Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 125-129

Acil serviste akut pankreatit ayýrýcý tanýsýnda idrar tripsinojen-2 testinin yeri

Yunsur Çevik¹, Cemil Kavalcý², Mehmet Özer³, Murat Daþ¹, Gülten Kýyak³, Mehmet Özdoðan^3
1Saðlýk Bakanlýðý, Atatürk Eðitim Ve Araþtýrma Hastanesi, Acil Kliniði, Ankara
²Trakya Üniversitesi Týp Fakültesi, Acil Týp Ana Bilim Dalý, Edirne
³Saðlýk Bakanlýðý, Atatürk Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara

AMAÇ
Çalýþmanýn amacý, idrar tripsinojen-2 dipstik testinin acil serviste akut pankreatit ayýrýcý tanýsýndaki yeri ve önemini araþtýrmak ve sonuçlarý konvasiyonel yöntemlerle karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM
Çalýþma üst abdominal aðrýyla acil servise baþvuran hastalarda prospektif olarak yapýldý. Çalýþmaya alýnan toplam 87 hastanýn 32’si akut pankreatit tanýsý alan hastalardan oluþmaktaydý. Tüm hastalarda amilaz, lipaz, C-reaktif protein (CRP) ve Actim pancreatit dipstick kullanýlarak, idrar tripsinojen-2 bakýldý. Ýstatistiksel analiz SPSS 11.5 paket programý kullanýlarak yapýldý.
BULGULAR
Akut pankreatit tanýsý alan 32 hastanýn 21’inde (%65,6) idrar tripsinojen-2 pozitif bulundu. Testin pankreatit açýsýndan duyarlýlýðý yaklaþýk %64, özgüllüðü %85, pozitif prediktif deðeri %72, negatif prediktif deðeri %81 olarak belirlendi. Bu deðerler kontrol grubuna göre istatistiksel olarak anlamlýydý (p<0,01).
SONUÇ
Ýdrar tripsinojen-2 testinin duyarlýlýðý ve özgüllüðü amilaz ve lipaza kýyasla düþük olsa da, acil servislerde 5 dakika gibi kýsa bir sürede sonuç vermesi, ucuz olmasý, kullaným kolaylýðýna sahip olmasý ve negatif belirleyicilik deðerinin yüksek olmasý nedeniyle akut pankreatit tanýsýnýn dýþlanmasýnda önemli bir taný aracý olacaðýný düþünmekteyiz.

Anahtar Kelimeler: Karýn aðrýsý, acil servis; pankreatit; idrar tripsinojen-2.

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The role of urine trypsinogen-2 test in the differential diagnosis of acute pancreatitis in the Emergency Department

Yunsur Çevik¹, Cemil Kavalcý², Mehmet Özer³, Murat Daþ¹, Gülten Kýyak³, Mehmet Özdoðan^3
1Ministry Of Health, Ataturk Training And Research Hospital, Department Of Emergency, Ankara, Turkey
²Department Of Emergency, Medicine Faculty Of Trakya University, Edirne, Turkey
³Ministry Of Health, Ataturk Training And Research Hospital, Department Of General Surgery, Ankara, Turkey

BACKGROUND
The aim of the study was to investigate the role and importance of the urine trypsinogen-2 dipstick test in the differential diagnosis of acute pancreatitis in the Emergency Department and to compare results with those of conventional tests.
METHODS
The study was performed prospectively in the patients admitting to the Emergency Department due to upper abdominal pain. Thirty-two of the 87 patients included in the study had acute pancreatitis diagnosis. Serum amylase, lipase, C-reactive protein (CRP) and urine trypsinogen-2 using Actim pancreatitis dipstick were studied in all patients. The statistical analysis was performed using SPSS 11.5 package program.

RESULTS
Urine trypsinogen-2 was found positive in 21 (65.6%) of 32 patients. The sensitivity of the test for pancreatitis was identified as 64%, specificity as 85%, positive predictive value as 72%, and negative predictive value as 81%. These values were statistically significant compared to the control group (p<0.01).

CONCLUSION
Although it has lower sensitivity and specificity compared to amylase and lipase, we suggest that urine trypsinogen-2 test may be an important diagnostic tool in excluding the diagnosis of acute pancreatitis, since it provides results within 5 minutes in the Emergency Department, is cheaper, has a higher negative predictive value, and is easy to use.

Keywords: Abdominal pain, emergency department; pancreatitis; urine trypsinogen-2.

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