血清淀粉酶水平对 CT 定义的内镜逆行胰胆管造影术后胰腺炎的诊断价值：一项前瞻性多中心观察研究。

Diagnostic Value of Serum Amylase Levels Indicating Computed Tomography-Defined Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Prospective Multicenter Observational Study.

机构信息

From the Division of Gastroenterology, Department of Medicine.

Division of Clinical Nutrition, Shiga University of Medical Science, Otsu.

出版信息

Pancreas. 2020 Aug;49(7):955-959. doi: 10.1097/MPA.0000000000001606.

DOI:10.1097/MPA.0000000000001606

PMID:32658080

Abstract

OBJECTIVE

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis involves persistent serum amylase levels of 3 times or more the standard upper limit. However, these criteria were mostly based on retrospective studies and not necessarily supported by diagnostic imaging. Our prospective study aimed to investigate cutoff serum amylase levels suggesting post-ERCP pancreatitis using computed tomography as the criterion standard.

METHODS

We prospectively followed 2078 cases. Computed tomography was performed in patients whose serum amylase levels exceeded the institutional upper limit 12 to 24 hours after ERCP. Two expert radiologists blindly assessed the images and judged the presence or absence of pancreatitis. Correlations between serum amylase levels with pancreatitis were investigated using receiver operating characteristic analysis.

RESULTS

Amylase levels increased in 416 (23.2%) of 1789 cases included, and 350 cases were analyzed using computed tomography. Post-endoscopic retrograde cholangiopancreatography pancreatitis was diagnosed in 12.0% (214/1789). The cutoff amylase levels for judging pancreatitis after 12 to 24 hours was 2.75 times higher than the institutional upper limit, with an area under the curve of 0.77.

CONCLUSIONS

The appropriate cutoff serum amylase level for judging post-ERCP pancreatitis at 12 to 24 hours after ERCP was 2.75 times higher than the institutional upper limit. These results may clarify the definition of post-ERCP pancreatitis.

摘要

目的

内镜逆行胰胆管造影（ERCP）后胰腺炎涉及血清淀粉酶水平持续高于正常上限 3 倍以上。然而，这些标准主要基于回顾性研究，不一定得到诊断影像学的支持。我们的前瞻性研究旨在使用计算机断层扫描作为标准，通过调查提示 ERCP 后胰腺炎的血清淀粉酶水平的截止值来研究该问题。

方法

我们前瞻性地随访了 2078 例患者。在 ERCP 后 12 至 24 小时内，血清淀粉酶水平超过机构上限的患者进行了计算机断层扫描。两名专家放射科医生对图像进行了盲法评估，并判断是否存在胰腺炎。使用受试者工作特征分析研究了血清淀粉酶水平与胰腺炎之间的相关性。

结果

在纳入的 1789 例患者中有 416 例（23.2%）的淀粉酶水平升高，其中 350 例使用计算机断层扫描进行了分析。在 1789 例患者中有 12.0%（214/1789）诊断为 ERCP 后胰腺炎。在 ERCP 后 12 至 24 小时判断胰腺炎的截止淀粉酶水平是机构上限的 2.75 倍，曲线下面积为 0.77。