Del Prete M, Castiglia D, Meli M, Perri S, Nicita A, Dalla Torre A, Moraldi A
Divisione di Chirurgia Generale Ospedale San Giacomo, Roma.
Chir Ital. 2001 Jan-Feb;53(1):33-8.
Controversy still exists regarding the clinical features of acute pancreatitis: it is not known whether this is a disease which progresses from mild to severe forms or which arises immediately as severe acute pancreatitis. An early diagnosis, however, is regarded as mandatory for successful treatment. Over the years many Authors have proposed different scoring systems for the early assessment of the clinical evolution of acute pancreatitis. The most widely used scoring systems (Ranson, Osborne, Apache II) are often cumbersome and difficult to use in clinical practice because of their multifactorial nature. Thus, a number of unifactorial prognostic indices have been employed in routine hospital practice, such as C-reactive protein, serum amylase and serum lipase. These serum enzymes are easy to obtain in normal clinical practice and many authors consider them as reliable as multifactorial scoring systems. One hundred and five patients affected by acute pancreatitis have been hospitalised in the Surgical Department of San Giacomo Hospital (Rome) over an nine-year period. All patients underwent C-reactive protein, amylase, and lipase serum assays on days 1, 3 and 5 after admission. The results show that C-reactive protein assay is highly sensitive in detecting necrotic forms of acute pancreatitis. The authors conclude that C-reactive protein, together with both serum amylase and serum lipase, often provides a precise picture of the clinical situation in patients with acute pancreatitis. On this basis the best therapeutic option can be chosen.
尚不清楚这是一种从轻度发展为重度的疾病，还是直接以重症急性胰腺炎形式出现的疾病。然而，早期诊断被认为是成功治疗的必要条件。多年来，许多作者提出了不同的评分系统用于急性胰腺炎临床进展的早期评估。最广泛使用的评分系统（兰森评分、奥斯本评分、急性生理与慢性健康状况评分系统II）由于其多因素性质，在临床实践中往往繁琐且难以使用。因此，一些单因素预后指标已被用于日常医院实践，如C反应蛋白、血清淀粉酶和血清脂肪酶。这些血清酶在正常临床实践中很容易获得，许多作者认为它们与多因素评分系统一样可靠。在九年的时间里，105例急性胰腺炎患者在罗马圣贾科莫医院外科住院。所有患者在入院后第1天、第3天和第5天进行了C反应蛋白、淀粉酶和脂肪酶血清检测。结果表明，C反应蛋白检测在检测急性胰腺炎坏死形式方面高度敏感。作者得出结论，C反应蛋白与血清淀粉酶和血清脂肪酶一起，常常能准确反映急性胰腺炎患者的临床情况。在此基础上，可以选择最佳的治疗方案。
