Evaluating exocrine function tests for diagnosing chronic pancreatitis
Evaluating exocrine function tests for diagnosing chronic pancreatitis
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DOI：
10.1097/00006676-199711000-00011
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发表时间：
1997-11-01
期刊：
影响因子：
2.9
通讯作者：
Hayakawa, T
中科院分区：
文献类型：
--
作者：
Kitagawa, M;Naruse, S;Hayakawa, T
为了评估外分泌功能测试在诊断慢性胰腺炎（CP）中的有效性，我们比较了十二指肠插管与无管测试的敏感性和特异性。虽然促胰液素试验 (ST) 对于诊断 CP 是必要的，尤其是在非钙化 CP 中，而无管试验显示诊断 CP 的敏感性不足，但无管试验的组合检测具有足够的特异性，足以诊断严重的外分泌功能障碍。我们的研究发现促胰液素检测诊断明确 CP 的敏感性为 87%。在可能患有 CP 的患者中，60% 具有轻度外分泌功能不全，40% 具有正常功能。除糖尿病外的非胰腺疾病ST结果假阳性率为5%。内镜逆行胰管造影（ERP）的形态变化与ST评估的外分泌功能之间的相关性为74%。在钙化 CP 患者中，81% 的 ERP 和 ST 具有平行结果，但在非钙化 CP 患者中，47% 具有平行结果。在 ST 证实的重度或中度外分泌功能不全的患者中，N-苯甲酰基-L-酪氨酰基-对氨基苯甲酸 (BT-PABA) 试验观察到异常低水平，粪便胰凝乳蛋白酶试验 (FCT) 试验观察到 63%，粪便胰淀粉酶 (PA) 试验观察到 61%，胰淀粉酶 (PA) 试验观察到 44%。在 ST 证明外分泌功能正常的患者中，BT-PABA 测试发现 28% 的患者出现异常低水平，FCT 测试发现 28%，PA 测试发现 10%。 BT-PABA 测试、FCT 和 PA 的联合检测提高了诊断 CP 的特异性，但没有提高敏感性。
To evaluate the effectiveness of exocrine function tests in diagnosing chronic pancreatitis (CP), we compared the sensitivity and specificity of duodenal intubation with tubeless tests. While the secretin test (ST) was necessary to diagnose CP, especially in noncalcified CP, and tubeless tests demonstrated insufficient sensitivity to diagnose CP, the combination assay of tubeless tests was specific enough to diagnose severe exocrine dysfunction. Our studies found the sensitivity of secretin testing to diagnose definite CP to be 87%. In patients with probable CP, 60% had mild exocrine insufficiency and 40% had normal function. The false-positive rate of the ST results in nonpancreatic diseases, except diabetes mellitus, was 5%. The correlation between morphological changes in endoscopic retrograde pancreatography (ERP) and exocrine function evaluated by ST was 74%. In patients with calcified CP, 81% had parallel results between ERP and the ST, but in noncalcified CP, 47% had parallel results. In patients with severe or moderate exocrine insufficiency demonstrated by ST, abnormally low levels were observed in 63% by N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test, 61% by fecal chymotrypsin test (FCT), and 44% by pancreatic amylase (PA). In patients with normal exocrine function demonstrated by ST, abnormally low levels were observed in 28% by BT-PABA test, 28% by FCT, and 10% by PA. A combination assay of BT-PABA test, FCT, and PA improved the specificity for diagnosing CP but not the sensitivity.