胰腺外分泌功能试验临床应用再评价

胰腺外分泌功能试验直接或间接测定胰腺分泌的酶和电解持量,对诊断慢性胰腺炎及评估其病期提供了一个功能方面的量化标准。本就胰腺外分泌功能试验的检测机制、分类及应用现状等作一综述。     

胰腺外分泌功能试验临床应用再评价

胰腺外分泌功能试验直接或间接测定胰腺分泌的酶和电解质量,对诊断慢性胰腺炎及评估其病期提供了一个功能方面的量化标准。本文就胰腺外分泌功能试验的检测机制、分类及应用现状等作一综述。     

粪弹性蛋白酶-1试验在胰腺外分泌功能不全诊断中的意义

背景：粪弹性蛋白酶（FE）-1试验是一种间接检测胰腺外分泌功能的方法,简便、安全、无创且不受胰酶替代治疗的影响。目的：了解FE-1试验在胰腺外分泌功能不全诊断中的意义。方法：纳入21例胰腺外分泌功能不全患者（慢性胰腺炎13例,胰腺癌8例）和20例胰腺外分泌功能正常者（6例非胰腺相关疾病患者作为阴性对照,14名健康志愿者作为正常对照）,以酶联免疫吸附测定（ELISA）检测FE-1水平。结果：胰腺癌组、慢性胰腺炎组、阴性对照组和正常对照组间FE-1水平差异有统计学意义（P=0.003）,其值依次递增。FE-1试验在慢性胰腺炎组、胰腺癌组和外分泌功能不全组中的敏感性分别为23.1%、62.5%和38.1%,特异性为100%。结论：FE-1试验对胰腺外分泌功能不全的诊断有一定意义,但尚需更多、更大样本的临床研究支持。     

胰弹力蛋白酶1在胰腺外分泌功能测定中的作用

粪胰弹力蛋白酶1(PE1)ELISA法可用于诊断胰腺外分泌功能不足,这一方法可间接反映胰腺外分泌功能,特异、敏感,操作简便,对患者无损伤,且不受非胰腺疾病和酶替代疗法的影响。     

胰弹力蛋白酶1在胰腺外分泌功能测定中的应用

粪胰弹力蛋白酶1（PE1）ELISA法可用于诊断胰腺外分泌功能不足,这一方面可间接反映胰腺外分泌功能,特异、敏感,操作简便,对患者无损伤,且不受非胰腺疾病和酶替代疗法的影响。     

继发于胰腺癌的胰腺外分泌功能不全的研究进展

目前国际上对胰腺外分泌功能不全的诊断和治疗标准尚未完善,胰腺外科医师对继发于胰腺癌的胰腺外分泌功能不全常常忽视或错误估计,使得胰腺外分泌功能不全未得到充分治疗,严重影响了胰腺癌患者的生存质量。对胰腺癌患者胰腺外分泌功能不全的发病机制、典型症状、诊断方法、不同胰腺癌阶段的胰酶替代治疗等方面的最新研究进展进行了归纳总结,分析认为胰酶替代治疗能显著改善不同疾病阶段胰腺癌患者的生存质量。     

慢性肾功能衰竭患者胰腺外分泌功能的改变

本文综述了慢性肾功能衰竭患者胰腺外分泌功能的损害及组织学改变的研究进展，包括发病机制，组织形态学，胰腺细胞功能变化以及内生肌酐清除率和透析对血胰酶浓度的影响。     

胰腺外分泌功能与胰腺坏死的关系

目的：研究胰腺外分泌功能与胰腺坏死程度之间的关系，并探讨其对胰腺坏死的诊断作用。方法1999—01／2004—01收治的重症急性胰腺炎病人39例，分别测量胰腺外分泌功能。按照BalthazarCT评分标准评估胰腺坏死程度。结果：胰腺外分泌功能与坏死程度之间无明显相关。但随着胰腺坏死程度加重，外分泌功能有下降趋势，其对胰腺坏死的诊断阈值为45．5％，灵敏度为43．8％，特异度为43．5％。结论：胰腺外分泌功能与胰腺坏死程度无显著性相关，不是诊断胰腺坏死的合适指标。     

第二讲 胰腺外分泌功能

胰腺是仅次于肝脏的人体内第二大外分泌器官。胰腺外分泌部分由腺泡、导管和间质3个部分组成．腺泡是合成、贮存和分泌消化酶的部位．导管的主要功能是分泌水和电解质，也是输送胰液的导管。胰腺的内分泌部分是胰岛．胰岛细胞产生胰岛索、胰高糖素等激素．经血液循环作用于多个靶器官。     

