壶腹周围癌粪弹力蛋白酶1检测及临床意义

目的探讨壶腹周围癌患者粪弹力蛋白酶1检测的临床意义。方法2005年1月至2006年3月首都医科大学附属北京友谊医院、北京市消化疾病中心临床表现、影像学或组织学检查确诊的无法手术切除的壶腹周围癌连续病例34例及非胰性胃肠疾病患者20例,采用双抗体夹心酶联免疫吸附试验进行粪弹力蛋白酶1检测,以200μg/g为临界值。结果34例壶腹周围癌中有29例粪弹力蛋白酶1<200μg/g(29/34,85.3%),粪弹力蛋白酶1平均(114.85±105.19)μg/g,与非胰性胃肠疾病组[(513.28±101.51)μg/g]比较,差异有统计学意义;21例胰头癌患者18例粪弹力蛋白酶1<200μg/g,粪弹力蛋白酶1平均(118.81±111.05)μg/g;13例壶腹部癌患者11例粪弹力蛋白酶1<200μg/g,粪弹力蛋白酶1平均(108.46±99.04)μg/g,胰头癌组粪弹力蛋白酶1与壶腹部癌组比较,差异无统计学意义,胰头癌组及壶腹部癌组弹力蛋白酶1均低于非胰性胃肠疾病组,差异有统计学意义。结论壶腹周围癌患者普遍存在胰腺外分泌功能障碍。     

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。     

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。     

小肠吸收功能及胰腺外分泌功能测定在消化疾病中的应用研究

应用Ｄ－木糖试验及苯酪酞（ＢＴ－ＰＡＢＡ）试验对４０例小肠及胰腺疾病患者分别检测小肠吸收功能及胰腺外分泌功能，结果显示Ｄ－木糖试验对检出小肠病变有较强特异性，胰腺病患者的对氨基苯甲酸（ＰＡＢＡ）排出率均呈低值。本试验安全、简便，易于推广，并可在一定程度上与ＣＴ、小肠镜及小肠气钡双重对比造影等检查相互补，有利于提高诊断率。     

13C-Hiolein呼气试验对胰腺外分泌功能检测的临床应用

目的测定慢性胰腺炎(CP)13C-Hiolein脂肪酸呼气试验,了解对胰腺功能检测的临床意义.方法A组8例正常志愿者为对照,8例无脂肪泻CP为B组,8例有脂肪泻CP为C组,进食13C-Hiolein后,检测呼气中13CO2,评估胰腺的外分泌功能.C组患者补充胰酶后再行13C-Hiolein试验.结果C组13C-Hiolein呼气试验显示,13C峰值(PDRpeak)和6 h呼出13C累积丰度(cPDR)较A组明显降低[(1.53±0.36)%比(2.87±0.73)%;(6.11±0.59)%比(11.22±1.22)%;P＜0.01],补充胰酶后PDRpeak和cPDR/6h较治疗前明显升高[(2.33±0.47)%,(9.03±0.84)%;P＜0.01],但cPDR/6h低于正常对照组(P＜0.05);B组PDRpeak和cPDR/6h与对照组无明显差异.13C通常在(5.90±1.17)h达到PDRpeak峰值.结论13C-Hiolein能有效地检测胰腺外分泌功能和了解胰酶治疗的疗效.     

粪弹性蛋白酶1对慢性胰腺炎诊断及临床分期价值的初步研究

粪弹性蛋白酶1(FE-1)是由胰腺腺泡分泌的蛋白水解酶,与胰腺外分泌功能密切相关。本研究检测137例CP患者(CP组)和92名健康者(对照组)的FE-1浓度,探讨FE-1对CP诊断和分期的临床价值。结果显示,CP组的FE-1水平明显低于对照组,且与患者的临床分期呈负相关,FE-1诊断CP有较高的灵敏度和特异度,并提高了...     

