﹤ 0. 05)be-tween the groups. LPS in AP group was also significantly higher than the non - AP group and the control group( P ﹤ 0. 05). The non - AP group and the control group was not statistically significant( P ﹥ 0. 05). The CRP in AP group and non - group was higher than the control group( P﹤ 0. 05). Compared with the MAP,CRP in SAP group was significantly higher( P ﹤ 0. 05). S - AMY and LPS from the two groups showed no significant difference( P ﹥ 0. 05). TB,ALT,AST in biliary AP group were higher than non - biliary AP group( P ﹤ 0. 05). DB in biliary AP group was higher than non - biliary AP group,but the difference was not statistically significance( P ﹥ 0. 05). Specificity of LPS was 90. 5% , and sensitivity was 91. 2% ,which were higher than the S - AMY and CRP. S - AMY and LPS joint detection specificity was 94. 1% ,sensitivity was 92. 9% ,which was higher than the diagnostic accuracy of the individual indicators. Conclusion S - AMY and LPS joint detection can help diagnose the AP,CRP is more focused on the assessment of the severity of the AP,monitoring the condition and prognosis. Serum TB,DB,AST, ALT has some reference value for the clinical distinction between the biliary AP and non - biliary AP,which would help improve the diagnosis of biliary AP.