Early Diagnosis Of Acute Pancreatitis Research Articles

A COMPARATIVE STUDY OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN EVALUATION OF ACUTE AND CHRONIC PANCREATITIS, ASSOCIATED COMPLICATIONS AND PREDICTING SEVERITY AND PROGNOSIS

Objectives: (1) The objective of the study was to determine the value of USG and computed tomography (CT) in early diagnosis of acute pancreatitis (AP). (2) The study aimed to compare which of the above two radiological investigations (USG/CT) provides the most important information of the disease process and to determine value of CT in evaluating complications, morbidity/severity, and predicting prognosis of AP using modified CT severity index (MCTSI). Methods: This study included 50 patients diagnosed with pancreatitis, consisting of 38 cases of AP and 12 cases of chronic pancreatitis (CP). Both USG and contrast-enhanced CT (CECT) were used to visualize the pancreas, assess its size, detect peripancreatic inflammation and fluid collections, and identify the extent of necrosis and complications. The sensitivity and specificity of USG and CECT were compared. The severity of AP was classified using the MCTSI within 3 days of symptom onset. Clinical outcomes, including hospital stay duration, organ failure, systemic infection, and the need for surgical intervention, were recorded and correlated with MCTSI scores. Statistical Package for the Social Sciences 22.0 was used for statistical analysis and p<0.05 was taken as statistically significant. Results: The mean age of patients was 37.92±12.14 years. USG had a sensitivity of 58% for detecting AP, significantly lower than the 95% sensitivity of CECT, primarily due to bowel gas interference. Both USG and CECT had high positive predictive values. The MCTSI effectively classified the severity of AP, with 41.5% of cases categorized as mild, 39% as moderate, and 19.5% as severe. Extrapancreatic complications were significantly correlated with adverse clinical outcomes and end-organ failure when included in the MCTSI scoring. USG was adequate for diagnosing CP through visualization of dilated ducts, calcifications, and atrophic pancreas, but CECT demonstrated higher specificity and accuracy, especially for rare forms like groove and mass-forming pancreatitis. The study showed a strong correlation between MCTSI scores and patient outcomes. The mortality rate was 2%, observed only in patients with severe AP. Conclusion: The MCTSI is a valuable tool for accurately classifying the severity of AP and predicting clinical outcomes. CECT is superior to USG in diagnosing and managing pancreatitis, providing better visualization and assessment of complications. While USG is useful for diagnosing CP, CECT offers greater specificity and accuracy. The study supports the use of MCTSI in routine clinical practice to guide the management and predict outcomes in patients with AP.

Impact of renal dysfunction on the diagnosis of acute pancreatitis using urinary trypsinogen-2: A retrospective study.

Early diagnosis of acute pancreatitis is crucial, and urinary trypsinogen has been recently reported as a useful biomarker for diagnosing acute pancreatitis. We aimed to evaluate the impact of renal dysfunction on the diagnostic performance of urinary trypsinogen-2 for acute pancreatitis. We conducted a retrospective study using the clinical data of patients who visited the Department of Emergency and Critical Care at the University of Tokyo Hospital between 1 October, 2021, and 30 June, 2022. Patients with available data on qualitative urinary trypsinogen-2 levels were identified. We compared the urinary trypsinogen-2 levels among patients who were clinically diagnosed with acute pancreatitis. We further stratified the patients according to renal function parameters, such as serum creatinine level, blood urea nitrogen level, and estimated glomerular filtration rate, and evaluated the performance of urinary trypsinogen-2 as a biomarker for acute pancreatitis. Within 9 months, 35 patients were identified. Of them, 22 patients showed positive results and 13 showed negative results on the urinary trypsinogen-2 test. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.40, 0.18, and 0.92, respectively. Based on the blood urea nitrogen level and estimated glomerular filtration rate, the prevalence of false-positive results was significantly higher in patients with reduced renal function than in those with normal renal function. In patients with reduced renal function, the urinary trypsinogen-2 qualitative test results might be interpreted with caution when used for diagnosing acute pancreatitis.

Complementary comments on diagnosis, severity and prognosis prediction of acute pancreatitis.

The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma, diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis. Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis, and dual energy computed tomography is also useful in severity assessment and prognosis prediction. Walled off necrosis is an important complication in terms of prognosis, and it is important to know its radiological findings and distinguish it from pseudocyst.

The laboratory parameters and scoring systems used to predict clinical outcomes in geriatric patients with acute pancreatitis.

