AIM:To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS:Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS:Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs >or= 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION:Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.

译文

目的:阐明血清淀粉酶水平的变化与ERCP后胰腺炎的关系。
方法:在1999年1月至2002年12月之间,进行了1291次与ERCP相关的程序。在手术前和手术后3、6和24小时测量血清淀粉酶浓度。估计了ERCP后胰腺炎的发生频率和严重程度,以及这些现象与淀粉酶水平变化之间的关系。
结果:ERCP后胰腺炎发生在47例患者中(3.6%)。 ERCP后3小时,淀粉酶水平正常的患者中发生胰腺炎的比例为1%,淀粉酶水平分别为1-2、2-3、3、3的患者中分别有1%,5%,20%,31%和39%发生胰腺炎ERCP后3 h分别为正常上限上限的5倍,5-10倍和10倍以上(水平<2倍vs>或= 2倍,P <0.001)。在143例患者中,ERCP术后3 h血脂水平高于正常水平,随后6 h升高,其中26%发生胰腺炎。相比之下,在45名患者中,有9%发生了胰腺炎,其水平在ERCP后3 h高于正常水平的两倍,然后在6 h降低(26%vs 9%,P <0.05)。
结论:ERCP后胰腺炎常常与血清淀粉酶水平升高超过ERCP后3小时正常极限值的两倍,并在6小时升高有关。 ERCP后6小时淀粉酶水平降低表明ERCP后胰腺炎发展的可能性很小。

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