Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI 53705-2281, USA.
Dig Dis Sci. 2011 Nov;56(11):3376-81. doi: 10.1007/s10620-011-1752-5. Epub 2011 May 26.
Our objective was to investigate the use of serum lipase levels >10,000 U/L as a tool for predicting the etiology of acute pancreatitis (AP) and to further address the relationship between lipase elevation and disease severity.
We compared patients with AP and serum lipase >10,000 U/L (HL) with patients with AP and lower serum lipase levels (855-10,000 U/L). The etiology and severity of AP were recorded. Differences between groups were calculated.
Of the 114 patients in the HL group, the common etiologies of AP were biliary (68%), iatrogenic trauma (14%), and idiopathic (10%). Only one patient had alcoholic AP. Conversely, the common etiologies of AP in the 146-patient comparison group (lipase 855-10,000 U/L) were broader: biliary (34%), idiopathic (23%), alcohol (14%), and iatrogenic trauma (10%). Biliary AP was twice as common in the HL group (P < 0.0001) whereas alcoholic AP was significantly less common (P < 0.0001). The positive predictive value (PPV) for biliary AP of lipase >10,000 U/L was 80% whereas the negative predictive (NPV) for alcoholic AP was 99%. No difference between groups was observed in the severity markers including ICU admission, length of hospital stay, complications, or mortality.
In AP a serum lipase of >10,000 U/L at presentation is a useful marker and portends a biliary etiology while virtually excluding alcoholic AP. Therefore, if ultrasonography is negative for stones in this population, these data suggest workup with MRCP or EUS is warranted to evaluate for microlithiasis or sludge given the high likelihood of occult stone disease in these individuals.
本研究旨在探讨血清脂肪酶水平>10000U/L 作为预测急性胰腺炎（AP）病因的工具，并进一步探讨脂肪酶升高与疾病严重程度的关系。
我们比较了血清脂肪酶>10000U/L（HL 组）与血清脂肪酶水平 855-10000U/L（AP 组）的 AP 患者。记录 AP 的病因和严重程度。计算组间差异。
HL 组 114 例患者中，AP 的常见病因是胆源性（68%）、医源性创伤（14%）和特发性（10%）。仅有 1 例为酒精性 AP。相反，在比较组（855-10000U/L 血清脂肪酶）的 146 例患者中，AP 的病因更为广泛：胆源性（34%）、特发性（23%）、酒精性（14%）和医源性创伤（10%）。HL 组胆源性 AP 更为常见（P<0.0001），而酒精性 AP 明显较少见（P<0.0001）。血清脂肪酶>10000U/L 对胆源性 AP 的阳性预测值（PPV）为 80%，对酒精性 AP 的阴性预测值（NPV）为 99%。两组在 ICU 入院率、住院时间、并发症或死亡率等严重程度标志物方面无差异。
在 AP 中，就诊时血清脂肪酶>10000U/L 是一个有用的标志物，预示着胆源性病因，几乎排除了酒精性 AP。因此，如果在该人群中超声检查未发现结石，这些数据提示应进行磁共振胰胆管成像或超声内镜检查，以评估是否存在微小结石或泥沙样结石，因为这些患者极有可能存在隐匿性结石病。
