Serum profiles of interleukin-18 in different severity forms of human acute pancreatitis

BACKGROUND: Interleukin 18 (IL-18) is a new mediator and modulator of the immune response; its role in acute pancreatitis (AP), however, has not yet been fully explained. The aim of our study was to evaluate the profile IL-18 serum concentrations in the course of acute pancreatitis. METHODS: The prospective study involves 30 patients with AP (n = 15 with mild AP and n = 15 with severe AP) as well as 10 healthy subjects. AP severity was defined according to Ranson's and Balthazar's criteria, supplemented by serum CRP concentration measurements. In the course of hospitalization, 2 patients with severe AP died. Serum IL-18 and plasma polymorphonuclear leukocyte elastase (PMN-E) concentrations were measured at admission (day 1) and on days 2, 3, 5 and 10. RESULTS: In both the mild and the severe forms of AP, serum IL-18 concentration was significantly higher than in the healthy controls. In severe AP, serum IL-18 reached the highest levels in all observed periods compared to that in patients with mild AP. Significant correlations, calculated for day 1, were found between serum IL-18 and plasma PMN-E (Rs = 0.514. P < 0.001) and between IL-18 and CRP (Rs = 0.463, P < 0.001) levels. CONCLUSIONS: Serum profile IL-18 during AP indicates that this cytokine was released early after AP onset and may play the key role in inflammatory and immune response. Positive correlation between serum IL-18 and commonly known early prognostic markers of AP severity suggest that serum IL-18 concentrations may represent another early marker indicating severe course of AP.     

Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis

We studied potential indicators of severe acute pancreatitis by measuring the blood concentrations of various cytokines, polymorphonuclear leucocyte elastase (PMN-E), acute phase reactants, pancreatic amylase (P-AMY), pancreatic elastase-1 (E-1) and white blood cell (WBC) counts in patients with acute pancreatitis. In addition, the presence of multiple organ damage was assessed. Subjects consisted of 22 patients with acute pancreatitis including severe (n= 11), moderate (n= 4) and mild (n= 7) cases. A significant positive correlation was observed between the number of organs damaged and the peak concentrations of interleukin (IL)-6, PMN-E, C-reactive protein (CRP) and pancreatic secretory trypsin inhibitor (PSTI). Among these markers, blood concentrations of PMN-E and IL-6 rapidly increased and peaked at the early phase of acute pancreatitis whereas CRP and PSTI did not. The elevation of PMN-E and IL-6 was greater the more severe the symptoms. However, no significant correlation was observed between the number of organs damaged and the maximum serum concentrations of P-AMY and E-1, or the WBC count, which have been considered to be markers of pancreatitis. These results suggest that PMN-E and IL-6 concentrations are useful indicators of severity and prognosis and their determination facilitates the selection of appropriate treatment in the early stages of disease to prevent the aggressive progression of acute pancreatitis.     

The Importance of Interleukin 18, Glutathione Peroxidase, and Selenium Concentration Changes in Acute Pancreatitis

Cytokinemia and oxidative stress are important factors responsible for an inadequate immune response in the early course of acute pancreatitis (AP). The aim of the study was to evaluate the profiles of interleukin 18 (IL-18), glutathione peroxidase (GPx), and selenium concentrations in serum with respect to AP severity and to study the relationships between these parameters and recognized prognostic indicators of AP severity. Prospective clinical analyses were performed on 61 patients with mild and severe forms of AP and for 15 healthy volunteers. In both forms of AP severity, the IL-18 concentration in the serum was significantly higher than in healthy controls. In the severe form of AP, the IL-18 concentration was the highest and exceeded significantly the values recorded on the 1st, 2nd, 3rd, 5th, and 10th days of mild AP. A significantly lower GPx concentration in the serum was recorded in severe AP compared to the mild form and in the control group. There was a significantly lower selenium concentration in the severe form of AP. Significant correlations between GPx and selenium, between IL-18 and GPx, and between IL-18 and selenium were recorded. The ROC analysis shows a high prognostic accuracy of IL-18 and GPx concentrations in the determination of AP severity. IL-18 is released early in the course of AP and may be a key immunomodulator of the inflammatory response in the severe form of this disease. Low GPx and selenium concentrations in severe AP reflect the lower antioxidative ability in this form of AP. IL-18 and GPx may represent new indicators of AP severity.     

