肝功能异常对急性胰腺炎病因和病情分级判定的临床意义

赵琦; 王兵; 李振方; 房春芳; 李聪; 李森林

doi:10.3969/j.issn.1001-5256.2018.01.031

肝功能异常对急性胰腺炎病因和病情分级判定的临床意义

DOI: 10.3969/j.issn.1001-5256.2018.01.031

1. 泰山医学院附属聊城市人民医院
2. 东昌府人民医院
3. 东昌府区妇幼保健院

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中图分类号: R576
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出版历程
- 出版日期: 2018-01-20

Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis

Liaocheng People′s Hospital Affiliated to Taishan Medical College, Liaocheng, Shandong 252000, China

摘要

摘要:
目的观察急性胰腺炎（AP）伴发肝损伤患者肝功能各项指标与病因及病情的关系,旨在探讨肝功能变化对明确AP病因及预测病情程度的临床意义。方法回顾性分析聊城市人民医院2011年1月-2016年3月住院的163例AP患者的临床资料,按病因分为胆源性（n=85）、非胆源性（n=78）2组;参照CT影像Balthazar分级标准将其分为轻型胰腺炎（MAP）和重型胰腺炎（SAP）,其中MAP患者138例,SAP患者25例。胆源性SAP 18例,胆源性MAP 67例;非胆源性SAP 7例,非胆源性MAP 71例。比较患者肝功能指标ALT、AST、GGT、ALP水平,并观察胆源性、非胆源性AP患者入院时、入院48 h、入院96 h肝功能变化情况。计量资料2组间比较采用t检验;3组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料组间比较采用χ2检验。结果对于MAP患者,胆源性与非胆源性组间ALT、AST、ALP、GGT水平差异均有统计学意义（P值均<0.05）;而SAP患者胆源性与非胆源性组间仅ALP和GGT水平差异有统计学意义（P值均<0.05）。胆源性A...
- 胰腺炎 /
- 肝功能试验 /
- 转氨酶类
Abstract:
Objective To investigate the association of liver function parameters with etiology and severity in patients with acute pancreatitis ( AP) complicated by liver injury, and to clarity the clinical significance of the change in liver function in determining the etiology and severity of AP. Methods A retrospective analysis was performed for the clinical data of 163 AP patients who were hospitalized in Liaocheng People's Hospital from January 2011 to March 2016, and according to the etiology, these patients were divided into biliary AP group with 85 patients and non-biliary AP group with 78 patients. According to the Balthazar CT grade, the patients were divided into mild acute pancreatitis ( MAP) group with 138 patients and severe acute pancreatitis ( SAP) group with 25 patients. Of all patients in the biliary AP group, 18 had biliary SAP and 67 had biliary MAP; of all patients in the non-biliary AP group, 7 had non-biliary SAP and 71 had non-biliary MAP. The groups were compared in terms of liver function parameters alanine aminotransferase ( ALP) , aspartate aminotransferase ( AST) , gamma-glutamyl transpeptidase ( GGT) , and alkaline phosphatase ( ALP) , and the change in liver function was observed on admission and at 48 and 96 hours after admission. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between three groups, and the SNK-q test was sued for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results In the patients with MAP, there were significant differences in the levels of ALT, AST, ALP, and GGT between the biliary AP group and the non-biliary AP group ( all P < 0. 05) ; in the patients with SAP, there were only significant differences in the levels of ALP and GGT between the biliary AP group and the non-biliary AP group ( both P<0. 05) . As for liver injury caused by biliary AP, there were significant reductions in the levels of ALT, AST, ALP, and GGT at 48-96 hours after admission ( all P < 0. 05) , while in the patients with non-biliary AP, there were no significant changes in these liver function parameters ( all P >0. 05) . Compared with the non-biliary AP group, the biliary AP group had a significantly higher incidence rate of an abnormal level of ALP, GGT, or ALP + GGT ( all P < 0. 05) . In the patients with AP caused by the same reason, there was no significant difference in liver function between SAP and MAP patients ( all P > 0. 05) . Conclusion Most patients with AP tend to have abnormal liver function, especially those with biliary AP. As for patients with MAP, abnormal liver function often indicates biliary AP; as for patients with SAP, ALT and AST have a low value in predicting etiology, while ALP and GGT are more sensitive, i. e., the increase in ALT and GGT indicates the possibility of biliary AP. When the change in liver function is monitored continuously, the patients with significant reductions in liver function parameters, especially the levels of ALT and AST, tend to have a higher possibility of biliary AP. The degree of liver injury, especially the activities of aminotransferases, is not associated with the severity of AP.
- pancreatitis /
- liver function tests /
- transaminases

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参考文献(17)

[1]ZHANG TP, YANG G, ZHAO YP.Advances in the diagnosis and treatment of severe acute pancreatitis[J/CD].Chin J Hepatic Surg:Electronic Edition, 2017, 6 (1) :1-5. (in Chinese) 张太平, 杨刚, 赵玉沛.重症急性胰腺炎诊治进展[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (1) :1-5.

[2]LEI ZQ, HU SM.Clinic study of acute pancreatitis compilcated by hepatic injury[J].J Pract Med Tech, 2008, 15 (26) :3650-3651. (in Chinese) 雷志群, 胡绍敏.急性胰腺炎并发肝损伤的临床研究[J].实用医技杂志, 2008, 15 (26) :3650-3651.

