口服BT-PABA作胰腺外分泌功能试验测血法优于测尿法

多肽胰功能试验可以给临床诊断慢性胰腺疾病提供有价值的实验依据,但正常人与胰腺疾病组有部份交叉。为了提高胰腺外分泌功能试验的特异性及准确性,我们做了血PABA 滞留率与尿PABA 排出     

胰腺外分泌功能诊断新药——胰功肽

最近重庆医药工业研究所根据国外报道,在有关单位的协作下,试制成功了一种新的胰腺外分泌功能诊断用药,定名为:胰功肽。化学名称:N—苯甲酰—L—酪氨酰—对—氨基苯甲酸(N—Benzoyl—L—tyrosyl—P—aminobenzoic acid; BT—PABA),     

胰腺功能试验时测定尿中对氨基苯甲酸的一种简易法—DACA法

N-苯甲酰-L-酪氨酰-对氨基苯甲酸(Bz-ty-PABA)是检测胰腺外分泌功能的一种可靠的新药.在小肠,这种肽被糜蛋白酶分解而释出对氨基苯甲酸(PABA),PABA在肠道被吸收后从尿中排出.尿中回收的PABA被作为胰外分泌功能的一个指标.尿中PABA及其代谢物的测定,通常是经HCl水解后,用改良的Bratton-marshall(重氮偶联)法.     

胰功定试验测定胰腺外分泌功能的临床价值

胰腺外分泌功能测定的方法很多,而胰腺疾病诊断又较困难,我们进行了胰功定(BT—PABA)试验的临床研究。本文对有关资料进行了统计分析,证实本试验在临床上对胰腺疾患具有一定的诊断和鉴别诊断价值.简便易行,实用价值较大。 1 病人与方法 1.1 病例选择与分组:①具有下列病症的患者选为实验对象:怀疑慢性胰腺疾患;具有上腹部饱胀、食欲不振等消化不良症状;不明原因的慢性腹     

13例胰管内支架治疗慢性胰腺炎疗效分析

目的 探讨胰管内支架治疗慢性胰腺炎的疗效.方法 回顾性分析13例慢性胰腺炎患者的资料,患者均接受胰管内支架治疗,术后随访观察临床症状及生化检查等变化情况.结果 所有患者胰管支架放置成功,12例腹痛症状在术后1.5个月内缓解,缓解率92.31%,消瘦、脂肪泻等症状均不同程度得到改善,所有患者血清淀粉酶均于术后10 d内降至正常,1例患者于术后15 d支架阻塞更换支架.结论 胰管内支架治疗慢性胰腺炎是一种安全、微创、相对高效的方法,可有效地防止慢性胰腺炎的复发和进展.     

肿瘤标志物CEA、CA19—9、CA50在联合诊断胰腺癌中的价值

目的研究与胰腺癌有关的三种肿瘤标志物癌胚抗原（CEA）、癌抗原19—9（CA19—9）、癌抗原50（CA50）在胰腺癌诊断中的价值。方法采用放免法同时测定36例正常体检者、30例慢性胰腺炎患者、41例胰腺癌患者血清中CEA、CA19-9、CAS0值。结果胰腺癌患者血清中CEA、CA19—9、CAS0与正常人及慢性胰腺炎患者比较有显著性差异（P〈0．01）。CEA、CA19-9、CAS0单独检测时敏感性分别为38．6％、80.8％、78．2％，联合检测特异性达98．6％。结论CEA、CA19—9、CA50三种肿瘤标志物联合应用比单项应用提高了对胰腺癌的诊断价值。     

