Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency

Background/Aim—The suggestion that estimation offaecal elastase 1 is a valuable new tubeless pancreatic function testwas evaluated by comparing it with faecal chymotrypsin estimation inpatients categorised according to grades of exocrine pancreatic insufficiency (EPI) based on the gold standard tests, thesecretin-pancreozymin test (SPT) and faecal fat analysis.
Methods—In 64 patients in whom EPI was suspected,the following tests were performed: SPT, faecal fat analysis, faecalchymotrypsin estimation, faecal elastase 1 estimation. EPI was gradedaccording to the results of the SPT and faecal fat analysis as absent,mild, moderate, or severe. The upper limit of normal for faecalelastase 1 was taken as 200 µg/g, and for faecal chymotrypsin 3 U/gstool. Levels between 3 and 6 U/g stool for faecal chymotrypsin areusually considered to be suspicious for EPI. In this study, both 3 and 6 U/g stool were evaluated as the upper limit of normal.
Results—Exocrine pancreatic function was normal in34 patients, of whom 94, 91, and 79% had normal faecal elastase 1 andfaecal chymotrypsin levels (<3 U/g and <6 U/g) respectively. Thirtypatients had EPI, of whom 53, 37, and 57% had abnormal faecal enzymelevels (differences not significant). When EPI was graded as mild,moderate, or severe, 63% of patients had mild to moderate EPI, and37% had severe EPI. In the latter group, between 73 and 91% ofpatients had abnormal faecal enzymes. In the group with mild tomoderate EPI, abnormal test results were obtained for both faecalenzymes in less than 50% of the patients (differences notsignificant). Some 40% of the patients had pancreatic calcifications.There were no significant differences for either faecal enzyme between the two groups with and without pancreatic calcifications. In 62% ofthe patients who underwent an endoscopic retrogradecholangiopancreatography (ERCP), abnormal duct changes were found.Again, there were no significant differences for either faecal enzymebetween the two groups with abnormal and normal ERCP.
Conclusion—Estimation of faecal elastase 1 is notdistinctly superior to the traditional faecal chymotrypsin estimation.The former is particularly helpful only in detecting severe EPI, but not the mild to moderate form, which poses the more frequent and difficult clinical problem and does not correlate significantly withthe severe morphological changes seen in chronic pancreatitis.

Keywords:faecal elastase 1; faecal chymotrypsin; secretin-pancreozymin test; faecal fat analysis; exocrine pancreaticinsufficiency; diagnosis

     

弹性酶治疗高脂血症伴非酒精性脂肪肝的临床疗效及评估

观察弹性酶 (Elastase)治疗高脂血症伴非酒精性脂肪性肝病的临床疗效。高脂血症伴非酒精性脂肪性肝病治疗组 30例 ,口服弹性酶肠溶片 (30 0IU/片 ) ,2片 /次 ,3次 /日 ,6 0天为一疗程 ,安慰剂组 2 0例。通过测定肝功、血脂、肾功及B超随访。治疗组肝功能、血脂明显改善 ,优于对照组 (P <0 0 5 ) ,治疗组总有效率为 90 % ,明显优于对照组 10 % (P <0 0 5 )。弹性酶具有改善肝功能、降低血脂 ,防治高脂血症伴非酒精性脂肪性肝病的作用     

精浆弹性蛋白酶水平与精液主要参数和精子功能的相关性分析

目的:探讨精浆弹性蛋白酶与精液主要参数和指标的关系。方法:用酶联免疫吸附法(ELISA)检测精浆中的弹性蛋白酶,按照WHO人类精液实验室手册要求进行精液常规分析、精子形态分析,检测精子顶体酶活性、精浆抗体(AsAb)、解脲支原体等,分析弹性蛋白酶与男性不育相关因素的关系。结果:209例男性不育患者中,43例患者精浆弹性蛋白酶≥290ng/ml,设为炎症组;166例患者精浆弹性蛋白酶<290ng/ml,设为非炎症组。炎症组的精子密度、精子活动率、a+b级活力精子率、精子顶体酶阳性率均低于非炎症组(P<0.05);而精子畸形率、精浆抗体(AsAb)、解脲支原体阳性率均高于非炎症组(P<0.05)。两组的精液量、PH值和液化时间差异无统计学意义。结论:精浆弹性蛋白酶水平与精液质量有密切的关系,生殖道感染是导致男性不育的重要原因。     

