血清hs-CRP、FIB联合尿CAPAP诊断急性重症胰腺炎的临床价值分析
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摘要
目的探讨血清超敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)联合尿液羧肽酶B激活肽(CAPAP)诊断急性重症胰腺炎(SAP)的临床价值。方法选取2016年3月至2017年12月该院收治的确诊为急性胰腺炎患者67例作为研究对象,其中SAP 29例,急性轻症胰腺炎(MAP)38例。选择同期在该院进行健康体检者40例作为对照组。检测并比较急性胰腺炎患者入院时,入院后24、48、72h时,以及健康体检者血清hs-CRP、FIB和尿CAPAP水平。计算和评价各项指标单独及联合检测的诊断效能。结果随入院时间的延长,SAP、MAP患者血清hs-CRP、FIB均显著升高,且显著高于对照组,差异均有统计学意义(P<0.05);SAP、MAP患者各时间点尿CAPAP阳性率显著高于对照组,差异均有统计学意义(P<0.05);SAP患者不同时间点血清hs-CRP、FIB水平及尿CPAPA阳性率均显著高于MAP患者,差异均有统计学意义(P<0.05)。尿CAPAP对急性重症胰腺炎的诊断效能最高,其次为血清hs-CRP,再次为血清FIB;3项指标联合检测诊断SAP的灵敏度为90.3%,准确度为94.3%,特异性为92.6%,阳性预测值为90.3%,阴性预测值为92.6%;3项指标联合检测的诊断效能均显著高于任一单项指标检测,差异均有统计学意义(P<0.05)。结论血清hs-CRP、血清FIB、尿CAPAP水平均可作为诊断SAP的监测指标,三者联合检测比任一单项指标检测更有助于早期诊断SAP,对病情严重程度的判断、治疗和预后评价具有重要临床价值。
Objective To explore the clinical value of serum high sensitivity C-reactive protein(hs-CRP),fibrinogen(FIB)and urine carboxypeptidase B activating peptide(CAPAP)in the diagnosis of severe acute pancreatitis(SAP).Methods 67 patients with acute pancreatitis admitted to the hospital from March 2016 to December 2017 were selected as the study subjects,including 29 cases of SAP and 38 cases of acute mild pancreatitis(MAP).40 health examinees in the same period were selected as the control group.Serum hs-CRP,FIB and urinary CAPAP levels were measured and compared in patients with acute pancreatitis at admission,24,48,72 hafter admission,and healthy persons.The diagnostic efficiency of individually and jointly detected indicators were calculated and evaluated.Results The serum hs-CRP and FIB of SAP and MAP patients increased significantly with the prolongation of admission time,and were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The positive rate of CAPAP in urine of SAP and MAP patients at different time points was significantly higher than that of control group,and the difference was statistically significant(P<0.05).Urinary CAPAP has the highest diagnostic efficacy for acute severe pancreatitis,followed by serum hs-CRP and serum FIB.The positive rate of urinary CAPAP of SAP and MAP patients at different time points was significantly higher than that of the control group(P<0.05);the serum hs-CRP of SAP patients at different time points was significantly higher than that of the control group(P<0.05).FIB level and CPAPA positive rate in urine were significantly higher than those in patients with MAP(P<0.05).The diagnostic efficacy of urinary CAPAP for acute severe pancreatitis was the highest,followed by serum hs-CRP and serum FIB.The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of combined detection of three indicators for SAP were 90.3%,94.3%,92.6%,90.3%and 92.6%,respectively.The diagnostic efficiency of combined detection of three indicators was significantly higher than that of any single indicator,and the difference was statistically significant(P<0.05).Conclusion Serum hs-CRP,serum FIB and urinary CAPAP levels can be used as monitoring indicators for the diagnosis of SAP.The combined detection of the three indicators is more helpful for the early diagnosis of SAP than any single indicator detection,and has important clinical value for judging the severity of the disease,treatment and prognosis evaluation.
Objective To explore the clinical value of serum high sensitivity C-reactive protein(hs-CRP),fibrinogen(FIB)and urine carboxypeptidase B activating peptide(CAPAP)in the diagnosis of severe acute pancreatitis(SAP).Methods 67 patients with acute pancreatitis admitted to the hospital from March 2016 to December 2017 were selected as the study subjects,including 29 cases of SAP and 38 cases of acute mild pancreatitis(MAP).40 health examinees in the same period were selected as the control group.Serum hs-CRP,FIB and urinary CAPAP levels were measured and compared in patients with acute pancreatitis at admission,24,48,72 hafter admission,and healthy persons.The diagnostic efficiency of individually and jointly detected indicators were calculated and evaluated.Results The serum hs-CRP and FIB of SAP and MAP patients increased significantly with the prolongation of admission time,and were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The positive rate of CAPAP in urine of SAP and MAP patients at different time points was significantly higher than that of control group,and the difference was statistically significant(P<0.05).Urinary CAPAP has the highest diagnostic efficacy for acute severe pancreatitis,followed by serum hs-CRP and serum FIB.The positive rate of urinary CAPAP of SAP and MAP patients at different time points was significantly higher than that of the control group(P<0.05);the serum hs-CRP of SAP patients at different time points was significantly higher than that of the control group(P<0.05).FIB level and CPAPA positive rate in urine were significantly higher than those in patients with MAP(P<0.05).The diagnostic efficacy of urinary CAPAP for acute severe pancreatitis was the highest,followed by serum hs-CRP and serum FIB.The sensitivity,accuracy,specificity,positive predictive value and negative predictive value of combined detection of three indicators for SAP were 90.3%,94.3%,92.6%,90.3%and 92.6%,respectively.The diagnostic efficiency of combined detection of three indicators was significantly higher than that of any single indicator,and the difference was statistically significant(P<0.05).Conclusion Serum hs-CRP,serum FIB and urinary CAPAP levels can be used as monitoring indicators for the diagnosis of SAP.The combined detection of the three indicators is more helpful for the early diagnosis of SAP than any single indicator detection,and has important clinical value for judging the severity of the disease,treatment and prognosis evaluation.
