Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis.
Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis.
复制标题
DOI：
10.1038/ajg.2013.148
复制
发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Sheth S
中科院分区：
文献类型：
--
作者：
Ketwaroo G;Brown A;Young B;Kheraj R;Sawhney M;Mortele KJ;Najarian R;Tewani S;Dasilva D;Freedman S;Sheth S
有特征性症状但胰腺影像学正常的慢性胰腺炎患者的诊断是具有挑战性的。在这种情况下，通过分泌素胰腺功能试验（SPFT）评估胰腺功能一直被提倡，但其诊断准确性尚不完全清楚。本研究回顾性分析了1995年1月至2008年12月在我们三级医疗机构因疑似慢性胰腺炎而接受SPFT治疗的患者。所有患者的医疗记录均通过影像学和/或病理学检查，以寻找随后发展为慢性胰腺炎的证据。然后根据随访影像或组织学证据将慢性胰腺炎患者分类为“真阳性”或“真阴性”。总共有116例患者接受了SPFT。在27名检测呈阳性的患者中，有7人未能随访。在剩余的20例spft阳性患者中，9例（45%）在平均4年（1-11年）后出现慢性胰腺炎的放射学或组织学证据。在89例SPFT检测阴性的患者中，有19例未能随访。其余70例患者中，2例在中位随访7年（3-11年）后，根据随后的影像学/组织学诊断为慢性胰腺炎。SPFT诊断慢性胰腺炎的敏感性为82%，特异性为86%。慢性胰腺炎的阳性预测值为45%，阴性预测值为97%。在疑似早期慢性胰腺炎且胰腺影像学正常的患者中，SPFT在排除早期慢性胰腺炎方面非常准确，NPV为97%。
The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through secretin pancreatic function testing (SPFT) has been advocated in this setting, but its diagnostic accuracy is not fully known. This was a retrospective review of patients who received SPFT at our tertiary care institution between January 1995 and December 2008 for suspected chronic pancreatitis. For all patients, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology. Patients were then categorized as “true positive” or “true negative” for chronic pancreatitis based on follow-up imaging or histologic evidence. In all, 116 patients underwent SPFT. Of the 27 patients who tested positive, 7 were lost to follow-up. Of the remaining 20 SPFT-positive patients, 9 (45 %) developed radiologic or histologic evidence of chronic pancreatitis after a median of 4 years (1–11 years). Of the 89 patients who had negative SPFT testing, 19 were lost to follow-up. Of the remaining 70 patients, 2 were eventually diagnosed with chronic pancreatitis based on subsequent imaging/histology after a median follow-up period of 7 years (3–11 years). The sensitivity of the SPFT in diagnosing chronic pancreatitis was 82 % with a specificity of 86 %. The positive predictive value (PPV) of chronic pancreatitis was 45 % with a negative predictive value (NPV) of 97 %. In patients with suspected early chronic pancreatitis and normal pancreatic imaging, SPFT is highly accurate at ruling out early chronic pancreatitis with a NPV of 97 %.