Acute pancreatitis (AP) is the leading cause of hospital admissions among gastrointestinal system disorders, and it can resolve independently or lead to life-threatening multiple organ failure. Acute pancreatitis can have a more severe clinical presentation in geriatric patients as compared to younger patients. In this study, we aimed to elucidate the clinical and laboratory characteristics of patients aged 65 and older who presented to the emergency department with a diagnosis of AP and assessed their impact on hospital stay, in-hospital mortality, and cost. We reviewed the records of patients aged 65 and older who presented to the emergency department and had lipase levels measured as exceeding three times the upper limit of the reference range during the evaluation. We recorded these patients' vital signs, medical histories, laboratory values, and etiologies. Using these data, we calculated the patients' clinical scores. We recorded data on 218 patients who met the inclusion criteria. The median age of the patients was 76 (65-113). Of these, 70.6% were females, 54.6% had gallstones, 90.4% (n = 197) were admitted to the general ward from the emergency department, and 7.3% (n = 16) were admitted to the intensive care unit (ICU). In-hospital mortality was 5.63% (n = 12). The Ranson, Glasgow Severity Score (GSS), and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, as well as lactate, procalcitonin, and the lymphocyte-albumin ratio, were independent predictors of ICU admission and mortality. The early diagnosis of AP is essential. When a severe disease course is likely, initiating treatment promptly becomes crucial, especially in patients aged 65 and older. This approach can lead to significant reductions in both complication rates and treatment costs.

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.

Evaluating the efficacy of urinary trypsinogen-2 Dipstick test in diagnosing acute pancreatitis

Acute Pancreatitis (AP) is a very common cause of acute abdomen in emergency department. The disease may vary from mild self-limiting symptoms to multi organ failure and has high mortality rate. Although most of the cases are treated by mild symptomatic treatment but severe cases require intensive monitoring, so early diagnosis and goal directed treatment is very essential to reduce mortality and morbidity of disease. The present study aims to know the efficacy of urinary trypsinogen-2 dipstick test in early diagnosis of acute pancreatitis. The prospective study sample included 98 patients who were presented to emergency department of Maharaja Krishna Chandra Gajapati Medical College & Hospital (MKCGMCH), Berhampur between August 2018 and July 2020 with acute severe pain abdomen suggestive of acute pancreatitis. Urine sample were obtained and results were recorded. Blood sample of all the patients were sent for serum amylase, lipase. Urinary Trypsinogen (UT)-2 dipstick test, based on principle of immunochromatographic, was done at the time of admission and serum amylase and lipase were sent for all patients. Serum Lipase was done through Calorimetric Method and Serum Amylase was done through Coupled Enzymatic Assay Method. Ultrasonography (USG) and Contrast-Enhanced Computed tomography (CECT) abdomen were sent after 4-5 days of admission and final diagnosis was made on the basis of CECT report. Of 98 patients, 47 cases were final diagnosed to have acute pancreatitis. Sensitivity and specificity of Urinary Trypsinogen (UT)-2 was found to be 91.48% and 94.11% respectively and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was found to be 93.47% and 92.30% respectively. Sensitivity, specificity, PPV and NPV of Serum Amylase was found to be 76.5%, 74.5%, 74.5% and 74.5% respectively and similarly, sensitivity, specificity, PPV and NPV was found to be 80.85%, 72.5%, 73.1% and 80.4% respectively. Urinary Trypsinogen (UT)-2 Dipstick test has high sensitivity, specificity, PPV and NPV and therefore can be used reliably in emergency setting for diagnosis and thereby start a goal directed treatment and thus, reduce the mortality and morbidity of the disease.

Clinical Prediction Score for Early Diagnosis of Acute Pancreatitis in Emergency Departments.

