Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis.
Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis.
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发表时间：
1994-10
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通讯作者：
Tenner Sm;H. Dubner;W. Steinberg
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作者：
Tenner Sm;H. Dubner;W. Steinberg
目的 为了确定生化实验室值在区分胆结石和非胆结石急性胰腺炎方面的有用性，我们进行了一项荟萃分析。方法 纳入利用胆红素、碱性磷酸酶、丙氨酸转氨酶 (ALT) 和天冬氨酸转氨酶评估胆源性胰腺炎的研究。结果 使用这四个参数中每一个参数的受试者工作特征曲线，我们确定 ALT 水平是临床上最有用的参数。血清ALT水平越高，其诊断胆源性胰腺炎的特异性和阳性预测价值就越大。当 ALT 水平大于或等于 150 IU/L（大约升高 3 倍）时，胆源性胰腺炎的可能性为 95%。我们对总胆红素和碱性磷酸酶血清水平的分析表明，这些测试对于诊断胆石性胰腺炎没有用处。天冬氨酸转氨酶水平几乎与 ALT 一样有用。结论 急性胰腺炎时 ALT 升高≥3 倍对于诊断急性胆石性胰腺炎具有 95% 的阳性预测值。
OBJECTIVES In order to define the usefulness of biochemical laboratory values in distinguishing gallstone from non-gallstone acute pancreatitis, we performed a meta-analysis. METHODS Studies that utilized the bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate transaminase in the evaluation of the gallstone pancreatitis were included. RESULTS Using receiver operating characteristic curves for each of these four parameters, we determined that the ALT level was the most clinically useful parameter. The higher the serum level of ALT, the greater its specificity and positive predictive value in diagnosing gallstone pancreatitis. At ALT levels greater than or equal to 150 IU/L (approximately a 3-fold elevation), the probability of gallstone pancreatitis is 95%. Our analyses of total bilirubin and alkaline phosphatase serum levels indicate that these tests are not useful in the diagnosis of gallstone pancreatitis. Aspartate transaminase levels are nearly as useful as ALT. CONCLUSIONS A > or = 3-fold elevation of ALT in the presence of acute pancreatitis has a positive predictive value of 95% in diagnosing acute gallstone pancreatitis.