Yadav Dhiraj, Agarwal N, Pitchumoni C S
Department of Surgery, Our Lady of Mercy University Medical Center, New York Medical College, Bronx 10466, USA.
Am J Gastroenterol. 2002 Jun;97(6):1309-18. doi: 10.1111/j.1572-0241.2002.05766.x.
An ideal laboratory test in the evaluation of a patient with acute pancreatitis (AP) should, in addition to accurately establishing the diagnosis of AP, provide early assessment of its severity and identify the etiology. None of the tests available today meet all these criteria, and presently there is no biochemical test that can be considered the "gold standard" for the diagnosis and assessment of severity of AP. In the diagnosis of AP, serum amylase and lipase remain important tests. Advantages of amylase estimation are its technical simplicity, easy availability, and high sensitivity. However, its greatest disadvantage is its low specificity. A normal amylase would usually exclude the diagnosis of AP, with the exception of AP secondary to hyperlipidemia, acute exacerbation of chronic pancreatitis, and when the estimation of amylase is delayed in the course of the disease. The major advantage of lipase is an increased sensitivity in acute alcoholic pancreatitis and in patients who initially present to the emergency room days after the onset of the disease, as lipase remains elevated longer than amylase. Although once considered to be specific for AP, nonspecific elevations of lipase have been reported in almost as many disorders as amylase, thus decreasing its specificity. Simultaneous estimation of amylase and lipase does not improve the accuracy. Other enzymes for the diagnosis of AP--pancreatic isoamylase, immunoreactive trypsin, and elastase--are more cumbersome and expensive and have no clear role in the diagnosis of AP. No enzyme assay has a predictive role in determining the severity or etiology of AP. Once the diagnosis of AP is established, daily measurements of enzymes have no value in assessing the clinical progress of the patient or ultimate prognosis and should be discouraged. A host of new serological and urinary markers have been investigated in the last few years. Their main use is in predicting the severity of AP. At present, serum C-reactive protein at 48 h is the best available laboratory marker of severity. Urinary trypsinogen activation peptides within 12-24 h of onset of AP are able to predict the severity but are not widely available. Serum interleukins 6 and 8 seem promising but remain experimental.
评估急性胰腺炎（AP）患者时，理想的实验室检查除了要准确确诊AP外，还应能对其严重程度进行早期评估并确定病因。目前可用的检查均无法满足所有这些标准，而且目前尚无一种生化检查可被视为诊断和评估AP严重程度的“金标准”。在AP的诊断中，血清淀粉酶和脂肪酶仍然是重要的检查项目。淀粉酶测定的优点是技术简单、易于获得且灵敏度高。然而，其最大的缺点是特异性低。除了继发于高脂血症的AP、慢性胰腺炎急性发作以及疾病过程中淀粉酶测定延迟的情况外，淀粉酶正常通常可排除AP的诊断。脂肪酶的主要优点是在急性酒精性胰腺炎以及发病数天后才首次到急诊室就诊的患者中灵敏度更高，因为脂肪酶升高的时间比淀粉酶更长。尽管脂肪酶曾一度被认为对AP具有特异性，但现已报道，与淀粉酶一样，几乎在同样多的疾病中脂肪酶也会出现非特异性升高，从而降低了其特异性。同时测定淀粉酶和脂肪酶并不能提高准确性。用于诊断AP的其他酶——胰淀粉酶同工酶、免疫反应性胰蛋白酶和弹性蛋白酶——操作更繁琐、成本更高，且在AP的诊断中没有明确作用。没有任何酶测定在确定AP的严重程度或病因方面具有预测作用。一旦确诊AP，每日测定酶对评估患者的临床进展或最终预后没有价值，应避免进行。在过去几年中，人们研究了许多新的血清学和尿液标志物。它们的主要用途是预测AP的严重程度。目前，发病48小时时的血清C反应蛋白是现有的最佳严重程度实验室标志物。AP发病12 - 24小时内的尿胰蛋白酶原激活肽能够预测严重程度，但尚未广泛应用。血清白细胞介素6和8似乎有前景，但仍处于实验阶段。