13C-呼气试验评估胰腺外分泌功能的临床应用

三酰甘油、蛋白质和淀粉均可作为13C-呼气试验的底物，用于检测胰腺外分泌功能。目前研究最多的是13C-三酰甘油呼气试验，其中以13C-混合三酰甘油呼气试验（MTG—BT）最具优势。N-苯甲酰-L-酪胺酰-【1-13C】丙氨酸（Bz—Tyr—Ala）呼气试验无需试餐，近年逐渐受到关注。13C-淀粉呼气试验影响因素较多，研究近况不甚理想。本文对各类，13C-呼气试验的底物特点及其评估胰腺外分泌功能的临床应用作一综述。     

Low prevalence of exocrine pancreatic insufficiency in patients with diabetes mellitus

IntroductionExocrine pancreatic insufficiency (EPI) can occur in patients with diabetes mellitus (DM). Incidence of EPI and its clinical significance remain poorly defined. The aim of our study was to determine whether exocrine pancreatic function is impaired in patients with DM.Patients and methodsOne hundred and fifty consecutive patients, mean age 59.0 (±12.0 years), with DM lasting at least 5 years were included in the study. We included 50 patients with type 1 DM (DM1), 50 insulin-treated patients DM type 2 (DM2-insulin) and 50 non-insulin treated patients with DM type 2 (DM2 no-insulin). Diagnosis of DM was established from health records, lasting 15.0 ± 9.9 years on average. EPI was diagnosed with a fecal elastase-1 concentration (FE1) of less than 200 μg/g (ELISA).ResultsFE1 was reduced in 8 (5.4%) patients: mildly reduced (100–200 μg/g) in 4 patients (2.7%) and markedly reduced (<100 μg/g) in 4 patients (2.7%). Frequency of EPI was 3 in DM1, 5 in DM2(insulin) and none in DM2 (no-insulin) groups.ConclusionsEPI in DM occurred less frequently than in previous studies, probably due to our strict exclusion criteria (age, alcohol intake).     

Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far. Received: 8 September 1999 / Accepted: 16 November 2000     

胰腺疾病中粪弹力蛋白酶检测的临床应用

目的：探讨粪弹力蛋白酶（E1）试验对胰腺疾病外分泌功能检测的临床应用价值。方法：应用酶联免疫吸附试验（ELISA）法对55例慢性胰腺炎、21例胰腺癌、25例非胰腺消化系统疾病患者进行粪E1的检测，并同时与尿BT－PABA检测进行对比。结果：慢性胰腺炎及胰腺癌患者粪E1及尿BT－PABA排除率均明显低于非胰腺疾病组（P＜0．05）。以200μg/g为界，对于轻度慢性胰腺炎患者粪E1的敏感性只有14．3％，中度慢性胰腺炎粪E1的敏感性为36．8％，重度慢性胰腺炎粪E1的敏感性为86．7％，总的敏感性为51．0％，特异性为86．0％。结论：慢性胰腺炎、胰腺癌患者存在粪E1的下降，但对于诊断轻至中度慢性胰腺炎其敏感性较差，而对于重度胰腺炎患者，其敏感性、特异性均较高，对临床诊断治疗有指导意义。     

Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multi-centre trial

BACKGROUND: Recently, high prevalence of exocrine dysfunction in diabetic populations has been reported. Patients with fecal elastase 1 concentration (FEC) <100 microg/g have also been demonstrated to suffer from steatorrhea in about 60% of cases, indicating the need of pancreatic enzyme replacement therapy. Until now, there have only been a few reports on the use of enzyme replacement therapy in diabetic patients with exocrine pancreatic insufficiency. This investigation was designed to evaluate the impact of enzyme-replacement therapy on glucose metabolism and diabetes treatment in a prospective study of insulin-treated patients with diabetes mellitus. METHODS: A total of 546 patients with diabetes mellitus requiring insulin treatment were screened for exocrine dysfunction by FEC measurements. One hundred and fifteen patients (21.1%) had FEC <100 microg/g (normal >200 microg/g). Of these, 95 patients entered the study and 80 patients were randomized to receive either pancreatin (Creon) (39 patients) or placebo (41 patients) in a double-blind manner. Parameters of glucose metabolism, diabetes therapy and clinical symptoms were recorded in standardized protocols for 16 weeks. RESULTS: During the observation phase of 16 weeks, there were no significant differences between both groups concerning HbA(1c), fasting glucose levels, 2-h pp glucose levels, clinical parameters and safety parameters. A reduction in mild and moderate hypoglycemia was observed in the pancreatin group at the end of the study. CONCLUSIONS: Pancreatin therapy can be used safely in patients with diabetes mellitus and exocrine dysfunction. Parameters of glucose metabolism were not improved by enzyme replacement therapy.     