胰腺外分泌功能及其检查方法的临床评价

胰腺外分泌生理胰液为无色。无臭碱性液体,渗透压约等于血浆,pH7.8～8.2,正常每日分泌量为1～2L,胰液中主要含有水。电解质和各种消化酶。其电解质主要是碳酸氢盐,生理作用是中和进入十二指肠的胃酸,使肠粘膜免受强酸的侵蚀,更重要的是提供小肠内多种消化酶作用最适宜的pH环境。胰液的酶组成非常复杂,包括淀粉水解酶。脂肪水解酶和蛋白水解酶三类主要的胰消化酶。胰腺外分泌的凋节受各种因素的影响,但以神经和体液调节为主。一。神经调节胰腺分泌的神经调节包括迷走神经。肾上腺素能神经和局部神经丛。近年有较多资料表明,迷走神经对胰腺…     

肾小球疾病患者测定尿半胱氨酸蛋白酶抑制剂C的临床意义

CystC能自由地被肾小球滤过 ,不被肾小管重吸收和分泌 ,被认为是一种比血肌酐更好的反映肾小球滤过功能的指标。我们对 76例肾小球疾病患者及正常人尿进行了CystC、视黄醇结合蛋白 (RBP)的检测并分析它们的相关性 ,探讨尿中CystC是否可以作为临床评价肾小管功能的指标。对象与方法1.对象 :我科 2 0 0 2年 3月～ 8月住院的肾小球疾病患者 76例 ,年龄 15～ 73岁 ,平均年龄 ( 2 8.5 4± 13 .78)岁 ,男性 5 5例 ,女性 2 1例。其中原发性肾病综合征肾功能正常组 (A组 ) 2 5例 ,狼疮性肾炎肾功能正常组 (B组 ) 13例 ,慢性肾炎肾功能不全组(C…     

胰腺外分泌功能检测方法的临床应用

胰腺外分泌功能的检测方法较多,且各种方法的检测指标不同,尚无统一标准。本文总结了临床上应用较广泛或具有良好应用前景的胰腺外分泌功能检测方法,简述了各种方法的操作过程并评述了其临床实用性和进展,为胰腺外分泌功能检测方法的临床应用与研究思路提供一定的参考。     

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。     

150例糖尿病患者胰腺外分泌功能检测及相关因素分析

目的探讨糖尿病患者胰腺外分泌功能不全的发生情况及其相关因素。方法选取2009年3月至2010年6月于第四军医大学西京医院内分泌科就诊的糖尿病患者150例,分为1型糖尿病组（T1DM,23例）、2型糖尿病组（T2DM,127例）,对照组为来我院健康体检者及我科医护人员共48人。记录糖尿病患者的年龄、性别、体质指数（BMI）、病程、糖尿病微血管病变发生情况、糖化血红蛋白（HbAle）等指标。收集受试者24h内排出的粪便,应用酶联免疫吸附实验（ELISA）法测定粪便中粪弹性蛋白酶（FE）的含量,对所有受试者的胰腺外分泌功能进行评估。率的比较采用X2检验或Fisher精确概率法。结果1型糖尿病患者、2型糖尿病患者及对照组粪便FE含量差异有统计学意义[分别为（394±237）比（502±194）比（576±170）μg／g,F=6．93,P〈0．01]。以FE〈200μg／g作为胰腺外分泌功能不全的判断标准,结果显示30．4％（7／23）的T1DM患者及7．9％（10／127）的T2DM患者存在胰腺外分泌功能不全,与对照组（0）相比,差异有统计学意义（Fisher检验P〈0．05）。以是否存在胰腺外分泌功能不全对糖尿病患者进行分组分析,结果显示两组间年龄、性别、BMI、病程、胰岛素治疗与否、糖尿病微血管病变发生情况、稳态模型胰岛素分泌指数（HOMA-B）、空腹胰岛素、餐后2h胰岛素及HbAlc等差异均无统计学意义（均P〉0．05）。结论本研究提示与健康对照相比,T1DM和他DM患者胰腺外分泌功能不全的发生率普遍较高。     

Altered diversity and composition of gut microbiota in Chinese patients with chronic pancreatitis