血清C反应蛋白、脂肪酶、白细胞介素1β和细胞间黏附分子1联合检测在急性胰腺炎诊断中的应用价值

目的通过动态检测急性胰腺炎(AP)患者外周血清C反应蛋白(CRP)、脂肪酶(LPS)、白细胞介素(IL)1β和细胞间黏附分子(ICAM)1的水平及变化,评价多种指标联合检测在AP临床诊断中的价值。方法收集2010年1月-2012年12月在中国医科大学附属第四医院进行治疗的AP患者86例,其中重症急性胰腺炎(SAP)患者39例,轻症急性胰腺炎(MAP)患者47例。于入院第1、3、5、7天分别采集患者血清,另选取12例同期健康体检者作为对照。采用ELISA法检测血清中CRP、IL-1β和ICAM-1水平,干片速率法测定血清LPS的浓度。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 MAP组患者入院第1天的CRP、IL-1β和LPS水平明显高于对照组,差异均有统计学意义(t值分别为-74.126、-60.135、-364.153,P值均0.001);SAP组患者入院第1天的CRP、ICAM-1、IL-1β、LPS水平均明显高于对照组,差异亦有统计学意义(t值分别为-121.355、-25.728、-89.422、-415.840,P值均0.001);各检测指标浓度的峰值出现在入院第1天或第3天,且随着治疗时间的延长,浓度呈进行性下降;与MAP患者相比,SAP患者血清中CRP、LPS、IL-1β和ICAM-1水平均较高,差异均有统计学意义(P值均0.05)。结论联合检测患者血清CRP、LPS、IL-1β和ICAM-1水平对于AP严重程度的早期判断具有一定的临床参考价值。     

急性胰腺炎早期临床多因素综合分析对病情轻重及预后的预警作用

目的 探讨影响急性胰腺炎(AP)早期病情严重程度及预后的因素.方法 确诊AP 286例,根据CT 分级分为轻症与重症两组,分析年龄、性别、病因及发病48 h内患者血氧分压、血清电解质、空腹血糖、C反应蛋白(CRP)、血淀粉酶变化与胰腺CT分级比较,判定影响AP早期病情严重程度的指标.结果 两组性别相比较X2=0.086...     

Serum lipase, C-reactive protein, and interleukin-6 levels in ERCP-induced pancreatitis

BACKGROUND: C-reactive protein (CRP) and interleukin-6 (IL-6) are elevated in acute pancreatitis. Limited studies have evaluated their role in ERCP-induced pancreatitis. The aim of this study was to assess the role of serum lipase, CRP, and IL-6 in ERCP-induced pancreatitis. METHODS: Eighty-five patients (62 women, 23 men; mean age 43 years; range 16-85 years) who underwent ERCP were entered in a prospective trial. ERCP-induced pancreatitis was classified as mild, moderate, or severe. Serum levels of lipase, CRP, and IL-6 were measured before ERCP and at 12 to 24 hours and 36 to 48 hours after ERCP. RESULTS: Mild, moderate, and severe pancreatitis occurred, respectively, in 9, 7, and 4 patients after ERCP. There were significant differences in levels of CRP and IL-6 but not lipase for patients with mild versus moderate and moderate versus severe pancreatitis. The mean CRP levels (mg/dL) at 12 to 24 hours were 0.98 +/- 0.24 in mild pancreatitis, 3.89 +/- 0.32 in moderate pancreatitis, and 12.0 +/- 1.60 in severe pancreatitis. The levels, respectively, at 36 to 48 hours were 1.60 +/- 0.31, 7.60 +/- 0.74, and 25.0 +/- 2.9. The mean IL-6 levels (pg/mL) at 12 to 24 hours were 16.6 +/- 2.06 in mild pancreatitis, 73.0 +/- 15.60 in moderate pancreatitis, and 235.5 +/- 26.31 in severe pancreatitis. The levels at 36 to 48 hours were, respectively, 18.92 +/- 3.28, 100.17 +/- 11.56, and 438.2 +/- 71.50. CONCLUSIONS: Serum CRP and IL-6 levels may be useful early markers for predicting the severity of ERCP-induced pancreatitis.     