BackgroundIn Thailand, most primary care hospitals cannot measure serum lipase and amylase; no 24 hours computed tomography and magnetic resonance imaging available, and no on-call gastroenterologists. Thus, acute pancreatitis cannot be diagnosed based on the established diagnostic criteria that require this information. The resultant delayed management increases morbidity and mortality. This study was performed to create a clinical prediction score for early diagnosis of acute pancreatitis in emergency departments without requiring a computed tomography scan or laboratory measurement to assist in the initial diagnosis, treatment, or referral.MethodsPatients with suspected acute pancreatitis who had available data regarding lipase and amylase measurements and visited the emergency department from June 2019 to August 2020 were retrospectively analyzed. The baseline predictive factors were compared between patients with and without acute pancreatitis according to the 2012 revised Atlanta classification. Multivariable logistic regression was used to explore potential predictive factors and develop a clinical prediction score for the diagnosis of acute pancreatitis.ResultsA total of 506 eligible patients, 84 (16%) had acute pancreatitis. The PRE-PAN score [area under the receiver operating characteristics curve, 0.88; 95% confidence interval (CI), 0.84–0.93] included six factors: alcohol drinking, epigastric pain, pain radiating to the back, persistent pain, nausea or vomiting, and the pain score. A score of >7.5 points suggested a high probability of acute pancreatitis [positive likelihood ratio, 6.80 (95% CI, 4.75–9.34; p < 0.001); sensitivity, 66.7% (95% CI, 54.6–77.3); specificity, 90.2% (95% CI, 86.6–93.1); positive predictive value, 58.5% (95% CI, 47.1–69.3);, 92.9% (95% CI, 89.6–95.4)].ConclusionA PRE-PAN risk score is a screening tool for predicting acute pancreatitis without using the lipase concentration or radiological findings. A high predictive score, especially >7.5, suggests a high probability of acute pancreatitis.

Acute Pancreatitis in Pregnancy: A Ten-Year Noninterventional, Retrospective Cohort Experience.

Background The study is aimed at evaluating the clinical attributes, types, and risk factors associated with poor outcomes in women with acute pancreatitis (AP) during pregnancy. Methods From 2011 to 2020, 45 antenatal mothers with AP were included in this noninterventional, retrospective study. The correlation between etiology of AP, its severity, biochemical parameters, length of stay, and treatment was analyzed. Based on the presence of organ failure and systemic complications, the severity of AP was classified according to the revised Atlantic criteria. Results In total, 19 (42.2%), 15 (33.3%), and 11 (24.2%) patients had mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), respectively. The major cause of AP in these patients was hypertriglyceridemia (26.6%), while only 2 (4.44%) suffered from biliary pancreatitis. The median length of stay at hospital was significantly longer in patients with SAP (P = 0.034), and these patients had significantly higher triglycerides and total cholesterol levels when compared to MAP and MSAP. It was observed that levels of liver function enzymes such as alanine aminotransferase serum levels and aspartate aminotransferase serum levels were significantly higher in patients who stayed in hospital for >13 days. The presence of hypertriglyceridemia significantly increased the duration of stay (>13 days, P = 0.04) and induced SAP (P = 0.001). Majority of patients with SAP received blood purification than those with MAP and MSAP (P < 0.001). Conclusion Hypertriglyceridemia was associated with AP during pregnancy in our study. Early diagnosis of AP and assessment of its severity are very important for the general management of this disease.

Application of nanotechnology in the diagnosis and treatment of acute pancreatitis.

Acute pancreatitis (AP) is a common digestive system disease. The severity of AP ranges from mild edema in the pancreas to severe systemic inflammatory responses leading to peripancreatic/pancreatic necrosis, multi-organ failure and death. Improving the sensitivity of AP diagnosis and developing alternatives to traditional methods to treat AP have gained the attention of researchers. With the continuous rise of nanotechnology, it is being widely used in daily life, biomedicine, chemical energy and many other fields. Studies have demonstrated the effectiveness of nanotechnology in the diagnosis and treatment of AP. Nanotechnology has the advantages of simplicity, rapidity and sensitivity in detecting biomarkers of AP, as well as enhancing imaging, which helps in the early diagnosis of AP. On the other hand, nanoparticles (NPs) have oxidative stress inhibiting and anti-inflammatory effects, and can also be loaded with drugs as well as being used in anti-infection therapy, providing a new approach for the treatment of AP. In this article, we elaborate and summarize on the potential of nanoparticles for diagnostic and therapeutic applications in AP from the current reported literature and experimental results to provide useful guidelines for further research on the application of nanotechnology.