Background/ObjectivesGut microbiota alterations in chronic pancreatitis (CP) are seldomly described systematically. It is unknown whether pancreatic exocrine insufficiency (PEI) and different etiologies in patients with CP are associated with gut microbiota dysbiosis.MethodsThe fecal microbiota of 69 healthy controls (HCs) and 71 patients with CP were compared to investigate gut microbiome alterations in CP and the relationship among gut microbiome dysbiosis, PEI and different etiologies. Fecal microbiomes were analyzed through 16S ribosomal RNA gene profiling, based on next-generation sequencing. Pancreatic exocrine function was evaluated by determining fecal elastase 1 activity.ResultsPatients with CP showed gut microbiota dysbiosis with decreased diversity and richness, and taxa-composition changes. On the phylum level, the gut microbiome of the CP group showed lower Firmicutes and Actinobacteria abundances than the HC group and higher Proteobacteria abundances. The abundances of Escherichia-Shigella and other genera were high in gut microbiomes in the CP group, whereas that of Faecalibacterium was low. Kyoto Encyclopedia of Genes and Genomes pathways (lipopolysaccharide biosynthesis and bacterial invasion of epithelial cells) were predicted to be enriched in the CP group. Among the top 5 phyla and 8 genera (in terms of abundance), only Fusobacteria and Eubacterium rectale group showed significant differences between CP patients, with or without PEI. Correlation analysis showed that Bifidobacterium and Lachnoclostridium correlated positively with fecal elastase 1 (r = 0.2616 and 0.2486, respectively, P < 0.05).ConclusionsThe current findings indicate that patients with CP have gut microbiota dysbiosis that is partly affected by pancreatic exocrine function.     

粪便弹力蛋白酶1在胰腺疾病中的检测及其作用评估

目的确定中国正常人粪便弹力蛋白酶1(fecalelastase1,FE1)的平均浓度及其范围并进行定量;FE1检测胰腺外分泌功能的敏感性与特异性;探讨其在胰腺疾病诊断与鉴别诊断中的意义。方法应用FE1检测试剂盒(ELISA),前瞻性地对73例不同年龄组的正常成年人进行FE1的检测;对24例非胰腺消化疾病、30例慢性胰腺炎、17例胰腺癌病人同时检测FE1和尿苯甲酰酪氨酰对氨基苯甲酸(BT PABA)。结果(1)正常人FE1浓度范围为136～1380(966.93±256.17)μg/g,各年龄组FE1浓度的差异无统计学意义。(2)慢性胰腺炎的FE1平均值为(208.80±197.72)μg/g,范围为15～900μg/g;胰腺癌组的FE1为(175.00±172.25)μg/g,范围为15～460μg/g;前两组FE1值均明显低于非胰腺疾病组[(502.63±210.28)μg/g](P<0.05)。(3)胰源性腹泻组FE1值[(166.11±192.35)μg/g]明显低于非胰源性腹泻组[(444.50±212.91)μg/g](P<0.01)。FE1检测胰源性腹泻的敏感性为77.8%,特异性为89.5%。尿BT PABA检测胰源性腹泻的敏感性为50.0%,特异性为42.9%。(4)FE1诊断慢性胰腺炎的敏感性为63.3%,特异性为97.3%。结论中国正常人的FE1浓度为(966.93±256.17)μg/g,不同年龄组正常人FE1浓度无明显差异。FE1诊断慢性胰腺炎的特异性较高,并对胰源性和非胰源性腹泻具有鉴别诊断价值。     

Serum elastase 1 in inflammatory pancreatic and gastrointestinal diseases and in renal insufficiency. A comparison with other serum pancreatic enzymes