Utility of Fecal Elastase-1 to diagnose severe exocrine insufficiency in chronic pancreatitis: Real world experience

IntroductionQuantitative fecal fat estimation is the gold standard test to diagnose steatorrhea (fecal fat >7 g/day) in chronic pancreatitis (CP), but cumbersome and inconvenient. So, fecal elastase-1 (FE) is proposed as a good alternative but the data on the diagnostic utility of FE to diagnose steatorrhea is variable.MethodsThis retrospective study included adult CP patients evaluated with both 24-h fecal-fat and FE tests within a 3-month period. The objective was to evaluate the diagnostic performance of FE to diagnose steatorrhea and to evaluate the FE progression over 9-month period.ResultsAmong the 147 included patients, the frequency of steatorrhea (fecal fat >7 g/day) was 34%. The sensitivity, specificity, and negative likelihood ratio (LR) of FE was 90%, 28.9% and 0.35 at cut-off of <100 μg/g stool to diagnose steatorrhea; and 96%, 11.3% and 0.35 at cut-off of <200 μg/g stool, respectively. The optimal cut-off of FE was <20 on receiver operating characteristic curve (sensitivity 66%; specificity 69%; positive LR 2.14). There was no statistically significant variation in FE levels over 9 months interval among a hundred patients.ConclusionCompared to FE ≥ 200 μg/g stool, FE ≥ 100 can used to exclude steatorrhea (better specificity and negative LR). FE < 20 alone cannot replace fecal fat estimation to confirm steatorrhea but to be interpreted with clinical features. Repeat FE testing for exocrine insufficiency progression can be done at least a year later.     

Importance of pancreatic exocrine dysfunction in patients with type 2 diabetes: A randomized crossover study

Background

Levels of faecal elastase-1 (FE-1), a marker of exocrine pancreatic function, are lower in patients with type 2 diabetes than without diabetes. We aimed to investigate the association between FE-1 and nutritional status, gastrointestinal symptoms, and lipid absorption.

Expression of neutrophil elastase and myeloperoxidase mRNA in patients with newly diagnosed type 2 diabetes mellitus

Background and aimsNeutrophil elastase and myeloperoxidase enzymes protect us from infection by killing pathogens. However, exaggerated activities of these enzymes can induce tissue damage, inflammation and oxidative stress. The present study was aimed to explore the expressions of neutrophil elastase and myeloperoxidase mRNA in the peripheral blood leukocytes (PBL) in patients with newly diagnosed type 2 diabetes mellitus.MethodsIn this cross-sectional study, 104 participants including 65 normoglycemic control subjects and 39 newly diagnosed type 2 diabetes patients were recruited. Glycemic and metabolic markers were evaluated from fasting blood samples. The mRNA levels of neutrophil elastase and myeloperoxidase genes in the PBL were quantified by real-time quantitative PCR.ResultsCompared to control subjects, diabetes patients showed a significant down regulation of both neutrophil elastase (p = 0.039) and myeloperoxidase (p = 0.023) mRNA expressions in the PBL. The neutrophil elastase and myeloperoxidase mRNA levels showed a negative trend with fasting glucose levels but did not show any significant correlations with HbA1c, insulin level, insulin resistance or sensitivity status.ConclusionsIt was concluded that type 2 diabetes mellitus is associated with a decrease in neutrophil elastase and myeloperoxidase gene expression in the PBL.     

Long term quality of life amongst pancreatectomy patients with diabetes mellitus

BackgroundPancreatogenic diabetes is common after pancreatectomy, and the impact on quality of life (QOL) is poorly understood. The objective of this study was to investigate QOL between diabetic and non-diabetic patients at least five years after pancreatectomy.MethodsPatients were recruited from a prospectively maintained institutional database. Participants were administered the Audit of Diabetes-Dependent Quality of Life (ADDQOL). Quality of life was compared between diabetics and non-diabetics using validated European Organization for Research and Treatment of Cancer questionnaires.Results80 individuals completed surveys. 55% were female, 80% non-Hispanic white, 44% underwent Whipple, 48% were cystic neoplasms and 39% were adenocarcinoma. Diabetic patients (42.5%) reported comparable EORTC QLQ-C30 and Pan26 scores to non-diabetic patients. Pre-operative diabetic patients reported more dyspnea (p = 0.02) and greater pain (p = 0.02) than new-onset diabetics. Diabetic patients reported an overall ADDQOL quality of life score ‘very good’ (IQR: excellent, good) though felt life would be much better without diabetes (IQR: very much better, little better). While operation type was not influential, patients diagnosed with cystic neoplasms were almost twice as likely as those with other pathologies to report that life would be much better without diabetes (p < 0.01).ConclusionAt a median of 9.3 years from pancreatic surgery, ADDQoL scores of patients were similar to cohorts of non-pancreatogenic diabetics in the general population. Patients without cancer were more likely to report that diabetes affected their overall QOL, regardless of operation. This study provides nuanced understanding of long-term QOL to improve the informed consent process and post-operative long-term care.