慢性胰腺炎外科治疗方法的选择

目的：探讨慢性胰腺炎的临床外科治疗方法的选择。方法：1999年5月至2005年11月期间所收治并经病理证实的64例慢性胰腺炎患者的资料进行回顾性分析。结果：胰十二指肠切除术12例，胰体尾或囊肿切除术23例，胰腺囊肿空肠Roux—en—Y吻合术6例，胰管空肠Roux—en—Y吻合术2例，胰腺囊肿外引流3例，胰床引流3例，胰腺活组织学检查21例。术后发生并发症4例，死亡1例，术后平均随访时间3年，手术治疗患者症状缓解率为85．2％。结论：慢性胰腺炎临床表现和影像学表现变化多样，应根据病变特点选择手术方式。强调慢性胰腺炎外科治疗的个体化。     

口服胰功肽检查胰腺外分泌功能的试验方法

胰腺外分泌功能检查对诊断胰腺疾病有重要意义,过去曾用的一些方法如Lundh试验及P-S(促胰酶素/促胰液素)试验,需要插管收集胰液,临床上难以推广使用。近年国内外已较广泛使用口服BT—PABA(N     

急性高脂血症性胰腺炎15例临床分析

目的:探讨急性高脂血症性胰腺炎的临床特点、实验室特征及治疗。方法:回顾性分析15例急性高脂血症性胰腺炎患者的临床资料。结果:治愈15例,随访1年,复发4例。结论:急性高脂血症性胰腺炎类似其他原因急性胰腺炎,重症较多,常见伴发2型糖尿病、慢性心血管疾病;以三酰甘油显著升高为特征,多有高血糖、凝血功能异常、动脉低氧血症,部分患者血淀粉酶可正常;降血脂、降血糖、早期扩容抗凝治疗有利于病情控制。     

多种MRI技术联合应用鉴别诊断胰腺癌与慢性胰腺炎

目的　评价联合应用多种MRI技术在鉴别诊断胰腺癌和慢性胰腺炎中的价值。方法　回顾分析 47例胰腺癌与 2 8例慢性胰腺炎的MRI表现。MRI技术包括 :平扫FSFLASHT1WI和TSET2 WI、MR胆胰管成像 (MRCP)及多时相动态增强扫描。测量肿块与正常胰腺信号值 ,计算对比噪声比 (CNR)。结果　平扫FSFLASHT1WI和TSET2 WI对胰头癌的敏感率为 5 9.4% ,对胰体癌为 86.7% ,对慢性胰腺炎为 78.6%。MRCP对胰头癌的敏感率为 90 .6% ,对胰体癌为 6.67% ,对慢性胰腺炎为 82 .1%。多时相动态增强扫描对胰头癌的敏感率为 78.1% ,对胰体癌为 93 .3 % ,对慢性胰腺炎为85 .7%。联合应用多种MRI技术对胰头癌的敏感率为 96.9% ,对胰体癌为 93 .3 % ,对慢性胰腺炎为 92 .9% (P <0 .0 1)。结论　多种MRI技术联合运用 ,是一项对胰腺癌和慢性胰腺炎进行鉴别诊断的准确有效的方法     

急慢性胰腺炎后新发2型糖尿病的危险因素Meta分析

目的 系统评价急慢性胰腺炎患者新发2型糖尿病危险因素的相关研究.方法 计算机检索中英文数据库,筛选符合纳入标准的病例对照研究,病例组为急慢性胰腺炎患者中新发2型糖尿病的患者,对照组为急慢性胰腺炎患者中未并发2型糖尿病的患者,对纳入的研究进行质量评估,提取数据并采用Review Manager5.3进行Meta分析及系统...     

The BT-PABA/PAS test in tropical diabetes.

A 'screening' test is needed to identify patients with chronic pancreatitis among diabetics in tropical field surveys. We have examined the potential diagnostic yield of the BT-PABA/PAS test of exocrine pancreatic function in this setting. The recoveries of both PABA and PAS in eight healthy controls from Madras, south India, were lower than in controls from Manchester, north west England (mean +/- S.D., 51 +/- 11 vs. 79 +/- 7%, P < 0.001 for PABA; 52 +/- 11% vs. 81 +/- 7%, P < 0.001 for PAS) but the % PABA/PAS excretion index (PEI) was similar (0.96 +/- 0.14 vs. 0.96 +/- 0.06). Using a cut-off value of 0.75 for the PEI in a study group including eight patients with chronic pancreatitis and 26 with primary forms of diabetes, test sensitivity was 75%, specificity 92%, positive predictive value 75%, negative predictive value 92% and efficiency 88%.     