Mononuclear histocompatibility leukocyte antigen-DR expression in the early phase of acute pancreatitis.

BACKGROUND: In acute pancreatitis (AP), several studies indicated that the balance between pro- and anti-inflammatory mediators is more important than the levels of proinflammatory response alone. This balance may be reflected by the expression of monocyte histocompatibility leukocyte antigen (HLA)-DR, with a low concentration indicating an excess of anti-inflammatory stimuli and relative immunodeficiency. We investigated the time course of HLA-DR expression in the early phase of AP and the relationship to markers of inflammation, severity of the disease, organ function, septic complications and outcome during AP. METHODS: The expression of HLA-DR on peripheral monocytes was measured in 74 patients by flow cytometry and serum IL-6 was determined by using an immunochemiluminescence assay obtained 24 h, 48 h, 72 h, 7 days, 10 days and 14 days after admission in parallel with clinical data collection. 25 patients had mild disease (grade 1), 31 had severe disease but recovered without organ failure (grade 2) and 18 had severe disease and developed organ failure (grade 3). RESULTS: In 49 patients with severe disease, 11 patients suffered from sepsis, and 3 of them died during the hospital stay. During the first 14 days of AP, the percentage of HLA-DR in AP was significantly below the normal range of healthy subjects, it dropped to the lowest level on day 3, but then gradually recovered from the prophase depression. The HLA-DR expression decreased in the order grade 3 < grade 2 < grade 1 (p < 0.001). We also observed a significant inverse correlation between the percentage of HLA-DR+ and AP severity as assessed by APACHE-II scores (r = 0.754, p < 0.001) and MODS score (r = 0.675, p < 0.001). The peak of systemic inflammatory reaction, documented by maximum serum concentration of CRP, coincided with the nadir of HLA-DR suppression. Moreover, IL-6 and CRP serum concentrations were inversely correlated with HLA-DR expression over the entire observation period. Persistent HLA-DR suppression and a second decrease in HLA-DR expression are associated with septic complications and poor outcome. CONCLUSION: Immune suppression develops early and rapidly in patients with AP, and the degree is parallel with the severity of the disease. Decreases in HLA-DR expression occurred simultaneously with signs of hyperinflammation in the early phase of AP, and persistent HLA-DR suppression and a second decrease in HLA-DR expression are associated with septic complications and poor outcome.     

Tissue factor in predicted severe acute pancreatitis

AIM: To study tissue factor (TF) in acute pancreatitis and evaluate the role of TF as a predictive marker of severity. METHODS: Forty-nine consecutive patients admitted to Lund University Hospital, fulfilling the criteria of predicted severe acute pancreatitis (AP), were recruited prospectively between 2002 and 2004. Blood samples for TF analyses were drawn at inclusion in the study and 12 h, 1 d and 3 d later. RESULTS: Twenty-seven patients developed mild AP, and 22 patients severe AP. At inclusion in the study, the groups were comparable with respect to gender, aetiology, Acute Physiology and Chronic Health Evaluation Ⅱ score, and duration of pain. At inclusion in the study and at 12 h, TF was higher in the severe AP group (P = 0.035 and P = 0.049, respectively). After 1 and 3 d, no differences in TF levels were noted. Interleukin (IL)-6 was significantly higher in the severe AP group at all of the studied time points. C-reactive protein (CRP) was significantly higher in the AP group at 1 and 3 d. In receiver operating characteristic-curves, the area under the curve (AUC) for TF was 0.679 (P = 0.035) at inclusion in the study, and a cut off level for TF of 40 pg/mL showed a sensitivity of 71% and a specificity of 67%, whereas corresponding AUC for IL-6 was 0.775, P = 0.001, and for CRP was 0.653. IL-6 showed better AUC-values than TF at all time points studied. CONCLUSION: TF-levels are raised early in severe AP. TF as an early predictive marker of severe AP is superior to CRP, but inferior to IL-6.     

