Evaluation of Duct-Cell and Acinar-Cell Function and Endosonographic Abnormalities in Patients With Suspected Chronic Pancreatitis
Evaluation of Duct-Cell and Acinar-Cell Function and Endosonographic Abnormalities in Patients With Suspected Chronic Pancreatitis
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DOI：
10.1016/j.cgh.2008.09.002
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发表时间：
2009-01-01
影响因子：
12.6
通讯作者：
Conwell, Darwin L.
中科院分区：
文献类型：
--
作者：
Stevens, Tyler;Dumot, John A.;Conwell, Darwin L.
背景与目的：内镜超声（EUS）可检测与纤维化相关的胰腺轻度和重度结构异常。直接胰腺功能试验（PFT）可检测与早期纤维化相关的轻度外分泌功能不全。本研究的主要目的是比较EUS结构标准与导管细胞和腺泡细胞功能。方法：50例评估为慢性胰腺炎的患者在第1天接受EUS和分泌素内镜PFT（ePFT）联合检查，第2天接受CCK ePFT检查。对EUS图像进行录像，并由3名设盲专家评审员一致解读。结果如下：EUS一致性评分与导管细胞碳酸氢盐分泌（R =-0.71，P < .001）和腺泡细胞脂肪酶分泌（R =-0.52，P < .001）呈负相关。以分泌素ePFT为参考标准，EUS（≥ 4个标准）显示敏感性为71%（95%置信区间[CI]，53%-89%），特异性为92%（95% CI，75%-99%）。以CCK ePFT为参考标准，EUS的敏感性为63%（95% CI，43%~ 82%），特异性为85%（95% CI，71%~ 98%）。主导管扩张、不规则、钙化和可见侧支是外分泌功能不全的最佳预测因素（腺泡和导管细胞功能不全的阳性预测值>80%）。结论：随着EUS结构异常的增加，腺泡和导管细胞功能下降。与胰泌素和CCK功能参考标准相比，EUS具有相当的敏感性和非常好的特异性。
Background & Aims: Endoscopic ultrasound (EUS) detects mild and severe structural abnormalities of the pancreas that correlate with fibrosis. Direct pancreatic function tests (PFTs) detect mild exocrine insufficiency associated with early fibrosis. The primary aim of this study was to compare EUS structural criteria with duct-cell and acinar-cell function. Methods: Fifty patients evaluated for chronic pancreatitis underwent combined EUS and secretin endoscopic PFTs (ePFT) on day 1 and CCK ePFT on day 2. EUS images were videotaped and interpreted by consensus of 3 blinded expert reviewers. Results: There were inverse correlations of EUS consensus score with both duct-cell bicarbonate secretion (R = -0.71, P < .001) and acinar-cell lipase secretion (R = -0.52, P < .001). With secretin ePFT as reference standard, EUS (>= 4 criteria) showed a sensitivity of 71% (95% confidence interval [CI], 53%-89%) and specificity of 92% (9S% CI, 75%-99%). With CCK ePFT as reference standard, EUS had a sensitivity of 63% (95% CI, 43%-82%) and specificity of 85% (95% CI, 71%-98%). Main duct dilation, irregularity, calcifications, and visible sidebranches were most predictive of exocrine insufficiency (positive predictive value >80% for both acinar- and duct-cell insufficiency). Conclusion : Acinar- and duct-cell function decreases as EUS structural abnormalities increase. EUS has fair sensitivity and very good specificity compared with secretin and CCK functional reference standards.