<原著>急性膵炎における臨床所見と画像所見との解離現象に関する研究 : 血中膵分泌性トリプシンインヒビター(PSTI)を用いたベイズ分析からのアプローチ

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Clinical signs,blood examinations and computed tomography (CT) of the abdomen play an important role not only for the diagnosis of acute pancreatitis (AP) but for the assessment of the severity and predictability of the clinical course of the disease. We experienced 123 cases of AP for the last 15 years. Six of those showed that after two or three weeks of the onset, both clinical sign and laboratory data were significantly improved although their CT findings of the abdomen were deteriorated. To evaluate quantitatively and objectively such an observed discrepancey, we conducted the odds-likelihood form of Bayesian analysis of serum pancreatic secretory trypsin inhibitor (PSTI) by using the previously published data of this inhibitor. The scoring scale of clinical and laboratory findings was devised to assess the prior probability of AP at onset and after one, two and three weeks. The receiver-operating characteristic plots proved the published cutoff value to be optimal (23 ng/ml). By using this value, the sensitivity and specificity of serum PSTI were calculated to be 88% and 90%, respectively. In Bayesian analysis, serum level of PSTI were divided into 4 groups ; ≦23 ng/ml, 24〜99 ng/ml, 100〜399 ng/ml, ≧400 ng/ml. The analysis revealed that the posterior probability of AP was altered with the different prior probability of the disease in all groups of the serum level of the inhibitor, and the posterior probability of AP after three weeks of the onset ranged from 1 to 4% in correspondence to the prior probability of the disease from 8 to 23%. These results indicated that inflammation of the pancreas itself was almost subsided two or three weeks after onset, and the observed CT findings undoubtedly represented the extensive peripancreatic inflmmatory collections.
愛知医科大学の論文
2002-12-15

<原著>急性膵炎における臨床所見と画像所見との解離現象に関する研究 : 血中膵分泌性トリプシンインヒビター(PSTI)を用いたベイズ分析からのアプローチ

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