血浆中性粒细胞弹性蛋白酶与冠心病的关系

目的 :探讨血浆中性粒细胞弹性蛋白酶 (neutrophilelastase,NE)与冠心病 (CHD)的关系。方法 :对85例观察对象进行分组 ,根据冠状动脉造影结果分为 :简单病变组 2 4例 ,复杂病变组 5 1例 ,正常对照组 10例。根据CHD病情分为 :急性心肌梗死 (AMI)组 9例 ,不稳定型心绞痛 (UAP)组 4 5例 ,稳定型心绞痛 (SAP)组 2 1例 ,正常对照组 10例。用酶联免疫吸附法 (ELASA)检测血浆NE含量 ,比较不同组间NE含量。结果 :血浆NE含量 :复杂病变组 [(6 3.4 2± 13.6 2 ) μg/L]高于简单病变组 [(4 4 .5 0± 12 .73) μg/L],差异有统计学意义 (P <0 .0 1)。AMI组 [(71.4 8± 10 .16 ) μg/L]高于UAP组 [(6 1.2 7± 14 .5 7) μg/L],但差异无统计学意义 (P >0 .0 5 ) ,明显高于SAP组 [(4 0 .95± 10 .0 9) μg/L]及正常对照组 [(36 .6 3± 12 .35 ) μg/L],差异均有统计学意义 (P <0 .0 1) ,后两组间比较差异无统计学意义 (P >0 .0 5 )。UAP组明显高于SAP组及正常对照组 ,差异有统计学意义 (P <0 .0 1)。结论 :血浆NE含量与冠状动脉病变稳定性及CHD病情严重性相关 ,NE可能是冠状动脉病变活动性的标志物。     

Epinephrine test and plasma elastase as diagnostic tools in a patient with CD3+ large granular lymphocyte proliferation

Large granular lymphocytes (LGL) proliferation is characterized by expansion of cytotoxic lymphocytes and associated with neutropenia. In a case of CD3⁺ LGL-proliferation the epinephrine stimulation test (EST) induced a striking elevation of CD3⁺, CD8⁺, CD57⁺ LGL in peripheral blood from 2.7 x 10⁹/1 to 20 x 10⁹/1 and might be an additional diagnostic tool in patients with normal or low absolute numbers of circulating LGL. After treatment with steroids, plasma elastase - a marker of neutrophil destruction - decreased from 162 to 40μg/1 (normal < 47μg/1) which correlated well with a simultaneous increase in peripheral neutrophil counts from 0.14 to 1.0 x 10⁹/1. This finding supports the hypothesis that neutropenia in CD3⁺ LGL proliferation is due to neutrophil destruction, possibly mediated by LGL.     

Nitric Oxide Level Profile in Human Liver Transplantation

The aim of this study was to monitor nitric oxide blood levels at various times intraoperatively and following liver transplantation in humans. Nitric oxide production was assessed directly as circulating nitrosyl-hemoglobin adducts by electron paramagnetic resonance spectroscopy in 22 patients undergoing orthotopic liver transplantation. Two significant peaks in nitrosyl-hemoglobin levels were detected at 5 and 60 min after reperfusion (5.02 ± 3.33 arbitrary units and 5.75 ± 4.19, respectively, vs 3.33 ± 2.28 under basal state; P < 0.05 for both comparisons). Postoperative nitrosyl-hemoglobin levels remained elevated, up to 5.42 ± 0.89 arbitrary units (P < 0.05 vs basal values). Neither soluble intercellular adhesion molecule- 1 or soluble endothelial-leukocyte adhesion molecule concentrations were altered intraoperatively. Only the former was significantly raised after transplantation. Neutrophil elastase levels showed an early increase and remained high throughout surgery, returning to basal values after transplantation. No correlations were found among studied parameters. These data suggest that nitric oxide may play a role in ischemia–reperfusion phases in human liver transplantation. Mechanisms other than leukocyte-endothelial adhesion and neutrophil activation seem to affect nitric oxide production under these conditions.     