RAPID URINE TRYPSINOGEN-2 DIPSTICK ASSAY TO DIAGNOSE ACUTE PANCREATITIS IN EMERGENCY SETUP

Background: Early diagnosis of acute pancreatitis remains a challenge in emergency set up. The early management results in better outcomes but none of the available investigations were rapid and accurate to guide the management in these patients. Hence in suspected cases of acute pancreatitis, the urinary trypsinogen 2 dipstick assay can be used to diagnose them at the earliest in the Emergency setup. The purpose of this study is to determine the accuracy of urine trypsinogen 2 assay in diagnosing acute pancreatitis. Methods: The patients presenting with symptoms consistent with acute pancreatitis to the emergency department, at a tertiary care hospital in Southern India between November 2018 to November 2019 were included in a prospective observational study after obtaining Institutional ethical committee clearance. In addition to the routine investigations done in cases of acute abdomen, patients underwent urine trypsinogen 2 dipstick test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated. Results were compared. Results: A total of 50 cases were included in the study. The urine trypsinogen 2 dipstick test was positive in 35 of 37 patients with acute pancreatitis (sensitivity, 94.59%) and in none of 13 patients with abdominal pain but without any evidence of acute pancreatitis (specificity, 100%). The diagnostic accuracy of the urine trypsinogen 2 dipstick test was 96% in this study higher than other conventional laboratory investigations. Conclusion: This study shows that the dipstick test has high diagnostic accuracy and can be considered for regular use for diagnosing pancreatitis along with the conventional methods.

Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Emergency Medicine

AbstractBackground: Acute pancreatitis is a grave condition that requires fast and accurate diagnosis to save lives and prevent complications. In this study, we evaluated the fast and bedside urinary trypsinogen-2dipstick test in the diagnosis of acute pancreatitis.Aim of Work: This study was designed to evaluate the predictive value of the rapid urinary trypsinogen-2 test strip in acute pancreatitis, in comparison with serum amylase and serum lipase in Emergency Department at Tanta University Hospital.Subjects and Methods: Thirty-five (35) patients with acute pancreatitis (Group I) and thirty-four (34) patients with other causes of acute abdomen (Group II) were included in the study.Full history taking, clinical examination, and laboratory investigations including urine analysis and serum levels of creatinine, random glucose, lipid profile, total and direct bilirubin, albumin, liver enzymes, total calcium, amylase, and lipase were undertaken.In addition, radiological examinations, using abdomi-nopelvic ultrasonography, computed tomography of the abdo-men and conventional X-ray when appropriate were under-taken.Urinary trypsinogen-2 was tested using dipstick.Results: We found that the most common cause of acute pancreatitis was gall stone obstructive pancreatitis (76.47%), serum amylase and lipase were elevated in (91.18% and 88.24% respectively) in acute pancreatitis.While urinary trypsinogen-2 dipstick test was positive in 100% of patients with acute pancreatitis.The specificity of serum amylase, serum lipase and urinary trypsinogen-2 in diagnosis of acute pancreatitis was (76.47%, 88.24% and 100% respectively).Conclusion: Urinary trypsinogen-2 dipstick test is a promising fast and easy test performed in the effort of diagnosis of acute pancreatitis. Further studies on large number of patients are mandatory to confirm the findings in this study.

A Clinical Model for the Early Diagnosis of Acute Pancreatitis in the Emergency Department.

This study aimed to develop a diagnostic model that predicts acute pancreatitis (AP) risk before imaging. Emergency department patients with serum lipase elevated to 3 times the upper limit of normal or greater were identified retrospectively (September 1, 2013-August 31, 2015). An AP diagnosis was established by expert review of full hospitalization records. Candidate predictors included demographic and clinical characteristics at presentation. Using a derivation set, a multivariable logistic regression model and corresponding point-based scoring system was developed to predict AP. Discrimination accuracy and calibration were assessed in a separate validation set. In 319 eligible patients, 182 (57%) had AP. The final model (area under curve, 0.92) included 8 predictors: number of prior AP episodes; history of cholelithiasis; no abdominal surgery (prior 2 months); time elapsed from symptom onset; pain localized to epigastrium, of progressively worsening severity, and severity level at presentation; and extent of lipase elevation. At a diagnostic risk threshold of 8 points or higher (≥99%), the model identified AP with a sensitivity of 45%, and a specificity and a positive predictive value of 100%. In emergency department patients with lipase elevated to 3 times the upper limit of normal or greater, this model helps identify AP risk before imaging. Prospective validation studies are needed to confirm diagnostic accuracy.

Acute pancreatitis, its diagnosis with special reference to contrast enhanced CT scan (CECT) and serum enzyme studies: a comparative study in tertiary referral hospital of Odisha, India

