Department of Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Private Bag X7, Congella, Durban, Kwa-Zulu Natal 4013, South Africa.
World J Surg. 2013 Jan;37(1):156-61. doi: 10.1007/s00268-012-1801-z.
The etiology of acute pancreatitis can be difficult to determine early in the course of the disease. The aim of the present study was to determine the relationship between biochemical parameters and the cause of acute pancreatitis.
A prospectively collected database of patients admitted with acute pancreatitis between 2001 and 2008 was analyzed. The relationships between etiology and age, sex, admission serum amylase level, and admission alanine transaminase (ALT) level were evaluated.
Acute pancreatitis was diagnosed in 464 patients. The disease was related to alcohol in 275 cases, gallstones in 81 cases, HIV in 49 cases, dyslipidemia in 42 cases, and it was idiopathic in 17 cases. Alcoholic pancreatitis was more common in men, whereas the other identifiable causes were more common in women (P < 0.001). Mean age at presentation was 39 years with no difference in age in relation to etiology (P = 0.057). When compared to patients with non-biliary causes of pancreatitis, patients with gallstone pancreatitis had greater median (range) serum amylase activity [1,423 U/l (153-7,500 U/l) versus 589 U/l (58-11,144 U/l); P < 0.001] and ALT activity [153 U/l (8-13,233 U/l) versus 31 U/l (6-421 U/l); P < 0.001]. No significant differences in amylase or ALT activity were found between non-biliary etiologies (P > 0.05). Alanine transaminase was the only factor independent of sex to predict gallstone etiology, with activity >150 U/l having a specificity of 97 %.
In patients with acute gallstone pancreatitis, the serum amylase and ALT activities were more than double those of other etiologies. An ALT level of >150 U/l was highly predictive of gallstone etiology independent of gender. Neither amylase nor ALT could differentiate non-biliary etiologies. The combination of amylase and ALT offered no improvement in predicting etiology over each alone.
急性胰腺炎的病因在疾病早期可能难以确定。本研究的目的是确定生化参数与急性胰腺炎病因之间的关系。
分析了 2001 年至 2008 年间因急性胰腺炎入院的患者的前瞻性收集数据库。评估了病因与年龄、性别、入院时血清淀粉酶水平和丙氨酸氨基转移酶（ALT）水平之间的关系。
诊断为急性胰腺炎的患者有 464 例。其中，275 例与酒精有关，81 例与胆石症有关，49 例与 HIV 有关，42 例与血脂异常有关，17 例为特发性。酒精性胰腺炎更常见于男性，而其他可识别的病因更常见于女性（P<0.001）。发病时的平均年龄为 39 岁，与病因无关（P=0.057）。与非胆源性胰腺炎患者相比，胆石性胰腺炎患者的中位（范围）血清淀粉酶活性更高[1423 U/L（153-7500 U/L）与 589 U/L（58-11144 U/L）；P<0.001]和 ALT 活性更高[153 U/L（8-13233 U/L）与 31 U/L（6-421 U/L）；P<0.001]。非胆源性病因之间的淀粉酶或 ALT 活性无显著差异（P>0.05）。丙氨酸氨基转移酶是唯一独立于性别预测胆石病因的因素，其活性>150 U/L 的特异性为 97%。
在急性胆石性胰腺炎患者中，血清淀粉酶和 ALT 活性是其他病因的两倍以上。ALT 水平>150 U/L 高度提示独立于性别与胆石症有关。淀粉酶和 ALT 均不能区分非胆源性病因。淀粉酶和 ALT 的联合应用并不能提高预测病因的准确性。