Neutrophil elastase in pressure ulcer fluid degrades fibronectin in the exudates

Background:   Pressure ulcers are classified as chronic wounds, which do not heal in a timely fashion. Fibronectin is condensed in granulation tissue, and essential glycoprotein of wound healing. It has been proposed that fibronectin degradation may be involved in delaying wound healing. We have investigated whether pressure ulcer fluid (PUF) contains degraded fibronectin. In addition, we tried to identify the proteinase which contributes to fibronectin degradation in PUF.
Methods:   Fibronectin degradation and the presence of neutrophil elastase (NE) in PUF were determined by immunoblot analysis. Fibronectin degradation activity in PUF was determined in the presence of various proteinase inhibitors. NE activity was assessed using NE specific substrate.
Results:   Immunoblot analysis revealed that degraded fibronectin was observed in PUF samples but not in acute wound fluid (AWF). The PUF contained a proteinase capable of degrading freshly added fibronectin and its activity in PUF was blocked by a broad-spectrum serine proteinase inhibitor or sivelestat, a specific neutrophil elastase inhibitor, but not by metalloproteinase and cysteine proteinase inhibitors. Immunoblot analysis of PUF using an antineutrophil elastase antibody revealed that neutrophil elastase was detected as three bands at molecular weights of ∼30 kDa, ∼38 kDa, and ∼54 kDa, indicating that neutrophil elastase in the exudates existed not only as free monomers, but also in polymers or complexes with other molecules.
Conclusion:   These results suggest that PUF contains a high level of neutrophil elastase which may be involved in the delay of the healing of pressure ulcer through the fibronectin degradation.     

Schistosoma japonicum reveals distinct reactivity with antisera directed to proteases mediating host infection and invasion by cercariae of S. mansoni or S. haematobium

Serine proteases released from the acetabular glands of cercariae, also known as cercarial elastases, are key enzymes in the penetration process of schistosomes through the skin of the final host. Antisera against these enzymes secreted from Schistosoma mansoni or S. haematobium reveal differences in the patterns of elastase expression among schistosome species and among different developmental stages of the larvae. Immunolocalization studies showed that antisera raised against the enzyme s28 protease react with S. mansoni, S. haematobium and also S. japonicum, in developing as well as mature cercariae and in both pre- and post-acetabular glands. Antisera against the enzyme SmCE detect the respective antigen solely in the pre-acetabular glands. Remarkably, the SmCE-1a isoform is detectable with DNA-vaccinated mouse sera in S. mansoni and S. haematobium only, but is apparently absent from the acetabular glands of S. japonicum. These differences in immunoreactivity of cercarial enzymes may be related to the distinct infection process of S. japonicum.     

High Prevalence of Steatorrhea in 101 Diabetic Patients Likely to Suffer from Exocrine Pancreatic Insufficiency According to Low Fecal Elastase 1 Concentrations: A Prospective Multicenter Study

Impaired exocrine pancreatic secretion has been frequently observed in diabetic patients by different methods, including direct function tests. However, the clinical importance remained unclear. In the present study, the fecal fat excretion in patients with type 1 or type 2 diabetes mellitus and exocrine dysfunction according to fecal elastase 1 concentrations <100 g/g was investigated. Subjects with a history of gastrointestinal cancer, gastrointestinal surgery, alcohol abuse, or inflammatory diseases were excluded. In 101 patients the mean (±SD) fat excretion was 9.19 ± 5.39 g. Only 41 patients (40.6%) had normal fat excretion <7 g/day. In 40 patients (39.6%), it was higher than 10 g/day, indicating relevant steatorrhea. The fat excretion did not correlate with diabetes type, duration, or clinical symptoms. This finding is of some clinical importance and might influence pathophysiological concepts and the management of diabetic patients.