The dynamics of the oxidant-antioxidant balance in the early phase of human acute biliary pancreatitis.

BACKGROUND/AIM: Reactive oxygen species play an important role in the pathogenesis of acute pancreatitis (AP) in animal models. Data on the oxidant-antioxidant balance in humans are scanty. The present study was undertaken to evaluate the dynamics of changes in the oxidant-antioxidant balance in the early phase of human AP. METHODS: 74 consecutive patients with acute biliary pancreatitis (16 with severe, 58 with mild pancreatitis), treated endoscopically, were included in the study. Serum concentrations of sulfhydryl groups (SH; main nonenzymatic antioxidant; 73 patients) and thiobarbituric acid reactive substances (TBARS; markers of reactive oxygen species-mediated tissue damage; 56 patients) were determined on admission and on each of 10 successive days. The analysis comprised the comparison of results in patients with mild and severe outcome of pancreatitis. RESULTS: Serum SH dropped by 27%, reaching the trough level on day 4 of hospitalization, whereas serum TBARS rose by 28%, reaching a peak 1 day later. Neither SH nor TBARS returned to initial values at the end of observation. The most dynamic changes in both SH and TBARS concentrations occurred in the first 3 days of hospitalization. The changes were significantly greater in patients with complicated pancreatitis in comparison to patients with mild disease, and were most pronounced in patients who developed infected pancreatic necrosis and who subsequently died. CONCLUSIONS: The oxidant-antioxidant balance changes rapidly in the early phase of human AP, confirming the role of oxidative stress in the pathogenesis of AP. The degree of changes correlates with the clinical severity of pancreatitis.     

急性胰腺炎患者血清白介素-8和C-反应蛋白含量变化及其临床意义

目的 :检测急性胰腺炎 (AP)患者血清白细胞介素 8(IL 8)和C 反应蛋白 (CRP)含量变化 ,探讨其临床意义。方法 :检测 30例AP患者入院时和入院后第 3、5、7天时血清IL 8和CRP含量 ,与 30例健康人作对照。结果 :入院时 ,AP患者血清IL 8和CRP含量均显著高于对照组 (P <0 .0 5 ) ,其中重症急性胰腺炎 (SAP)患者血清IL 8和CRP含量又明显高于轻症急性胰腺炎 (MAP)患者 (P <0 .0 5 )。入院后第 5、7天 ,MAP组中血清IL 8和CRP含量均显著低于入院时 (P <0 .0 5 ) ,入院后第 3天 ,SAP组中血清IL 8和CRP含量均显著性高于入院时 (P <0 .0 5 ) ,血清IL 8含量和CRP含量变化呈正相关 (r =0 .6 931,P <0 .0 5 )。结论 :血清IL 8和CRP含量变化与AP病情变化密切相关 ,联合检测有助于了解病情发展     

