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（P0.05）.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（P0.05）.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（P0.05）.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.
作者
黄勤烽
陈敏
HUANG Qinfeng;CHEN Min(Department of Clinical Laboratory,Fuzhou General Hospital of Nanjing Military Region,Fuzhou,Fujian 350025,China)
出处
《国际检验医学杂志》
CAS
2018年第23期2930-2933,共4页
International Journal of Laboratory Medicine
关键词
急性病
危重病
胰腺炎
C反应蛋白质
纤维蛋白原
羧肽酶B
acute disease
critical illness
pancreatitis
C reactive protein
fibrinogen
urine
carboxypeptidase B
作者简介
黄勤烽，男，主管技师，主要从事临床生化检验方向的研究。;通信作者，E-mail：misszhic520@163．com。
