Lankisch P G, Blum T, Bruns A, Dröge M, Brinkmann G, Struckmann K, Nauck M, Maisonneuve P, Lowenfels A B
Department of Internal Medicine, Municipal Clinic of Lüneburg.
Pancreatology. 2001;1(3):224-9. doi: 10.1159/000055815.
Early detection of pancreatic necrosis allows better management of the disease. Contrast-enhanced computed tomography (CT) as the gold standard for detecting pancreatic necrosis is expensive.
This study was to evaluate for the first time whether blood glucose estimation on hospital admission--a simple, cheap, readily available laboratory parameter--may detect pancreatic necrosis and have prognostic value in acute pancreatitis.
Single blood glucose estimation upon hospital admission was evaluated prospectively for detecting pancreatic necrosis and as a prognostic indicator. The study included 241 nondiabetic patients with a first attack of acute pancreatitis. All underwent CT within 72 h of admission.
High blood glucose (> 125 mg/dl) correlated significantly with complex high clinical and biochemical prognostic scores (Ranson, Imrie), a high Balthazar score, pancreatic pseudocysts, and a long hospital stay, but not with organ failure, indication for artificial ventilation, dialysis, surgery, length of intensive care, and mortality. Pancreatic necrosis detection sensitivity of high blood glucose was 83%, specificity 49%, positive predictive value 28%, and negative predictive value 92%.
A patient with normal blood glucose on admission is unlikely to have pancreatic necrosis. Contrast-enhanced CT would not be needed unless the patient fails to improve.
早期发现胰腺坏死有助于更好地管理该疾病。作为检测胰腺坏死金标准的对比增强计算机断层扫描（CT）费用高昂。
本研究旨在首次评估入院时的血糖测定——一项简单、廉价且易于获取的实验室参数——是否可检测胰腺坏死并对急性胰腺炎具有预后价值。
前瞻性评估入院时单次血糖测定对检测胰腺坏死及作为预后指标的情况。该研究纳入241例首次发作急性胰腺炎的非糖尿病患者。所有患者在入院72小时内均接受了CT检查。
高血糖（>125mg/dl）与复杂的高临床和生化预后评分（兰森、伊姆里评分）、高巴尔萨泽尔评分、胰腺假性囊肿及住院时间延长显著相关，但与器官衰竭、人工通气指征、透析、手术、重症监护时长及死亡率无关。高血糖检测胰腺坏死的敏感性为83%，特异性为49%，阳性预测值为28%，阴性预测值为92%。
入院时血糖正常的患者不太可能发生胰腺坏死。除非患者病情无改善，否则无需进行对比增强CT检查。
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