炎症因子联合Ranson评分预测急性胰腺炎严重程度和指导临床治疗的价值分析

目的 探讨炎症因子联合Ranson评分预测急性胰腺炎（AP）严重程度和指导临床治疗的价值。方法 根据2012年Atlanta标准将150例AP患者分为轻度组（50例）、中度组（50例）和重度组（50例），比较各组血清炎症因子[白细胞介素（IL）-6、降钙素原（PCT）、C反应蛋白（CRP）、IL-8、IL-10]水平和Ranson评分，并统计各组病死率，绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），比较各指标评估器官功能衰竭和病死率的价值。结果 3组患者发病12h、24h、48h时的PCT、IL-6、CRP逐渐升高，且随着病情严重程度增加而逐渐增高（P＜0.05）；3组患者发病24h时的IL-10水平高于发病12h，但发病48h低于发病24h（P＜0.05）；轻、中、重度组Ranson评分随病情严重程度增加呈递增趋势（P＜0.05）；重度组病死率（16.0%）高于轻度组（0）和中度组（2.0%，P＜0.05）。血清炎症因子中，IL-6评估器官功能衰竭和病死率的AUC＞PCT、CRP；CRP评估胰腺坏死的AUC＞PCT、IL-6；Ranson评分评估器官功能衰竭和病死率的AUC＞PCT、IL-6、CRP；PCT+IL-6+CRP+Ranson评分评估器官功能衰竭、胰腺坏死及病死率AUC均＞Ranson评分及任一血清炎症因子。结论IL-6评估AP患者器官功能衰竭、病死率价值较高，CRP评估胰腺坏死价值较高，PCT、IL-6、CRP与Ranson评分系统联合应用可进一步提高对其器官功能衰竭、胰腺坏死、病死率的预测能力，为临床治疗策略的选择提供参考。     

Resistin is not an appropriate biochemical marker to predict severity of acute pancreatitis: A case-controlled study

AIM: To assess levels of serum resistin upon hospital admission as a predictor of acute pancreatitis (AP) severity.METHODS: AP is both a common and serious disease, with severe cases resulting in a high mortality rate. Several predictive inflammatory markers have been used clinically to assess severity. This prospective study collected data from 102 patients who were diagnosed with an initial acute biliary pancreatitis between March 2010 and February 2013. Measurements of body mass index (BMI) and waist circumference (WC) were obtained and serum resistin levels were analyzed at the time of hospital admission using enzyme-linked immunosorbent assay. Additionally, resistin levels were measured from a control group after matching gender, BMI and age.RESULTS: A total of 102 patients (60 females and 42 males) were diagnosed with acute gallstone-induced pancreatitis. The mean age was 45 years, and mean BMI value was 30.5 kg/m² (Obese, class I). Twenty-two patients (21.6%) had severe AP, while eighty-eight patients had mild pancreatitis (78.4%). Our results showed that BMI significantly correlated with pancreatitis severity (P = 0.007). Serum resistin did not correlate with BMI, weight or WC. Furthermore, serum resistin was significantly higher in patients with AP compared to control subjects (P < 0.0001). The mean resistin values upon admission were 17.5 ng/mL in the severe acute biliary pancreatitis group and 16.82 ng/mL in the mild AP group (P = 0.188), indicating that resistin is not an appropriate predictive marker of clinical severity.CONCLUSION: We demonstrate that obesity is a risk factor for developing severe AP. Further, although there is a correlation between serum resistin levels and AP at the time of hospital admission, resistin does not adequately serve as a predictive marker of clinical severity.     

Significant elevation of serum interleukin-18 levels in patients with acute pancreatitis

