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膵炎 및 基他 急性腹症例에 있어서의 Amylase/Creatinine淸淨率
金秉九,張性國,郭圭植,鄭俊謨,鄭克守 慶北大學校 醫科大學 1977 慶北醫大誌 Vol.18 No.1
著者는 1975年 10月1日부터 1976年 9月30日까지 慶北大學校 醫科大學 附屬病院에 入院한 急性膵炎 23例, 急性膵炎을 同伴한 단도질환 9例, 慢性再發性膵炎2例, 急性膵炎을 同伴하지 않은 단도질환 25例 그리고 肝疾患 14例, 胃疾患 16例 및 正常成人 25例를 對象으로 amylase-Creatinine 淸淨率을 測定하여 다음과 같은 成績을 얻었다. 1) 正常成人의 Cam./Ccr. 比는 1.86±0.38%이었고 急性膵炎을 同伴하지 않은 단도질환, 肝疾患, 胃疾患例에서는 各各 1.89±0.41%, 1.92±0.63%, 1.76±0.52%로 거의 正常 範圍이었다. 2) 急性膵炎에서와 急性膵炎을 同伴한 단도질환 및 慢性再發性膵炎 例들의 Cam./Ccr. 比는 各各 4.75±1.38%, 4.36±1.31% 4.28±1.87%로 正常人例의 1.86±0.38%에 比해2.3-2.9倍의 有意한 數値를 보였다.(*P〈0.05) 急性膵炎例의 血淸 amylase値는 發病後 1∼4日까지는 正常人例(105.2±38.2 units)에서 보다 높은 426.3±177.6 units를 보이다가 그후 점차 減少하며 24時間尿中의 amylase 値는 發病 第 5∼10日까지는 正常人例(2,151.2±682.7 units)에서 보다 增加한 뒤(4,963.5±1,838.2 units) 다시 減少하나 第 10∼15病日까지도 다소 높은 數値(2,963.9±1,058.3 units)를 유지했고 Cam./Ccr. 比는 發病 初期부터 增加하여 (4.62±1.29%) 第 5∼10病日에 最高値(6.39±1.57%)에 達하였다가 그후 低下하지만 第 10∼15日 病에도 正常人例(1.86±0.38%)보다는 높은 數値 (3.96±0.97%)를 나타냈다. 血淸 amylase値가 300 Somogyi units以上으로 增加되어 있으면서 臨床像이나 理學的所見 및 其他 檢査室 所見으로 急性膵炎과 단도질환과의 鑑別이 因難한 例에 있어서의 Cam./Ccr. 比도 急性膵炎및 急性膵炎을 同伴한 患者例들에 있어 各各 5.31.±0.84%, 4.93±1.20%로 急性膵炎을 同伴하지 않은 단도질환의 1.92±0.51% 보다 2.6∼2.9倍의 意義한 數値를 보였다. (*P〈0.05) 이와 같은 成績은 急性膵炎의 診斷에 있어서 Cam./Ccr. 比測定이 보다 有意있고 診斷에 도움을 주는 方法임을 立證하는 所見이라고 할 수 있겠다. The serum amylase test is routinly used as a diagnostic method of acute pancreatits. However in many non-pancreatic conditions such as acute cholecysititis, ileus, mumps, intestinal perforation and kidney trouble, we can observe hyperamylasemia. Therefore, hyperamylasemia only have not specific diagnostic meaning for acute pancratitis. Also urine amylase test is available but its data is conflicting and in consequence urine amylase test is infrequently used in practice. Recently in 1969, Levitt et al introduced amylasc-creatinine clearance ratio which would enhance the diagnostic value of amylase determination in actue pancreatitis. Thereafter many interesting data were reported for supporting Levitt's results. The author examined on amylase-creatinine clearance ratio in total 89 cases of various diseases with acute abdominal pain including 23 cases of acute pancreatitis, 9 cases of biliary tract diseases accompanying acute pancreatitis, 2 cases of relapsing pancreatitis, 9 cases of biliary tract diseases without pancreatitis, 14 cases of liver diseases and 16 cases of various gastric diseases and results obtained were as follows. Amylase-creatinine clearance ratio(Cam/Ccr) of the liver, biliary tract and stomach diseases were 1.92±1.63%, 1.89±0.41% and 1.76±0.52% respectively (Cam/Ccr in healthy Korean adult as a control was 1.86±0.3%) Cam/Ccr in acute pancreatitis, acute pancreatitis accompanied by biliary tract diseases and relapsing pancreatitis were 4.75±1.38%, 4.36±1.31% and 4.28±1.87% respectively and they were significantly higher than healthy control (*P<0.05). Serum amylase in acute pancreatitis was seen to be elevated on 1-4 days of illness while urine amylase remained more or less higher level than the healthy control up to 10-15days. Cam/Ccr of acute pancreatitis showed significantly high level from the first day of illness, recording peak level on 5-10 illness days. And then it gradually came down but still showed higher level than the control even on 10-15 illness days when the serum amylase level had become within normal range. Cam/Ccr in those with acute pancreatitis, acute pancreatitis, accompanied by biliary tract diseases and in those with biliary tract disease without pancreatitis, who showed high serum amylase level of over 300 Somogyi units and differential diagnosis by physical examination or usual laboratory findings was difficult, were 5.13±0.8%, 4.93±1.20% and 1.92±0.51% res pectively and the former two (cases with acute pancreatitis, primary or secondary) were significantly higher than the last (cases without pancreatitis) (p<0.05).
김호각,권영오,곽규식,이상채,배정동,최용환,정준모 慶北大學校 醫科大學 1987 慶北醫大誌 Vol.28 No.3
Heterotopic pancreas, as being the presence of pancreatic tissue outside its usual or habitual location and without anatomical relation either of continuity or of vascularization with the pancreas proper, is a rare anomaly of the pancreas. The main sites of heterotopic pancreas are stomach(esp. greater curvature of the antrum), duodenum and jejunum. We represent a case of 42year old man, who visited our hospital with chief complain of epigastric discomfort and indigestion. After antrectomy, we found submucosal mass in greater curvature side of antrum which posessed pancreatic acini, ducts, lobules and Brunner's glands.