Plasma trypsin in chronic pancreatitis and pancreatic adenocarcinoma.

We have used a simple and precise radioimmunoassay to measure trypsin in human plasma. Fasting plasma trypsin concentrations were extremely low in patients with chronic pancreatitis with steatorrhoea (5 +/- 2 ng/ml) when compared to healthy controls (86 +/- 7 ng/ml, p less than 0.001). In patients with chronic pancreatitis but no steatorrhoea basal plasma trypsin levels were similar to those of the normal controls (99 +/- 25 ng/ml). A small but significant postprandial rise in plasma trypsin concentrations was observed in normal subjects (mean increment 15 +/- 4%, p less than 0.005, paired t test) but was absent in patients with chronic pancreatitis with steatorrhoea. In contrast to exocrine deficient chronic pancreatitis, other malabsorptive conditions associated with steatorrhoea (active coeliac disease and acute tropical sprue) demonstrated mean fasting trypsin concentrations similar to controls. Patients with adenocarcinoma of the pancreas had basal trypsin concentrations similar to healthy subjects as did patients with adenocarcinoma of the stomach, colon, rectum, brochus, and breast. In some cases measurement of plasma trypsin may be of help in the differential diagnosis of steatorrhoea.     

Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis.

We investigated the diameter of pancreatic duct using ultrasonography in 51 children with pancreatitis and age-matched healthy control children over a 5 year period. The diameters of pancreatic duct and pancreatic body were measured simultaneously by sonography. The mean ages of children with acute pancreatitis and chronic pancreatitis were 9.7 +/- 3.9 and 10.3 +/- 3.1 years, respectively (range, 1 to 8 years). The mean age of normal children was 9.6 +/- 5.3 years. A significant difference was found in diameter of the pancreatic duct between children with acute and chronic pancreatitis versus that of age-matched control. In addition, a significant difference in diameter of the pancreatic body was found between children with acute pancreatitis and age-matched controls, but there was no marked difference in diameter of the pancreatic body between normal persons and those with chronic pancreatitis. The mean diameters of the pancreatic duct in acute pancreatitis and chronic pancreatitis were 2.34 +/- 0.47 mm and 2.84 +/- 0.67 mm, respectively, which was greater than that of normal children (1.65 +/- 0.45 mm). Pancreatic ducts with diameters greater than 1.5 mm in children between 1 and 6 years, greater than 1.9 mm at ages 7 to 12 years, or greater than 2.2 mm at ages 13 to 18 years were significantly associated with the presence of acute pancreatitis. Thirty-two patients, including 25 with acute pancreatitis and 7 with chronic pancreatitis, underwent follow-up measurement of pancreatic duct and serum lipase examination on at least three occasions. A good correlation between the diameter of pancreatic duct and serum lipase level was found. Thus, ultrasonography of the pancreatic duct is valuable in diagnosis and monitoring of pancreatitis in children.     

Secretion of somatotropic hormone in patients with pancreatitis

The concentration of somatotropic hormone (STH) was measured by radioimmunoassay in 108 patients with acute and chronic pancreatitis and in 15 healthy persons. In addition, to study the reserve capacity of the somatotropic function of the pituitary, insulin hypoglycemia was employed. It was established that during exacerbation, the pancreatitis patients manifested an increase in the hormone content. In the patients suffering from acute pancreatitis, the STH level returned to normal following treatment. In chronic pancreatitis, the hormone concentration remained elevated after treatment. No correlation was discovered between alterations in the STH level and the activity of pancreatic enzymes. The data obtained point to a definite role of STH in the pathogenesis of chronic pancreatitis.     

