Mathuram Thiyagarajan Umasankar, Ponnuswamy Amirthavarshini, Thomas Rhys
Hepatobiliary and Pancreatic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Family Medicine, Kent, Surrey and Sussex Deanery, Epsom, GBR.
Cureus. 2020 Dec 9;12(12):e11989. doi: 10.7759/cureus.11989.
Background Acute pancreatitis (AP) is a common cause of emergency hospital admission. Predictive value of biochemical markers including alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin and lipase on pancreatitis has not been fully established. This study aimed to assess the role of ALT, ALP, bilirubin and lipase levels at admission on predicting the aetiology and length of hospital stay in AP. This study also assesses quantitative high lipase as a predictor of gallstone pancreatitis (GP). Methods All patients above the age of 18 with a diagnosis of AP between October 2016 - 2017 were included in our study. The exclusion criteria were patients with a known history of pancreatitis or biliary disease/bile duct stones and pregnancy. This is a retrospective study performed from a prospectively collected electronic patient database at our hospital. Results Among the 143 patients with AP, 50 patients were diagnosed with gallstone pancreatitis (GP) and the remaining of 93 patients suffered non-gallstone pancreatitis (NGP). Mean ALT level was significantly higher in gallstone pancreatitis (237 ± 351 IU) compared to non-gallstone pancreatitis (107 ± 162 IU; P = 0.005). ALP level was numerically high in GP (151.5 ± 186) compared to NGP (138 ± 105 IU; P = 0.64). Similar results in bilirubin level also noted in GP (35.5 ± 24.5) comparing to NGP (20.7 ± 79.6 µmol/L; P = 0.09). Raised ALT (9.3 ± 8.2 versus 3 ± 2.19 days), bilirubin (8.5 ± 2.5 versus 6.9 ± 1.19 days) and ALP levels (6.26 ± 6.1 versus 3.5 ± 10 days respectively; P = 0.05) were associated with longer hospitalisation in GP comparing to NGP. The lipase level more than 10 times the upper reference level (10-URL) was found to be associated with GP (39/50) than NGP (54/93; P = 0.027). Conclusion Raised ALT, high lipase of 10 URL levels were associated with gallstone pancreatitis. In gallstone pancreatitis, patients with high ALT, bilirubin and ALP levels had longer hospital stay.
背景 急性胰腺炎（AP）是急诊入院的常见原因。包括丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、胆红素和脂肪酶在内的生化标志物对胰腺炎的预测价值尚未完全明确。本研究旨在评估入院时ALT、ALP、胆红素和脂肪酶水平在预测AP病因及住院时间方面的作用。本研究还评估了高定量脂肪酶作为胆石性胰腺炎（GP）预测指标的价值。方法 纳入2016年10月至2017年期间所有年龄在18岁以上、诊断为AP的患者。排除标准为有胰腺炎或胆道疾病/胆管结石病史及妊娠的患者。这是一项基于我院前瞻性收集的电子患者数据库进行的回顾性研究。结果 在143例AP患者中，50例诊断为胆石性胰腺炎（GP），其余93例为非胆石性胰腺炎（NGP）。与非胆石性胰腺炎（107±162 IU；P = 0.005）相比，胆石性胰腺炎患者的平均ALT水平显著更高（237±351 IU）。与NGP（138±105 IU；P = 0.64）相比，GP患者的ALP水平在数值上较高（151.5±186）。与NGP（20.7±79.6 µmol/L；P = 0.09）相比，GP患者的胆红素水平也有类似结果（35.5±24.5）。与NGP相比，GP患者中升高的ALT（9.3±8.2天对3±2.19天）、胆红素（8.5±2.5天对6.9±1.19天）和ALP水平（分别为6.26±6.1天对3.5±10天；P = 0.05）与住院时间延长相关。脂肪酶水平超过参考上限值（10-URL）10倍以上被发现与GP（39/50）相关，而非NGP（54/93；P = 0.027）。结论 升高的ALT、10倍URL水平的高脂肪酶与胆石性胰腺炎相关。在胆石性胰腺炎中，ALT、胆红素和ALP水平高的患者住院时间更长。
