Deng Lihui, Wang Lei, Yong Fengjiao, Xiong Junjie, Jin Tao, De La Iglesia-Garcia Daniel, Bharucha Shameena, Altaf Kiran, Huang Wei, Xia Qing
Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
Clin Biochem. 2015 Jul;48(10-11):740-6. doi: 10.1016/j.clinbiochem.2015.04.018. Epub 2015 Apr 25.
The assessment of acute pancreatitis severity on admission currently remains a challenge to clinicians. A single, rapid biochemical marker would be preferable to clinical and radiological scoring systems. The aim of this study was to undertake a meta-analysis on the value of carboxypeptidase-B activation peptide (CAPAP) in predicting severity of acute pancreatitis on admission.
Major databases and trial registries were searched to identify all relevant studies from January 1998 to March 2015. Pooled sensitivity, specificity and the diagnostic odds ratios (DOR) with 95% confidence interval (CI) were calculated for each study and were compared to other biomarkers, if included, within the same study. Summary receiver-operating curves (ROC) were conducted and the area under the curve (AUC) was evaluated.
In total, six studies were included. At the time of admission, the AUC of serum CAPAP for predicting severity of acute pancreatitis was 0.86 with pooled sensitivity, specificity and DOR of 0.90, 0.70 and 19.08, respectively. When serum CAPAP was compared with urinary CAPAP, the AUC, pooled sensitivity, specificity and DOR were 0.69 vs 0.88, 0.90 vs 0.81, 0.68 vs. 0.77 and 17.96 vs. 18.58, respectively. Similarly, the AUC, pooled sensitivity, specificity and DOR of serum CAPAP vs maximal serum C-reactive protein within the first 3 days of admission were found to be 0.97 vs. 0.82, 0.92 vs. 0.88, 0.81 vs 0.68 and 37.90 vs. 18.80, respectively.
Both serum and urinary CAPAP have the potential to act as a stratification marker on admission in predicting severity of acute pancreatitis.
目前，入院时评估急性胰腺炎的严重程度对临床医生来说仍是一项挑战。单一、快速的生化标志物比临床和放射学评分系统更可取。本研究的目的是对羧肽酶B激活肽（CAPAP）在预测急性胰腺炎入院时严重程度的价值进行荟萃分析。
检索主要数据库和试验注册库，以识别1998年1月至2015年3月期间的所有相关研究。计算每项研究的合并敏感性、特异性和诊断比值比（DOR）以及95%置信区间（CI），并在同一研究中与其他生物标志物（如包含）进行比较。绘制汇总的受试者工作特征曲线（ROC）并评估曲线下面积（AUC）。
总共纳入了六项研究。入院时，血清CAPAP预测急性胰腺炎严重程度的AUC为0.86，合并敏感性、特异性和DOR分别为0.90、0.70和19.08。当将血清CAPAP与尿CAPAP进行比较时，AUC、合并敏感性、特异性和DOR分别为0.69对0.88、0.90对0.81、0.68对0.77和17.96对18.58。同样，入院后前3天血清CAPAP与最大血清C反应蛋白相比，AUC、合并敏感性、特异性和DOR分别为0.97对0.82、0.92对0.88、0.81对0.68和37.90对18.80。
血清和尿CAPAP都有可能作为入院时预测急性胰腺炎严重程度的分层标志物。
