Leese T, Shaw D, Holliday M
Department of Surgery, University of Leicester.
Ann R Coll Surg Engl. 1988 Jul;70(4):227-32.
The value of six prognostic markers was assessed prospectively in 198 attacks of acute pancreatitis with specific attention to their ability to predict pancreatic necrosis. The Imrie Prognostic Score (IPS) was recorded within 48 h of diagnosis. The serum C-reactive protein (CRP) alpha 1 antiprotease (A1AP), alpha 2 macroglobulin (A2M), amylase and white cell count (WCC) were measured on days 1, 3 and 7. When comparing all severe clinical outcomes to mile outcomes, serum CRP concentrations were higher on all three days (P less than 0.02, less than 0.001, less than 0.001), A1AP concentrations were higher on day 3 (P less than 0.05), A2M concentrations were lower on day 7 (P less than 0.01) and WCC was higher on all three days (P less than 0.001, less than 0.001, less than 0.001). Serum amylase concentrations showed no significant differences. None of the measured parameters were helpful in distinguishing patients who subsequently developed pancreatic necrosis from patients who had other severe outcomes. Multivariate analysis revealed that the initial IPS showed greatest independent significance in predicting severe outcome followed by the WCC (days 1 and 7) and CRP (day 3). CRP and WCC may be clinically useful predictors of severe outcome to supplement the initial IPS. These methods are unlikely to distinguish pancreatic necrosis from other severe outcomes, but they may supplement clinical judgment in selecting a high risk group of patients for contrast enhanced computed tomography.
对198例急性胰腺炎发作患者的六个预后标志物进行了前瞻性评估，特别关注其预测胰腺坏死的能力。在诊断后48小时内记录Imrie预后评分（IPS）。在第1、3和7天测量血清C反应蛋白（CRP）、α1抗蛋白酶（A1AP）、α2巨球蛋白（A2M）、淀粉酶和白细胞计数（WCC）。将所有严重临床结局与轻症结局进行比较时，血清CRP浓度在所有三天均较高（P<0.02、<0.001、<0.001），A1AP浓度在第3天较高（P<0.05），A2M浓度在第7天较低（P<0.01），WCC在所有三天均较高（P<0.001、<0.001、<0.001）。血清淀粉酶浓度无显著差异。所测参数均无助于区分随后发生胰腺坏死的患者与有其他严重结局的患者。多因素分析显示，初始IPS在预测严重结局方面显示出最大的独立意义，其次是WCC（第1天和第7天）和CRP（第3天）。CRP和WCC可能是补充初始IPS的严重结局的临床有用预测指标。这些方法不太可能区分胰腺坏死与其他严重结局，但它们可能有助于临床判断，以选择高危患者组进行对比增强计算机断层扫描。