Serum pancreatic secretory trypsin inhibitor in pancreatic disease

The clinical usefulness of serum pancreatic secretory trypsin inhibitor (PSTI) in pancreatic diseases was evaluated. The mean serum PSTI level of 41 healthy normal persons was 9.4 ng/ml (ranging from 5.2 to 16.7 ng/ml). Serum PSTI levels were abnormally raised in all patients with acute pancreatitis ranging from 35.0 to 4500 ng/ml, but were almost within normal range in patients with chronic pancreatitis, pancreatic cyst, acute abdominal emergencies such as perforated ulcer and intestinal obstruction, and macroamylasemia. There was no correlation between serum PSTI levels and total or pancreatic-type isoamylase activity. Patients with acute pancreatitis in whom the elevation of serum PSTI was transient and occurred after that of serum amylase activity had relatively mild symptoms and recovered along with normalization of serum PSTI levels. On the other hand, patients whose serum PSTI values became increased coincidentally with serum amylase activity and remained elevated, had severe clinical symptoms and unfavorable clinical outcome. Of 2 patients who underwent partial pancreatectomy, the serum PSTI level increased markedly in one who developed postoperative pancreatitis but not in the other without pancreatitis. In contrast to patients with acute pancreatitis, the serum response to the secretin stimulation in patients with chronic pancreatitis, was only small and transient, reaching the maximum at 10 min after administration of secretin. These results suggest that measurement of serum PSTI concentration may be useful in the diagnosis of acute pancreatitis and that the degree of rise and the duration of the elevated levels of serum PSTI are closely related to the severity of acute pancreatitis.     

Serum amyloid A versus C-reactive protein in acute pancreatitis: clinical value of an alternative acute-phase reactant

OBJECTIVES: The acute-phase reactant C-reactive protein (CRP) is currently the serum variable of choice for an early, accurate, and cost-effective severity assessment of acute pancreatitis in the daily clinical routine. Serum amyloid A (SAA) proteins comprise a family of apolipoproteins that constitute another major acute-phase reactant and thus could be a potential alternative to CRP assessment. In the present study we investigated the clinical usefulness of SAA determinations in acute pancreatitis using an automated immunoassay technique. DESIGN: Cohort study, comparing patients with complicated and mild acute pancreatitis; control groups included individuals with further abdominal disorders and healthy volunteers. SETTING: A collaborative study between the department of general surgery and the routine laboratory of the department of clinical chemistry/pathobiochemistry. PATIENTS: We enrolled 66 patients with acute pancreatitis in the present study. Control groups consisted of healthy subjects (n = 30), patients with chronic pancreatitis (n = 20), patients with pancreatic carcinoma (n = 20), and patients with acute appendicitis (n = 20). INTERVENTIONS: Blood samples were collected during 14 consecutive days in patients with acute pancreatitis. A single blood specimen was taken in all control groups after the diagnosis was established. MEASUREMENTS AND MAIN RESULTS: SAA concentrations were 3 mg/L (median; range, 3-93) in healthy subjects. Although SAA and CRP both reached their maximum within 4 days after onset of symptoms in patients with acute pancreatitis, SAA concentrations rose faster above normal ranges and reached 676 mg/L (median; range, 12-1880), higher than CRP, which reached 313 mg/L (median; range, 29-613). As observed for CRP, SAA was significantly higher in patients who developed complications such as necrosis, infection of necrosis, or multiple organ dysfunction syndrome or in patients who died. SAA achieved best results in discriminating between necrotizing pancreatitis and interstitial edematous pancreatitis. However, CRP provided an earlier differentiation between both entities and a significantly better overall accuracy, as shown by receiver operating characteristics analysis. SAA concentrations in patients with chronic pancreatitis were 6 mg/L (median; range, 3-756). In patients with pancreatic carcinoma, SAA concentrations were 7 mg/L (median; range, 3-492), and in patients with acute appendicitis, they were 50 mg/L (median; range, 3-2140). CONCLUSION: SAA is a nonspecific and rapidly produced variable in inflammatory abdominal disorders with a wider dynamic range than CRP. The current assay technique renders SAA an applicable and readily available variable under clinical routine conditions. In cases of acute pancreatitis, however, CRP is still superior to SAA for early and accurate stratification of patients with a complicated course.     

