血清淀粉酶和脂肪酶对预测内镜逆行胰胆管造影术后胰腺炎严重程度的作用。

Usefulness of serum amylase and lipase as predictors of the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis.

机构信息

Servicio de Cirugía General, Ciudad de México, México.

Sociedad Médico Quirúrgica Hospital Juárez de México, Ciudad de México, México.

出版信息

Cir Cir. 2020;88(4):428-434. doi: 10.24875/CIRU.20001691.

DOI:10.24875/CIRU.20001691

PMID:32567590

Abstract

BACKGROUND

Post-ERCP pancreatitis (PEP) is the most common complication of Post-endoscopic retrograde cholangiopancreatography.

OBJECTIVE

to demonstrate whether serum amylase and lipase values correlate with the presence and severity of PEP.

METHOD

We conducted a retrospective, observational and analytical study of patients who underwent ERCP, those who developed pancreatitis were classified by severity according to the 2012 revised Atlanta criteria and their serum enzyme levels were analyzed. We used ROC (Receiver Operating Characteristics) curves to know the best enzyme cutoff points and analyzed their diagnostic yields. Chi-square, t-distribution and Mann-Whitney U test were used in the variable analysis and it was considered statistically significant when p < 0.05.

RESULTS

A total 621 patients, 54 presented pancreatitis. For moderately severe and severe forms: lipase level of 1500 U/L had an area under the curve (AUC) = 0.827, 95% CI (0.67-0.98), sensitivity = 72.7%, specificity = 86%, negative predictive value = 92.5%, p < 0.05. Amylase level of 920 U/L presented AUC = 0.65, 95% CI (0.43-0.86), sensitivity = 63%, specificity = 67%, p > 0.05.

CONCLUSIONS

Serum lipase shows correlation with the presence and severity of PEP. Amylase shows no significant correlation with PEP.

摘要

背景

内镜逆行胰胆管造影术后胰腺炎（PEP）是内镜逆行胰胆管造影术后最常见的并发症。

目的

证明血清淀粉酶和脂肪酶值是否与 PEP 的存在和严重程度相关。

方法

我们对接受 ERCP 的患者进行了回顾性、观察性和分析性研究，根据 2012 年修订的亚特兰大标准对发生胰腺炎的患者进行严重程度分类，并分析其血清酶水平。我们使用 ROC（接收者操作特征）曲线来了解最佳酶截断点，并分析其诊断效果。卡方检验、t 分布和曼-惠特尼 U 检验用于变量分析，当 p<0.05 时认为具有统计学意义。

结果

共有 621 例患者，其中 54 例发生胰腺炎。对于中度和重度胰腺炎：脂肪酶水平为 1500 U/L 时，曲线下面积（AUC）为 0.827，95%CI（0.67-0.98），灵敏度为 72.7%，特异性为 86%，阴性预测值为 92.5%，p<0.05。淀粉酶水平为 920 U/L 时，AUC 为 0.65，95%CI（0.43-0.86），灵敏度为 63%，特异性为 67%，p>0.05。