问题 单项选择题

急性胰腺炎时,血清淀粉酶变化的特点,下列哪项不正确

A.发病24小时内即可被测得

B.淀粉酶>500U/dl(索氏法)可诊断

C.尿淀粉酶升高持续时间比血淀粉酶长

D.淀粉酶值的高低与病变程度成正比

E.淀粉酶的测值越高,诊断的准确率也越高

答案

参考答案:D

解析:①急性胰腺炎时,血淀粉酶3~4小时开始升高,6~8小时可测,24小时达高峰,4—5天降至正常。 ②其它急腹症,如消化性溃疡穿孔、胆囊炎、肠梗阻等血淀粉酶也可升高,但一般不超过正常值的2 倍,血淀粉酶>500U/dl(索氏法,正常值40—180 U/d1)可确诊急性胰腺炎。③急性胰腺炎时,由于 胰腺腺泡细胞破坏、细胞膜通透性增高,细胞内的淀粉酶大量释放人血,导致血尿淀粉酶升高。急 性水肿性胰腺炎表现为血清淀粉酶升高,但晚期重症坏死性胰腺炎由于胰腺腺泡细胞大量坏死丧 失,无淀粉酶可供释放,血清淀粉酶可正常、甚至低于正常。可见急性胰腺炎时,血尿淀粉酶的高低 与病情严重程度并不成正比,但淀粉酶的高低与诊断准确率成正比(类似的:甲亢时,-r3和T4的高 低与病情严重程度不成正比,但BMR的高低与病情严重程度成正比)。④尿淀粉酶发病24小时开 始升高,48小时达高峰,持续l一2周后恢复正常。可见尿淀粉酶持续时间比血淀粉酶长。

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     Knowing how much her own children loved presents at Christmas, Ann Sutton, a social worker, always
tried to seek help for one or two poor families. This year, Kinzie, Ann's seven-year-old daughter, was   1  
that Santa Claus would make a special visit to a young mother named Ashley who worked in a factory and
was   2   her 12-month-old son, Evan, and her 12-year-old brother, Kenny, by herself.
     At a   3   dinner, the phone rang. A representative from a local charity was calling to say that the   4   Ann
had requested for Ashley had been cancelled. No Santa Claus, no presents, nothing. Ann saw the cheer fade
away from her children's faces at the news. Without a word, Kinzie   5   down from her chair and ran from
the room. Now, it didn't feel much   6   Christmas anymore. Kinzie returned, her face set with determination.
She had opened up her piggy   7  , and now she counted out the coins and broken dollar   8  , one by one,
onto the dining table: $3.30. Everything she had.
     "Mom," she told Ann, "I know it's not much.   9   maybe this will buy a present for the baby."
     Then  10  everyone was reaching into pockets and purses. Adding to Kinzie's gift became a game, with
everyone  11  for loose change. By the time the search ended, there was a small mountain of bills and a neat
pile of coins. The  12 : $130, plenty for a Christmas for three. "God multiplied your gift," Ann said to Kinzie.
     That evening, Kinzie went with her mother and sisters to  13  the money.
     On Christmas Eve, Ann  14  through the pouring rain to the small cottage where the family lived. When
Ashley opened the door, Ann stood under her umbrella and  15  the astonished woman a merry Christmas.
Then she began to  16  the gifts from the car, handing them to Ashley one by one. Ashley laughed in disbelief,
and still the presents came. Ann abandoned the umbrella, and the young woman joined her in the rain, passing
gifts  17  to Kenny. "Please, can I open up just one tonight?" he begged. Soon both women were  18  to the
skin, and surprise had turned to something  19 , the kind of joy that brought them close to tears.
     Reflecting on a little girl's generosity, Ashley says she hopes she'll one day be able to do something similar
for someone else in  20 . "Kinzie could have used that money for herself, but she gave it away," Ashley says.
"She's the type of kid I'd like my son to grow up to be."
( )1. A. disappointed
( )2. A. raising    
( )3. A. sorrowful  
( )4. A. reward     
( )5. A. knelt      
( )6. A. like       
( )7. A. pocket     
( )8. A. checks     
( )9. A. So         
( )10. A. hopefully    
( )11. A. hunting   
( )12. A. goal      
( )13. A. spend     
( )14. A. looked    
( )15. A. owed      
( )16. A. unload    
( )17. A. out       
( )18. A. wet       
( )19. A. sadder    
( )20. A. vain      
B. pleased      
B. teaching       
B. joyful         
B. job            
B. fell         
B. at            
B. case          
B. bills          
B. And           
B. luckily         
B. struggling      
B. budget       
B. save          
B .drove         
B. offered       
B. separate        
B. inside       
B. excited      
B. heavier        
B. store      
C. surprised    
C. helping        
C. pitiful     
C. aid             
C. rolled      
C. over         
C. basket       
C. receipts     
C. But          
C. obviously        
C. rushing    
C. total       
C. distribute   
C. wandered     
C. brought      
C. divide          
C. down        
C. close       
C. wilder         
C. need       
D. puzzled      
D. protecting     
D. grateful    
D. prize        
D. slipped      
D. for          
D. bank         
D. signs        
D. Or           
D. suddenly                    
D. trading  
D. maximum      
D. collect       
D. walked        
D. wished        
D. choose         
D. up          
D. familiar     
D. deeper        
D. touch      
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