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目的探讨空腹C肽、血尿淀粉酶检测在脓毒症患者是否继发胰腺功能损伤中的运用及其诊断价值。方法选取2013年6月至2014年12月60例脓毒症继发胰腺功能损伤患者为观察组,同期无胰腺功能损伤的54例脓毒症患者为对照组。比较两组患者血浆胰高血糖素、血清淀粉酶、脂肪酶、血浆空腹C肽及血尿淀粉酶水平。结果观察组胰高血糖素、淀粉酶、脂肪酶水平显著高于对照组,差异均有统计学意义(P<0.05,P<0.01),但仅从数值上很难判断存在胰腺功能损伤。两组入院后第2天空腹C肽达到高峰,以后逐渐降低,第4、6天观察组C肽水平显著低于对照组,差异均有统计学意义(P均<0.05);观察组血、尿淀粉酶检测阳性率分别为61.67%、58.33%,对照组仅分别为3.70%、1.85%,两组比较差异均有统计学意义(P均<0.01)。结论空腹C肽、血尿淀粉酶可作为脓毒症继发胰腺功能损伤诊断指标。血尿淀粉酶敏感度不高,但具有一定的特异性。
Objective To investigate the use of fasting C-peptide and hematuria amylase in the diagnosis of pancreatic injury following sepsis and its diagnostic value. Methods From June 2013 to December 2014, 60 patients with sepsis secondary pancreatic injury were selected as observation group and 54 sepsis patients without pancreatic injury during the same period as control group. Plasma glucagon, serum amylase, lipase, plasma fasting C-peptide and hematuria amylase were compared between the two groups. Results The levels of glucagon, amylase and lipase in the observation group were significantly higher than those in the control group (P <0.05, P <0.01). However, it was difficult to judge the existence of pancreatic function impairment only from the numerical value. The fasting C-peptide peaked on the second day after admission in the two groups and then gradually decreased. The C-peptide levels in the observation group on the 4th and 6th day were significantly lower than those in the control group (all P <0.05) The positive rates of urinary amylase were 61.67% and 58.33% respectively, while those in the control group were only 3.70% and 1.85%, respectively. There were significant differences between the two groups (all P <0.01). Conclusion The fasting C-peptide and hematuria amylase can be used as diagnostic indicators of pancreatic injury following sepsis. Hematuria amylase sensitivity is not high, but has a certain specificity.