Diagnosing Chronic Pancreatitis.
Diagnosing Chronic Pancreatitis.
复制标题
DOI：
10.1007/s10620-017-4493-2
复制
发表时间：
2017-07
影响因子：
3.1
通讯作者：
Conwell DL
中科院分区：
文献类型：
--
作者：
Anaizi A;Hart PA;Conwell DL
诊断CP的范围可以从那些患有严重疾病和CT成像上明显钙化的常规患者到那些CP早期变化的患者。对于临床表现可疑且有风险因素的患者，应采用逐步无创至更具侵入性的逐步方法对疑似CP进行检查，这些风险因素会提高其疾病的预检测概率。在全面的病史和体格检查后，应获得基础实验室检查，如脂肪酶、淀粉酶、代谢组和间接PFT（粪便弹性蛋白酶-1、血清胰蛋白酶）。计算机断层扫描仍然是最好的初始成像方式，因为它对严重CP具有良好的敏感性，并且可能不需要其他诊断测试。当不确定时，应进行MRCP以更详细地评估胰腺实质和胰管。如果诊断仍有疑问，EUS应进行或不进行胰腺功能检查。ERCP仍然是最后的诊断测试，很少应用于治疗目的之外。未来的进展应该针对优化目前的诊断工具，以更准确地诊断早期CP，因为在这一人群中，延迟CP进展的益处可能具有最深远的影响。在这些患者中建立诊断的最佳方法可能是在EUS结果不确定的情况下通过胰腺功能检测。胰液的生物标志物研究可以补充诊断。
Diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes in CP. The workup of suspected CP should follow a progressively noninvasive to more invasive STEP-wise approach in a patient with a suspicious clinical presentation and risk factors that raise their pretest probability of disease. After a thorough history and physical examination, basic laboratories should be obtained such as lipase, amylase, metabolic panel, and indirect PFTs (fecal elastase-1, serum trypsin). Computed tomography remains the best initial imaging modality to obtain as it has good sensitivity for severe CP and may obviate the need for other diagnostic tests. When equivocal, an MRCP should be obtained for a more detailed evaluation of the both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, EUS should be performed with or without pancreas function testing. ERCP remains a last-line diagnostic test and seldom should be used outside of therapeutic purposes. Future advances should target optimizing current diagnostic tools to more accurately diagnose early CP, as it is in this population where the benefits of delaying progression of CP may have the most profound effect. Likely the best way at establishing a diagnosis in these patients is via pancreatic function testing in the setting of indeterminate EUS results. Biomarker studies of pancreas fluid may supplement diagnosis.