C reactive protein in pancreatic cancer and chronic pancreatitis

Serum C reactive protein was determined in 30 control subjects, 32 patients with pancreatic cancer, 28 with chronic pancreatitis and 23 with extra-pancreatic diseases of the upper gastrointestinal tract. The aim was to ascertain possible alterations of this index in chronic pancreatic disease and to speculate on some influencing factors. Higher C reactive protein levels were found in pancreatic cancer as compared to controls. Pancreatic cancer patients with systemic metastases had higher levels of this index compared to those with non-metastatic disease. Raised concentrations of C reactive protein were detected in 7/28 subjects with chronic pancreatitis. In this group these higher levels were found in patients in a relapsing phase of the disease; no association was observed with pancreatic pseudocysts. Among all subjects a correlation was found, between C reactive protein and age; patients with abnormal fasting blood glucose levels or increased white blood cell count had higher levels of this protein as compared to the remaining patients. We may conclude that C reactive protein increases in pancreatic cancer, specially in relation to tumour extent; in chronic pancreatitis it reflects the inflammatory status of the gland. While acting in the context of the acute phase response, this test may provide an adjunct in evaluating patients with a chronic pancreatic disease.     

Immunoreactive trypsin in the blood serum of patients with endogenous hypercorticism

Radioimmunoassay (RIA) was used to measure the response of serum trypsin to intravenous secretin and pancreozymin in 16 subjects with adrenocortical hyperfunction (group I) versus 6 subjects with hypercorticism (group II). In group I the enzyme reaction to the peptides was active and long-term. A similar rise in trypsin level occurred equally in patients free of chronic pancreatitis often present in Itsenko++ -Cushing syndrome. In group II patients RIA trypsin values comply with normal levels. The data obtained suggest an affected pancreatic status in adrenal hyperfunction both in the presence and absence of chronic pancreatitis which minimizes the informative value of the test in identification of chronic pancreatitis in endogenic hypercorticism.     

Comparisons between absorption of vitamin E in patients with chronic pancreatitis and healthy controls: the bioavailability of vitamin E

The fasting serum levels of alpha-tocopherol were determined by high-pressure liquid chromatography in 13 patients with chronic pancreatitis of whom 7 were positive for pancreatic calcification (CCP) and 6, negative (NCP) and 10 healthy subjects. The fasting serum levels of alpha-tocopherol were significantly lower in patients with chronic pancreatitis (7.2 +/- 1.1 micrograms/ml for CCP and 7.9 +/- 0.6 for NCP) than in healthy subjects (11.3 +/- 0.7 micrograms/ml). Vitamin E absorption was determined in those with chronic pancreatitis and in healthy subjects after postprandial oral administration of 400 mg of vitamin E, using soft capsules which contained tocopherol nicotinate along with an appropriate amount of a suspension of an ester of fatty acids with glycerol and middle chain triacylglycerol. The mean absorption of vitamin E was 12.7 +/- 2.0 micrograms/ml X hr for healthy subjects, 9.1 +/- 3.1 micrograms/ml X hr for CCP and 13.0 +/- 2.7 micrograms/ml X hr for NCP, respectively. There was no significant difference in vitamin E absorption between patients with chronic pancreatitis and healthy subjects. Further, the rate of hydrolysis of tocopherol nicotinate did not significantly differ between healthy subjects and patients with chronic pancreatitis. It is of interest to note that vitamin E absorption in patients with chronic pancreatitis was increased by the postprandial use of an oily suspension type preparation of tocopherol nicotinate.