Background: Acute pancreatitis is sudden swelling and inflammation of the pancreas. It can be diagnosed on the basis of clinical and laboratory data. At times, it may be difficult to differentiate it from other acute abdominal conditions. In these patients, serum enzymes (amylase and lipase) study, imaging by ultrasonography (USG) and/or computed tomography (CT) is of immense value in arriving at a diagnosis. In this study, we have compared the role of serum enzymes (amylase and lipase) levels, with the imaging studies (US/CECT scan) in relation to early diagnosis of acute pancreatitis and to find out the most specific and sensitive diagnostic modality.Methods: 300 patients (220 males, 80 females) in age group of 21 to 62 years with a clinical diagnosis of acute pancreatitis, which were admitted to surgical ward of S.C.B. Medical College Hospital, Cuttack during a period from November 2013 to October 2015, were included in the study. All selected cases (clinically diagnosed as acute pancreatitis) were serially subjected to tests of serum amylase and lipase estimation, USG and CECT scan of abdomen.Results: In our study the most common cause found was gall stone disease followed by chronic alcoholism. Serum amylase test showed diagnostic accuracy of 46.66% whereas serum lipase it was 70 %. Further USG of abdomen diagnostic accuracy was 83.33%, finally CECT scan had a diagnostic accuracy of 93.33%.Conclusions: Comparing all the diagnostic modalities described above it was found that contrast enhanced CT scan has highest accuracy rate (i.e. about 93% in our study) in detecting acute pancreatitis. This study proved that CECT scan was very important in the following up of the patients in order to detecting regression of disease appearance and complication in relation to acute pancreatitis.

Діагностична і прогностична цінність прокальцитоніну і окремих загальноклінічних обстежень у ранній діагностиці інфікованого гострого некротичного панкреатиту

&lt;span lang="UK"&gt;У статті відображені результати визначення прокальцитоніну у хворих на гострий панкреатит&lt;/span&gt;&lt;span lang="UK"&gt;(ГП) з метою ранньої діагностики і прогнозування інфікованого гострого некротичного панкреатиту (ГНП). Одержані результати порівнювались з іншими лабораторними показниками, даними УЗД та комп’ютерної томографії&lt;/span&gt;&lt;span lang="UK"&gt;(КТ) черевної порожнини при тяжкому та нетяжкому панкреатиті. Лабораторні методи обстеження проводились на 1-шу,2-гу,3-тю,7-му доби захворювання, а інструментальні при госпіталізації і в динаміці залежно від ситуації. Проведено кореляційний аналіз між клінічними і лабораторними показниками. Діагностична цінність УЗД у діагностиці гострого панкреатиту (ГП) була на рівні 75,67 %, що зумовлено малоінформативністю методу при метеоризмі. Візуалізація змін ПЗ при КТ, що діагностично була достовірна, становила 86,66 %. Тому визначення прокальцитоніну в поєднанні з іншими лабораторними показниками є діагностично цінним у ранній діагностиці ГП та інфікованого ГНП зокрема.&lt;/span&gt;

Value of serum amylase and lipase in early diagnosis of acute pancreatitis: A Meta-analysis

Value of serum amylase and lipase in early diagnosis of acute pancreatitis: A Meta-analysis

Urinary trypsinogen-2 for diagnosing acute pancreatitis: a meta-analysis

Currently, serum amylase and lipase are the most popular laboratory markers for early diagnosis of acute pancreatitis with reasonable sensitivity and specificity. Urinary trypsinogen-2 (UT-2) has been increasingly used but its clinical value for the diagnosis of acute pancreatitis and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has not yet been systematically assessed. A comprehensive search was carried out using PubMed (MEDLINE), Embase, and Web of Science for clinical trials, which studied the usefulness of UT-2 as a diagnostic marker for acute pancreatitis. Sensitivity, specificity and the diagnostic odds ratios (DORs) with 95% confidence interval (CI) were calculated for each study and were compared with serum amylase and lipase. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated. A total of 18 studies were included. The pooled sensitivity and specificity of UT-2 for the diagnosis of acute pancreatitis were 80% and 92%, respectively (AUC=0.96, DOR=65.63, 95% CI: 31.65-139.09). The diagnostic value of UT-2 was comparable to serum amylase but was weaker than serum lipase. The pooled sensitivity and specificity for the diagnosis of post-ERCP pancreatitis were 86% and 94%, respectively (AUC=0.92, DOR=77.68, 95% CI: 24.99-241.48). UT-2 as a rapid test could be potentially used for the diagnosis of post-ERCP pancreatitis and to an extent, acute pancreatitis. Further studies are warranted to confirm these results.