[3]PENG XR.CT manifestations of gastointestinal involvement and its anatomical basis in acute pancreatitis[J].Chin J CT and MRI, 2013, 11 (1) :68-71. (in Chinese) 彭晓容.急性胰腺炎累及胃肠道的CT表现及解剖学基础[J].中国CT和MRI杂志, 2013, 11 (1) :68-71.

[4]Group of Pancreas Surgery, Chinese Society of Surgery, Chinese Medical Association.Guidelines for the management of acute pancreatitis (2014) [J].J Clin Hepatol, 2015, 31 (1) :17-20. (in Chinese) 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南 (2014) [J].临床肝胆病杂志, 2015, 31 (1) :17-20.

[5]ZHANG JH.Clinical analysis of 52 caseas with acute pancreatitis complicated with hepatic injury[J].Clin Med China, 2003, 19 (8) :708-709. (in Chinese) 张金华.急性胰腺炎并肝损害52例临床分析[J].中国综合临床, 2003, 19 (8) :708-709.

[6]COHEN ME, SLEZAK L, WELLS CK, et al.Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends[J].Am J Gastroenterol, 2001, 96 (12) :3305-3311.

[7]WANG HL, WU CX.Relation between HMGB1 and hepatic injury in patient with severe acute pancreatitis[J].Int J Lab Med, 2011, 32 (2) :210-211. (in Chinese) 王洪亮, 吴传新.重症急性胰腺炎时HMGB1与肝损害的关系[J].国际检验医学杂志, 2011, 32 (2) :210-211.

[8]MENG XY.Practicaldiagnostics and therapeutics of digestive diseasis[M].2nd ed.Beijing:World Publishing Corporation, 2006:89-97. (in Chinese) 孟宪镛.实用消化病诊疗学[M].2版.北京:世界图书出版公司, 2006:89-97.

[9]LI ZF, ZHAO Q, LI SL, et al.Correlation between abnormal liver function and etiology and severity of acute pancreatitis[J].Shandong Med J, 2004, 44 (34) :28-29. (in Chinese) 李振方, 赵琦, 李森林, 等.肝功能异常与急性胰腺炎病因学和病情分级的相关性研究[J].山东医药, 2004, 44 (34) :28-29.

[10]LI F, LU LG.Evaluation of abnormal liver function and its clinical significance[J].J Clin Hepatol, 2015, 31 (9) :1543-1546. (in Chinese) 李飞, 陆伦根.肝功能异常的评估及临床意义[J].临床肝胆病杂志, 2015, 31 (9) :1543-1546.

[11]PRATT DS, KAPLAN MM.Evaluation of abnormal liver-enzyme results in asymptomatic patients[J].N Engl J Med, 2000, 342 (17) :1266-1271.

[12]WU ZY.Serum AFP, GGT, AFU, TSGF and DCP joint detection in the diagnosis of primary liver cancer[J].J World Latest Med Inf, 2016, 16 (13) :26-27, 31. (in Chinese) 吴志永.血清AFP、GGT、AFU、TSGF及DCP联合检测在原发性肝癌诊断中的应用[J].世界最新医学信息文摘, 2016, 16 (13) :26-27, 31.

[13]ZHOU HS.GGT detection in the diagnosisof primary liver cancer[J].Hebei Med, 2006, 12 (3) :269-271. (in Chinese) 周华胜.GGT的测定在肝癌诊断中的临床应用[J].河北医学, 2006, 12 (3) :269-271.

[14]WEI XF, HAN ZY.Assessment of serum alkaline phosphatase, gamma glutamyl transpeptidase and ALP/ULN divided by GGT/ULN in the differential diagnosis of the cholestatic liver disease[J/CD].Chin J Diagn:Electronic Edition, 2017, 5 (2) :115-119. (in Chinese) 魏小丰, 韩子岩.血清碱性磷酸酶与γ-谷氨酰转肽酶水平及其倍值比对胆汁淤积性肝病的鉴别价值[J/CD].中华诊断学电子杂志, 2017, 5 (2) :115-119.

[15]CHEN C, ZHANG WJ, LIU Y, et al.Acute pancreatitis accompanied with liver function damage:a clinical observation of 207 cases[J].Chin J Pancreatol, 2006, 6 (5) :259-261. (in Chinese) 陈畅, 张文俊, 刘岩, 等.270例急性胰腺炎合并肝功能损害的临床观察[J].胰腺病学, 2006, 6 (5) :259-261.

[16]SUN ZQ, MAO YL.Liver enzyme indicators and Clinical application progress[J].Chin J Lab Med, 2005, 28 (6) :659-663. (in Chinese) 孙志强, 毛远丽.肝病酶学指标及临床应用进展[J].中华检验医学杂志, 2005, 28 (6) :659-663.

[17]ZHANG Y, WANG DK.The pathogenesis and treatment progress in Gallstone pancreatitis[J].Surg Foreign Med Sci, 1992, 5:273-276. (in Chinese) 张跃, 王代科.胆石性胰腺炎的发病机制和诊治进展[J].国外医学:外科学分册, 1992, 5:273-276.

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