Mönkemüller Klaus E, Harewood Gavin C, Curioso Walter H, Fry Lucia C, Wilcox C Mel, Morgan Desiree E, Baron Todd H
Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL, USA.
J Gastroenterol Hepatol. 2005 Nov;20(11):1667-73. doi: 10.1111/j.1440-1746.2005.04067.x.
Despite our understanding of the pathophysiology of different types of pancreatic fluid collections (PFC), few studies have attempted to correlate the biochemical analysis of PFC contents with clinical and radiological characteristics. The aim of this study was to assess the predictive value of fluid analysis for discerning collection type (pseudocyst vs acute fluid collection with necrosis), presence of infection or communication with the pancreatic duct in the setting of acute and chronic pancreatitis.
Pancreatic fluid from 34 consecutive patients undergoing endotherapy of PFC was prospectively analyzed for seven variables: lactate dehydrogenase (LDH), total protein, albumin, glucose, amylase, lipase and specific gravity.
In multivariate analysis, adjusting for age and gender, high intracystic levels of protein (OR 6.2; 95% CI 1.3-37.0), LDH (OR 6.8 [2.3-38.3]), and albumin (OR 7.8 [1.3-67.4]), and low levels of glucose (OR 0.2 [0.03-0.9]) predicted the presence of PFC infection. The optimal threshold value for protein was 1000 g/dL, which achieved a sensitivity of 73% and specificity of 75% for detecting infection; the optimal cut-off for LDH was 1000 U/L (sensitivity 64%, specificity 85%), and the cut-off for albumin was 500 g/dL (sensitivity 75%, specificity 85%). There were no statistically significant differences in biochemical fluid analysis with respect to fluid collection type (pseudocysts vs acute fluid collection with necrosis) and the presence of pancreatic duct communication.
Biochemical analysis of PFC fluid is clinically helpful in detecting fluid infection in patients with bacteria on Gram stain or positive fluid cultures. Our findings fail to support the utility of fluid analysis in characterizing cyst type, and we caution against its use in distinguishing pseudocysts from acute fluid collection with necrosis.
尽管我们对不同类型胰腺液体积聚（PFC）的病理生理学有所了解，但很少有研究尝试将PFC内容物的生化分析与临床及影像学特征相关联。本研究的目的是评估在急性和慢性胰腺炎背景下，液体分析对于鉴别液体积聚类型（假性囊肿与伴有坏死的急性液体积聚）、感染的存在或与胰管的连通性的预测价值。
对34例连续接受PFC内镜治疗的患者的胰液进行前瞻性分析，检测七个变量：乳酸脱氢酶（LDH）、总蛋白、白蛋白、葡萄糖、淀粉酶、脂肪酶和比重。
在多变量分析中，校正年龄和性别后，囊内蛋白水平高（比值比[OR]6.2；95%置信区间[CI]1.3 - 37.0）、LDH水平高（OR 6.8[2.3 - 38.3]）、白蛋白水平高（OR 7.8[1.3 - 67.4]）以及葡萄糖水平低（OR 0.2[0.03 - 0.9]）可预测PFC感染的存在。检测感染时，蛋白的最佳阈值为1000 g/dL，灵敏度为73%，特异性为75%；LDH的最佳截断值为1000 U/L（灵敏度64%，特异性85%），白蛋白的截断值为500 g/dL（灵敏度75%；特异性85%）。在液体积聚类型（假性囊肿与伴有坏死的急性液体积聚）及胰管连通性方面，生化液体分析无统计学显著差异。
PFC液体的生化分析在临床上有助于检测革兰氏染色发现细菌或液体培养阳性患者的液体感染。我们的研究结果不支持液体分析在表征囊肿类型方面的实用性，并且我们提醒不要用其来区分假性囊肿与伴有坏死的急性液体积聚。
