Sultan Shahnaz, Baillie John
Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA.
JOP. 2002 Nov;3(6):188-94.
Acute pancreatitis is one of the major complications of ERCP. It is of paramount importance that we accurately identify which patients will go on to develop post-ERCP pancreatitis. As most ERCPs are performed on an outpatient basis, early evaluation can allow safe discharge of the majority of patients who will not develop post-ERCP pancreatitis or develop only mild symptoms that will be self-limited. Alternatively, early detection of those patients who will go on to develop moderate or severe post-ERCP pancreatitis can guide decisions regarding hospital admission and aggressive management and can help direct the use of targeted therapies that have the potential to prevent or mitigate pancreatic inflammation. Thus, significant efforts have focused on trying to identify predictors of post-ERCP pancreatitis. These parameters can be organized into three categories of tests: 1) pancreatic enzymes as markers of pancreatic injury: serum amylase/urine amylase; 2) markers of proteolytic activation: trypsinogen, trypsinogen activation peptide; 3) markers of systemic inflammation: C-reactive protein, various interleukins such as IL-6 and IL-10. A serum amylase level greater than 4-5 times the upper reference limit in conjunction with clinical symptoms has been shown to be an accurate and reliable predictor of post-ERCP pancreatitis. However, the exact timing and level of amylase elevation remains debatable. Urine testing of amylase and trypsinogen-2 in post-ERCP patients has also been shown to be highly sensitive and specific for detecting pancreatitis. The main advantage of these urinary markers is that they are available as rapid dipstick tests. Serum trypsinogen-2 levels have also been studied in post-ERCP pancreatitis patients; high levels seem to correlate with severity of disease. Among the markers of systemic inflammation, serum CRP is an accurate and readily available laboratory test for predicting severity of post-ERCP pancreatitis, but it appears to be helpful at 24-48 hours and, therefore, is not an early marker. Several other markers remain investigational and have not yet found wide clinical applicability.
急性胰腺炎是内镜逆行胰胆管造影术（ERCP）的主要并发症之一。准确识别哪些患者会发展为ERCP术后胰腺炎至关重要。由于大多数ERCP手术是在门诊进行的，早期评估可以让大多数不会发生ERCP术后胰腺炎或仅出现自限性轻微症状的患者安全出院。另外，早期发现那些会发展为中度或重度ERCP术后胰腺炎的患者，可以指导关于住院和积极治疗的决策，并有助于指导使用有可能预防或减轻胰腺炎症的靶向治疗。因此，大量努力都集中在试图识别ERCP术后胰腺炎的预测指标上。这些参数可分为三类检测：1）作为胰腺损伤标志物的胰腺酶：血清淀粉酶/尿淀粉酶；2）蛋白水解激活标志物：胰蛋白酶原、胰蛋白酶原激活肽；3）全身炎症标志物：C反应蛋白、各种白细胞介素，如IL-6和IL-10。血清淀粉酶水平高于参考上限4 - 5倍并伴有临床症状，已被证明是ERCP术后胰腺炎准确可靠的预测指标。然而，淀粉酶升高的确切时间和水平仍存在争议。对ERCP术后患者进行尿淀粉酶和胰蛋白酶原-2检测，也被证明对检测胰腺炎具有高度敏感性和特异性。这些尿液标志物的主要优点是可以通过快速试纸检测获得。在ERCP术后胰腺炎患者中也研究了血清胰蛋白酶原-2水平；高水平似乎与疾病严重程度相关。在全身炎症标志物中，血清CRP是预测ERCP术后胰腺炎严重程度的一项准确且易于获得的实验室检测指标，但它似乎在24 - 48小时时才有帮助，因此不是早期标志物。其他几种标志物仍在研究中，尚未发现广泛的临床应用价值。