引文
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[6]肖忠,庄炯宇,蔡家骥,等.血浆纤维蛋白原用于急腹症诊断临床现状及展望[J].中国实用外科杂志,2015,35(3):339-341.
[7]颜敏,瞿新.羧肽酶B活性肽和磷脂酶A2在急性胰腺炎临床诊断中的价值[J].胃肠病学和肝病学杂志,2017,26(7):744-747.
[8]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年)[J].胃肠病学,2013,18(7):428-433.
[9]林浩,朱方擎,王桂良,等.早期肠内营养对重症急性胰腺炎大鼠TNF-α,IL-6和IL-10表达水平的影响[J].中华消化内镜杂志,2014,31(2):105-107.
[10]刘京伟,陈玲玲,赵安成.血清SAA,CRP,PCT及TAP联合检测在急性重症胰腺炎早期诊治中的临床意义[J].国际检验医学杂志,2016,37(13):1811-1813.
[11]JIA R,TANG M,QIU L,et al.Increased interleukin-23/17axis and c-reactive protein are associated with severity of acute pancreatitis in patients[J].Pancreas,2015,44(2):321-325.
[12]刘盛兰,陆士奇.高脂血症性急性胰腺炎严重程度的早期评估[J].中国急救医学,2014,34(3):230-233.
[13]幸定培,龚建平,冯虎翼,等.枯否细胞通过组织因子对大鼠急性胰腺炎凝血系统变化的影响[J].重庆医科大学学报,2015,40(3):329-334.
[14]常艳敏,郑治钢,徐金颖,等.尿羧肽酶B激活肽在重症急性胰腺炎中的临床应用价值[J].天津医药,2009,37(8):683-684.
[15]刘斌,龙延滨,刘栋,等.尿羧肽酶B和尿胰蛋白酶原激活肽诊断急性重症胰腺炎的临床价值分析[J].现代检验医学杂志,2015,30(5):81-83.
[2]敖万萍,傅小云,付豹,等.黔北地区ICU重症急性胰腺炎流行病学特点及并发症对预后的影响[J].中国中西医结合急救杂志,2017,24(3):234-238.
[3]NIEMINEN A,MAKSIMOW M,MENTULA P,et al.Circulating cytokines in predicting development of severe acute pancreatitis[J].Crit Care,2014,18(3):R104.
[4]王春友,勾善淼.重症急性胰腺炎外科治疗理念与策略的历史变迁[J].中华外科杂志,2015,53(9):646-648.
[5]范永熙,单海滨,李兆然.急性胰腺炎患者血清PCT、IL-6和hs-CRP水平变化的临床意义[J].中国现代医学杂志,2014,24(10):46-49.
[6]肖忠,庄炯宇,蔡家骥,等.血浆纤维蛋白原用于急腹症诊断临床现状及展望[J].中国实用外科杂志,2015,35(3):339-341.
[7]颜敏,瞿新.羧肽酶B活性肽和磷脂酶A2在急性胰腺炎临床诊断中的价值[J].胃肠病学和肝病学杂志,2017,26(7):744-747.
[8]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年)[J].胃肠病学,2013,18(7):428-433.
[9]林浩,朱方擎,王桂良,等.早期肠内营养对重症急性胰腺炎大鼠TNF-α,IL-6和IL-10表达水平的影响[J].中华消化内镜杂志,2014,31(2):105-107.
[10]刘京伟,陈玲玲,赵安成.血清SAA,CRP,PCT及TAP联合检测在急性重症胰腺炎早期诊治中的临床意义[J].国际检验医学杂志,2016,37(13):1811-1813.
[11]JIA R,TANG M,QIU L,et al.Increased interleukin-23/17axis and c-reactive protein are associated with severity of acute pancreatitis in patients[J].Pancreas,2015,44(2):321-325.
[12]刘盛兰,陆士奇.高脂血症性急性胰腺炎严重程度的早期评估[J].中国急救医学,2014,34(3):230-233.
[13]幸定培,龚建平,冯虎翼,等.枯否细胞通过组织因子对大鼠急性胰腺炎凝血系统变化的影响[J].重庆医科大学学报,2015,40(3):329-334.
[14]常艳敏,郑治钢,徐金颖,等.尿羧肽酶B激活肽在重症急性胰腺炎中的临床应用价值[J].天津医药,2009,37(8):683-684.
[15]刘斌,龙延滨,刘栋,等.尿羧肽酶B和尿胰蛋白酶原激活肽诊断急性重症胰腺炎的临床价值分析[J].现代检验医学杂志,2015,30(5):81-83.