Rapid urinary trypsinogen-2 test in the early diagnosis of acute pancreatitis: A meta-analysis

Urinary trypsinogen-2 has been implicated as a promising biomarker for the early diagnosis of acute pancreatitis (AP). The meta-analysis was used to establish the overall accuracy of urinary trypsinogen-2 test for diagnosing AP. Based on comprehensive searches of the PubMed and Embase databases, we identified and abstracted outcome data from all articles evaluating the diagnostic value of urinary trypsinogen-2. A summary estimate for sensitivity, specificity, 95% confidence region and 95% prediction region was calculated using the bivariate random-effects approach. The meta-analysis included 13 studies (2342 patients, the proportion of severe AP from 13.21% to 30.00%). Overall, the pooled sensitivity was 82.3% (95%CI 79.3%-85.1%) and specificity was 93.5% (95%CI 92.2%-94.6%). The diagnostic odds ratios (DOR) was 85.23 (95%CI 40.14-180.99). The area under the summary ROC curve (AUC) was 0.9673. The urinary trypsinogen-2 test is a reliable and rapid method for the early diagnosis of AP.

Comparison of Urine Trypsinogen-2, Serum lipase and Serum Amylase in Application of Early Diagnosis of Acute Pancreatitis

目的 本实验旨在探讨尿胰蛋白酶原-2、血淀粉酶、血脂肪酶检测对急性胰腺炎的早期诊断意义.方法对70例急性胰腺炎患者、70例非急性胰腺炎患者,70例正常健康体检者测定尿胰蛋白酶原-2,血淀粉酶及血脂肪酶,比较其对诊断胰腺炎的敏感性及特异性.结果尿胰蛋白酶-2诊断急性胰腺炎的敏感性为96.0%;特异性为94.3%,血脂肪酶分别为78.0%、76.0%;血淀粉酶分别为80.0%、80.0%.结论胰蛋白酶原-2较之常规的血淀粉酶、血脂肪酶检测,在急性胰腺炎早期诊断中具有更高的价值。

Rapid Urinary Trypsinogen-2 Test Strip in the Diagnosis of Acute Pancreatitis

Early diagnosis of acute pancreatitis remains a challenge. A rapid dipstick screening test for acute pancreatitis has been developed. This prospective study was designed to evaluate the diagnostic value and time course of the rapid urinary trypsinogen-2 test strip in acute pancreatitis, with comparisons with serum amylase and serum lipase. A total of 165 patients with acute abdominal pain (67 with acute pancreatitis and 98 with other acute abdominal diseases) attending our emergency unit were included. All patients were tested with the urinary trypsinogen-2 test strip, and serum amylase and serum lipase concentrations were determined simultaneously. To measure the time course of the urinary trypsinogen-2 test, 32 patients with acute pancreatitis were tested with a urinary trypsinogen-2 test strip on days 1, 2, 3, and 4 after admission. Using a cutoff level of 50 microg/L for urinary trypsinogen-2, the sensitivity, specificity, and accuracy of the urinary trypsinogen-2 test strip for recognition of acute pancreatitis were 89.6%, 85.7%, and 87.3%, respectively. The diagnostic accuracy rates of serum amylase and serum lipase were 88.5% and 93.3%, using cutoff values of 3 times the upper normal limits for serum amylase and serum lipase, respectively. All but one of the 17 patients with severe acute pancreatitis was detected by the test strip (sensitivity, 94.1%). The time-course study of the urinary trypsinogen-2 test strip revealed that the sensitivity on days 1, 2, 3, and 4 was 90.6%, 81.2%, 59.4%, and 50%, respectively. There was no significant difference in the sensitivity between urinary trypsinogen-2 and serum lipase; however, the sensitivity values of serum lipase were significantly higher than those of serum amylase from days 1 to 4. The rapid urinary trypsinogen-2 test is a reliable and simple method for the early diagnosis of acute pancreatitis. A positive test identifies patients in need of further diagnostic measures. The urinary trypsinogen-2 test can be performed in health care units where laboratory testing facilities are not immediately available.

Detection of urine trypsinogen-2、serum lipase、serum amylase in application of early diagnosis of acute pancreatitis

目的 本实验旨在探讨尿胰蛋白酶原-2、血淀粉酶、血脂肪酶联合检测对急性胰腺炎的早期诊断意义.方法对60例急性胰腺炎患者、50例非急性胰腺炎患者,5 0例正常健康体检者测定尿胰蛋白酶原-2,血淀粉酶及血脂肪酶,比较其对诊断胰腺炎的敏感性及特异性.结果尿胰蛋白酶-2诊断急性胰腺炎的敏感性为95.0%;特异性为96.0%,血脂肪酶分别为80.0%、78.0%;血淀粉酶分别为78.3%、76.0%.结论胰蛋白酶原-2较之常规的血淀粉酶、血脂肪酶检测,在急性胰腺炎早期诊断中具有更高的价值。