E-Cadherin、血液淀粉酶同工酶P3亚型及胰脂肪酶对急性胰腺炎病情变化的预测价值

袁伟红 毛伯能 刘芊 潘琦 宁月季 刘雷 张征

[關键词] 急性胰腺炎;E-Cadherin;血液淀粉酶同工酶P3亚型;胰脂肪酶;诊断价值

[中图分类号] R576          [文献标识码] B          [文章编号] 1673-9701（2021）29-0072-05

Predictive value of E-Cadherin，P3 subtype of blood amylase isoenzyme and pancreatic lipase for changes in the condition of acute pancreatitis

YUAN Weihong   MAO Boneng   LIU Qian   PAN Qi   NING Yueji   LIU Lei   ZHANG Zheng

Department of Gastroenterology，Yixing People's Hospital，Yixing   214200，China

[Abstract] Objective To investigate the predictive value of E-Cadherin，P3 subtype of blood amylase isoenzyme，and pancreatic lipase for changes in the condition of acute pancreatitis. Methods A total of 80 patients with acute pancreatitis who met the criteria and were admitted to our hospital from June 2018 to June 2019 were selected and divided into the mild group（MAP group，n=40） and the severe group（SAP group，n=40）according to the guidelines.The quantification of serum E-cadherin，AMY-P3， pancreatic lipase，Ranson score，and APACHE II score were compared between the two groups.The ROC curve method in SPSS was used to deduce the early diagnostic value of serum E-cadherin，AMY-P3，and pancreatic lipase for severe pancreatitis. Pearson correlation analysis was used to analyze the correlation between serum E-cadherin，AMY-P3，pancreatic lipase，and Ranson score，and APACHE II score. Results E-Cadherin，AMY-P3，and pancreatic lipase in the SAP group were significantly higher than those in the MAP group，and the differences were statistically significant（P<0.05）.The Ranson score and APACHE II score of patients in the SAP group were significantly higher than those in the MAP group，and the differences were statistically significant（P<0.05）.The sensitivity，specificity，and area under the ROC curve of combined detection of E-Cadherin，AMY-P3，and pancreatic lipase in serum for the diagnosis of SAP were 76.90%，80.50%，and 0.850，respectively（95% CI：0.768-0.932，P<0.001）.The diagnostic value of the combined detection was better than that of the single detection.E-Cadherin，AMY-P3，and pancreatic lipase in serum were positively correlated with Ranson score，and positively correlated with each other（P<0.05）. Conclusion The combined detection of E-Cadherin，AMY-P3，and pancreatic lipase has a good early predictive value for evaluating the severity of acute pancreatitis.It can be used as one of the important indicators for evaluating the early prognosis of severe pancreatitis.

[Key words] Acute pancreatitis;E-Cadherin;Blood amylase isoenzyme P3 subtype;Pancreatic lipase;Diagnostic value

急性胰腺炎（Acute Pancreatitis，AP）本质上是一种化学性炎症反应，发病是由于各种原因导致的胰腺中的胰腺酶被激活，引起胰腺组织被消化，最终出现水肿、出血甚至坏死等病理变化[1-2]。AP以发热、恶心、呕吐、急性上腹部疼痛及胰酶升高为特征，根据具体病理改变程度的不同，可分为轻症急性胰腺炎（Mild Acute Pancreatitis，MAP）和重症急性胰腺炎（Severe Acute Pancreatitis，SAP）。据报道，约有20%的AP患者会发展为SAP，SAP病情复杂且凶险，预后较差，因此，对SAP患者实现早期识别并采取针对性治疗措施对改善患者预后至关重要[3]。临床上常采用Ranson評分和APACHE II评分评价急性胰腺炎的严重程度，但内容过于复杂且主观程度高，因此寻找新型评定方法异常重要。E-Cadherin是一种跨膜糖蛋白，主要发挥保持上皮细胞间的紧密连接作用，陈海川[4]等发现E-Cadherin与急性胰腺炎加重具有一定的关联。血液淀粉酶同工酶可分为唾液型（S型）和胰型（P型），血液淀粉酶同工酶P3亚型（AMY-P3）是血清淀粉酶同工酶胰型中的一种类型，对急性胰腺炎的诊断具有一定的价值。陈虎[5]等通过探究血清淀粉酶同工酶在急性胰腺炎中的作用发现，血清淀粉酶同工酶对急性胰腺炎的诊断及预后的影响具有重要的意义。胰脂肪酶是急性胰腺炎临床上常用的诊断指标，但对急性胰腺炎的严重程度无明显影响。因此本实验通过测定不同分型急性胰腺炎患者血清中E-Cadherin、血液淀粉酶同工酶P3亚型以及胰脂肪酶的定量，探究E-Cadherin、血液淀粉酶同工酶P3亚型以及胰脂肪酶对急性胰腺炎病情变化的预测价值。……