Parodi H C, Gutiérrez S, Lattanzi M, Martínez R, Colombato L O
Servicio de Gastroenterología, Hospital Nacional Dr. Alejandro Posadas, Buenos Aires, Argentina.
Acta Gastroenterol Latinoam. 1990;20(3):137-44.
The aim of this study was to investigate the usefulness of serum bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (APh) and real time ultrasonography (US) in distinguishing between gallstone and non gallstone related acute pancreatitis (A.P.). The second aim was to evaluate whether or nor there was biliary tract hypertension. Both aims were designed in order to evaluate them in the early stage of A.P. Two Groups of patients were studied. Group 1--gallstone related A.P., 63 pts. Group 2--Non gallstone related A.P. 21 pts. Fifty nine (93.6%) of Group 1 and 11 (52.3%) of Group 2 had surgical confirmation. In the other, the diagnosis was based on US and C.T. Blood samples were taken during the three days after admission for biochemical test and US was performed within the same period. Statistical evaluation and Student's t test were used. Biochemical test: when the cut off level was expressed by the upper limit of normal (ULN), the highest diagnostic sensibility was (table 1): ALT 85.7%, APH 80.9%. AST 71%, bilirubin 65%. When the cut off level was chosen at twice the ULN (Table 1), the sensibility was: ALT 61.9%, bilirubin and AST 47%, APh 30%, Group 2 (Table 2) values higher than the ULN were: AST 42.8%, bilirubin 33%, ALT 19%, APh 14.2%. The differences between the two Groups were statistically significant: APh and bilirubin P less than 0.001, ALT less than 0.05 m AST, NS. Ultrasonography: Group 1: gallstones were detected in 96.6% (58/60). Biliary tree was not visualized in 10 (15.8%), diagnosed as normal in 38 (60.3%) and pathologic (dilatation and/or lithiasis) in 15 (23.8%).(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是探讨血清胆红素、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（APh）及实时超声检查（US）在鉴别胆石性和非胆石性急性胰腺炎（A.P.）中的作用。第二个目的是评估是否存在胆道高压。这两个目的都是为了在急性胰腺炎的早期对其进行评估。研究了两组患者。第1组——胆石性急性胰腺炎，63例患者。第2组——非胆石性急性胰腺炎，21例患者。第1组中59例（93.6%）和第2组中11例（52.3%）有手术证实。在其他病例中，诊断基于超声检查和CT。入院后三天内采集血样进行生化检测，并在同一时期进行超声检查。采用统计学评估和学生t检验。生化检测：当临界值以上限正常（ULN）表示时，最高诊断敏感性为（表1）：ALT为85.7%，APh为80.9%。AST为71%，胆红素为65%。当临界值选择为ULN的两倍时（表1），敏感性为：ALT为61.9%，胆红素和AST为47%，APh为30%。第2组（表2）高于ULN的值为：AST为42.8%，胆红素为33%，ALT为19%，APh为14.2%。两组之间的差异具有统计学意义：APh和胆红素P小于0.001，ALT小于0.05，AST无统计学意义。超声检查：第1组：96.6%（58/60）检测到胆石。10例（15.8%）未显示胆道树，38例（60.3%）诊断为正常，15例（23.8%）为病理性（扩张和/或结石）。（摘要截短于250字）
