Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study
Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study
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DOI：
10.1016/s0140-6736(00)02327-8
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发表时间：
2000-06-03
期刊：
影响因子：
168.9
通讯作者：
Puolakkainen, PA
中科院分区：
文献类型：
--
作者：
Neoptolemos, JP;Kemppainen, EA;Puolakkainen, PA
背景：临床上迫切需要对急性胰腺炎的严重程度进行早期简单的检测。我们研究了胰蛋白酶原激活肽（TAP）测定的使用。方法我们对246例患者（172例急性胰腺炎[35例重症]，74例对照）进行了多中心研究。我们评估了经验证的竞争性免疫测定法测定的尿TAP浓度的预测价值。我们将结果与血浆C反应蛋白和三种临床生物化学评分系统进行比较。TAP和C反应蛋白浓度在症状发作后的设定时间进行分析，并与住院期间关键时间的临床生物化学系统评分进行比较。结果在症状发作后24 h，尿TAP浓度中位数为37 nmol/L（IQR 17-110）和15 nmoI/L（5-35）对于轻度疾病（p35 nmol/L）分别为58%、73%、39%和86%，对于C-反应蛋白（>150 mg/L）分别为0%、90%、0%和75%。入院后48 h，临床生物化学评分系统的数值为：APACHE II（大于或等于8），56%、64%、30%和85%;兰森评分（大于或等于3），89%、64%、38%和96%;以及格拉斯哥评分（大于或等于3），77%、75%、44%和93%。在48 h时，C-反应蛋白的值分别为86%、61%、37%和94%，TAP的值分别为83%、72%、44%和94%。C-反应蛋白和TAP联合检测的准确性并不上级单独的TAP。急性胰腺炎严重程度的单一标志物值得常规临床应用。
Background There is a pressing clinical requirement for an early simple test of severity in acute pancreatitis. We investigated the use of an assay of trypsinogen activation peptide (TAP).Methods We undertook a multicentre study in 246 patients (172 with acute pancreatitis [35 with severe disease], 74 controls). We assessed the predictive value of urinary TAP concentrations measured by a validated competitive immunoassay. We compared the results with those for plasma C-reactive protein and three clinicobiochemical scoring systems. TAP and C-reactive protein concentrations were analysed at set times after symptom onset and compared with the clinicobiochemical systems scores at key times during hospital stay.Findings At 24 h after symptom onset, the median urinary TAP concentration was 37 nmol/L (IQR 17-110) for severe and 15 nmoI/L (5-35) for mild disease (p35 nmol/L), 58%, 73%, 39%, and 86%, respectively, and for C-reactive protein (>150 mg/L), 0%, 90%, 0%, and 75%. 48 h after admission the values for the clinicobiochemical scoring systems were: APACHE II (greater than or equal to 8), 56%, 64%, 30%, and 85%; Ranson score (greater than or equal to 3), 89%, 64%, 38%, and 96%; and Glasgow score (greater than or equal to 3), 77%, 75%, 44%, and 93%. At 48 h, the Values for C-reactive protein were 86%, 61%, 37%, and 94% and for TAP were 83%, 72%, 44%, and 94%. Combined testing of C-reactive protein and TAP was not superior to TAP alone for accuracy.Interpretation Urinary TAP provided accurate severity prediction 24 h after onset of symptoms. This single marker of severity in acute pancreatitis deserves routine clinical application.