Summary Serum elastase 1 has been evaluated in 115 patients with pancreatic and nonpancreatic gastrointestinal diseases and in 36 healthy controls. Increased serum elastase 1 values were found in all 27 patients with acute pancreatitis. If the diagnostic cutoff was established as the 2-fold increase above the upper normal range, sensitivity of elastase 1 (100%) was superior to pancreatic lipase (90%), immunoreactive trypsin (87%) and pancreatic amylase (78%). Specificity was 96% for elastase 1 at this cutoff. No distinction was possible between edematous and necrotizing acute pancreatitis on the basis of peak serum elastase 1 concentrations. Among 32 patients with chronic pancreatitis increased serum elastase 1 values were found in 22% and decreased values in 16% of patients, showing a striking parallelism to serum values of pancreatic lipase and immunoreactive trypsin. Specificity, established in controls and 49 patients with different gastrointestinal diseases, was 77% for elastase 1, 76% for immunoreactive trypsin, 83% for pancreatic lipase and 91% for pancreatic amylase. In addition, we investigated 21 patients with severe chronic renal diseases. In patients with renal insufficiency elastase was increased in 33%, comparable to the frequency of increased amylase and pancreatic amylase serum levels, whereas immunoreactive trypsin was increased in 95%. Immunoreactive trypsin showed a significant correlation to creatinin serum concentration, whereas the other enzymes did not.     

Fecal pancreatic elastase: a reproducible marker for severe exocrine pancreatic insufficiency

Background In order to apply fecal pancreatic elastase for follow-up of exocrine pancreatic function in chronic pancreatitis and cystic fibrosis, we examined the sensitivity, specificity, and long-term variability of a new polyclonal antibody-based enzyme-linked immunosorbent assay (ELISA). Methods Patients with definite chronic pancreatitis (n = 23), probable or possible chronic pancreatitis (n = 14), autoimmune pancreatitis (n = 7), or acute pancreatitis (n = 11), and 51 healthy subjects and 11 healthy infants participated in this study. Pancreatic function was graded as normal (n = 3), mild (n = 18), moderate (n = 9), or severe (n = 18) exocrine insufficiency on the basis of secretin tests. Fecal pancreatic elastase was measured by a new ELISA. Results Fecal pancreatic elastase concentration in control subjects varied widely, with a median of 478 μg/g. The specificity of this test was 90.2% with a cutoff value of >200 μg/g. The sensitivities were 60.9% for detecting definite chronic pancreatitis, 76.5% for calcifying pancreatitis, 71.4% for autoimmune pancreatitis, and 7.1% for probable or possible chronic pancreatitis. The sensitivities were 16.7% for mild, 12.5% for moderate, and 72.2% for severe exocrine pancreatic insufficiency. Forty patients were reexamined after a median interval of 347 days. The fecal pancreatic elastase levels between the first and second tests were not significantly different. Two infants, 4.5 and 5 months old, had abnormally low values, but after a median of 304 days all infants showed normal levels (median, 444 μg/g). Conclusions Fecal pancreatic elastase is a reproducible marker for severe exocrine pancreatic insufficiency. This test is valuable for longitudinal follow-up of exocrine pancreatic function.     

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).     

Comparison of BT-PABA test and fecal chymotrypsin measurements in normal subjects and diabetic patients

Summary A N-benzoil-L-tyrosil-PABA test on 6h urine collection, a plasma PABA assay 2h after administration and a fecal chymotrypsin assay were performed on 66 patients (36 controls and 30 type 2 diabetic patients on insulin therapy). All patients were hospitalized and without gastrointestinal and renal disease. The mean values of plasmatic PABA and fecal chymotrypsin were significantly lower in the diabetic group than in the controls (p<0.025 and p<0.01, respectively), although they remained within normal range. But this was not the case for PABA urinary excretion values. This may indicate a slower but more protracted PABA absorption during the third or fourth hour with the result that urinary excretion over 6h is not greatly affected. There was good correlation between fecal chymotrypsin values and both PABA urinary excretion values and serum PABA values, a trend observed both in diabetics (p<0.005 and p<0.001, respectively) and in controls (p<0.001 and p<0.005, respectively). This could indicate that even at lower mean levels, the diabetic patients show the same behavior pattern and therefore maintain the same indexes of correlation as the control population. Our results suggest that these indirect, but simple, economical and well-tolerated tests could be considered a valid alternative for investigating pancreatic function especially in those patients that cannot be tested by a Secretin-Cerulein test.     

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。     

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

     

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.