目的 探讨血清脂肪酶在经内镜逆行胰胆管造影(ERCP)术后胰腺炎早期诊断中的价值。方法 回顾性分析2017-03至2020-03武警重庆总队医院普外科和陆军军医大学第一附属医院住院肝胆胰微创外科中心行ERCP手术治疗的患者3190例,分别比较血清脂肪酶和淀粉酶ROC曲线下AUC面积、术后早期是否发生胰腺炎的ROC曲线界值点和该数值的ERCP术后胰腺炎(PEP)早期诊断属性(敏感性、特异性、阳性预测值和阴性预测值)。结果 纳入研究的802例病例中,ERCP术后胰腺炎共发生56例,占总例数6.9%,其中ERCP术后3 h发生胰腺炎30例(53.6%),ERCP术后24 h发生胰腺炎26例(46.4%)。ERCP术后3 h血清脂肪酶AUC面积为0.93(95%可信区间为0.80～0.96),血清淀粉酶AUC面积为0.87(95%可信区间0.78～0.90),其差异具有统计学意义(P＜0.01)。ROC曲线显示血清脂肪酶的最佳界点值为382 U/L,其敏感度88.0%,特异性89.0%,阳性预测值0.50,阴性预测值0.98;血清淀粉酶的最佳切点值228U/L,其敏感度82.0%,特异度78.0%,阳性预测值0.36,阴性预测值0.97。结论 血清脂肪酶在早期诊断PEP中有较高敏感度和特异度,其在ERCP术后早期检测值为PEP的早期干预提供重要依据。
Abstract
Objective To explore the value of serum lipase in the early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Methods A retrospective analysis was performed on 3190 patients who underwent ERCP in Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force and PLA Army Military Medical University from March 2017 to March 2020 to compare the AUC area under the ROC curve of serum lipase (S-Lip)and amylase (S-Amy), the threshold values of the ROC curve for early diagnosis of PEP, and the attributes of these values in the early diagnosis of pancreatitis after ERCP surgery(sensitivity, specificity, positive predictive value and negative predictive value). Results Among the 802 cases included in the study, 56 cases (6.9%) of ERCP postoperative pancreatitis occurred, including 30 cases (53.6%) at 3 h after ERCP and 26 cases (46.4%) at 24 h after ERCP. The AUC of S-Lip and S-Amy were 0.93 (95% confidence interval, 0.87-0.96) and 0.865 (95%CI, 0.78-0.90) at 3 hours after ERCP, and the differences were statistically significant (P<0.01). ROC curve showed that the optimal threshold value were 382 U/L for s-Lip(sensitivity 0.88,specificity 0.89,PPV 0.502,NPV 0.985)and 228 U/L for s-Amy(sensitivity 0.82,specificity 0.78,PPV 0.363,NPV 0.977). Conclusions Serum lipase is characterized by high sensitivity and specificity in the early diagnosis of PEP, and its early detection value after ERCP provides an important basis for the early intervention of PEP.
关键词
ERCP /
ERCP术后胰腺炎 /
血清脂肪酶 /
血清淀粉酶
Key words
ERCP /
pancreatitis after ERCP /
serum lipase /
serum amylase
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