Güngör Bülent, Cağlayan Kasım, Polat Cafer, Seren Deniz, Erzurumlu Kenan, Malazgirt Zafer
Department of Surgery, Faculty of Medicine, Ondokuz Mayıs University, 55139 Samsun, Turkey.
ISRN Gastroenterol. 2011;2011:279607. doi: 10.5402/2011/279607. Epub 2010 Dec 14.
Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.
背景与目的。目前尚无准确区分急性胆源性胰腺炎的方法。胆管梗阻、特发性胰腺炎可能与胆源性有关，这在急性治疗中需要鉴别。我们探寻了早期急性胆源性胰腺炎生化标志物的预测价值。
患者与方法。测定了157例急性胰腺炎患者血清中的谷草转氨酶（AST）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、总胆红素、直接胆红素、乳酸脱氢酶（LDH）、淀粉酶、脂肪酶、C反应蛋白（CRP）和白细胞（WBC）水平。通过磁共振胰胆管造影（MRCP）、内镜逆行胰胆管造影（ERCP）、术中胰胆管造影（IOC）来区分胆源性和非胆源性胰腺炎。在确定显著变量后，确定入院时生化标志物的截断点及其敏感性、特异性、阳性预测值和阴性预测值。为每个生化标志物绘制受试者工作特征曲线。
结果。胆源性胰腺炎患者血清碱性磷酸酶、总胆红素、直接胆红素、淀粉酶和脂肪酶水平显著升高，阳性预测值分别为80.8%、83.9%、81.6%、78.8%、79.7%。
结论。碱性磷酸酶、总胆红素、直接胆红素、淀粉酶和脂肪酶水平升高可用于预测胆源性胰腺炎。