Background We have reported that peripheral lymphocyte reduction due to apoptosis is linked to the development of subsequent infectious complications in patients with severe acute pancreatitis and that Th1 (helper T cell type 1)/Th2 (helper T cell type 2) balance tends to cause Th1 suppression in experimental severe acute pancreatitis. It has been reported that interleukin (IL)-18 is a cytokine produced from Kupffer cells and activated macrophages, and that IL-18 acts on Th1 cells and in combination with IL-12 strongly induces production of interferon-γ. However, the role of IL-18 in acute pancreatitis has not yet been fully understood. Methods Serum IL-18 concentrations were determined by an enzyme-linked immunosorbent assay in 43 patients with acute pancreatitis at the time of admission. The relationships with etiology, pancreatic necrosis, severity, blood biochemical parameters on admission, infection, and organ dysfunction during the clinical course and prognosis were analyzed. Results Serum IL-18 levels in patients with acute pancreatitis (656 ± 11pg/ml) were significantly higher than those in healthy volunteers (126 ± pg/ml). Serum IL-18 levels were significantly positively correlated with the Ranson score and Japanese severity score. Among the blood biochemical parameters on admission, base excess and total protein were significantly negatively correlated with serum IL-18 levels. Moreover, the CD4/CD8 rate of lymphocytes, serum IL-6 levels, and serum IL-8 levels were significantly positively correlated with serum IL-18 levels. On day 7 after admission, the CD4/CD8 rate of lymphocytes and the rate of CD4-positive lymphocytes were significantly positively correlated with serum IL-18 levels. Furthermore, serum IL-18 levels in patients with hepatic dysfunction (980 ± 25pg/ml) were significantly higher than those without hepatic dysfunction (464 ± 8pg/ml). Serum IL-18 levels were not related to infection or prognosis. Elevation of serum IL-18 levels continued during 4 weeks after admission. Conclusions These results suggest that serum IL-18 levels are significantly elevated and are correlated with severity in patients with acute pancreatitis and that IL-18 may be closely related to helper T cell response and hepatic dysfunction in this disease.     

血清白细胞介素-6和细胞间黏附分子-1对急性胰腺炎严重程度的早期判断价值

目的:研究血清白细胞介素-6(IL-6)和细胞间黏附分子-1(ICAM-1)对急性胰腺炎严重程度的早期判断价值.方法:收集临床确诊的28例急性胰腺炎(AP)患者,分为重症急性胰腺炎(SAP)13例和轻症急性胰腺炎(MAP)15例两组,另选择10例体检健康人群作对照组(CG),分别测定血清IL-6和ICAM-1的浓度、并进行比较.结果:(1)发病24 h 内入院的SAP患者血清IL-6和ICAM-1浓度与MAP患者及对照组之间有显著性差异(P＜0.01);而MAP患者与CG之间无显著性差异(P＞0.05)(2)入院时SAP患者血清IL-6浓度与MAP患者及对照组之间有明显差异(P＜0.01);入院后SAP患者的血清IL-6浓度逐渐下降,5 d后与MAP比较无显著性差异(P＞0.05).(3)入院2 d后 SAP患者血清ICAM-1的浓度升高最明显,以后逐渐下降,但与MAP比较均有显著性差异(P＜0.05).讨论:血清IL-6和ICAM-1对急性胰腺炎病情严重程度有早期判断价值.     

C-reactive protein (CRP) and serum phospholipase A2 in the assessment of the severity of acute pancreatitis.

The present study examines the value of C-reactive protein (CRP) determinations in the assessment of the severity of acute pancreatitis and the correlation of CRP with serum phospholipase A2 activity and the clinical status. Fifty three patients with acute pancreatitis were studied; 17 with haemorrhagic pancreatitis and 36 with a mild form of the disease. S-phospholipase A2 activity increased significantly (p less than 0.05) in patients with fatal pancreatitis but not in those with mild disease. Phospholipase A2 concentrations were below 10 nmol FFA/ml min in mild, while they rose to 20-40 nmol FFA/ml min in haemorrhagic pancreatitis. In fatal cases very high (up to 50-60 nmol FFA/ml min) serum phospholipase A2 concentrations were recorded. The increase in CRP was greater in the patients with severe pancreatitis. One day after admission mean CRP was 280 mg/l in patients with haemorrhagic and 45 mg/l in those with the mild pancreatitis (p less than 0.001). High CRP values also correlated with the prognostic signs indicative of severe pancreatitis. CRP and S-phospholipase A2 determinations are valuable in the early assessment of the severity of acute pancreatitis, but the CRP assay is much easier to include in hospital routine.     

Soluble CD40 ligand in prediction of acute severe pancreatitis

AIM: To assess the early predictability of the soluble CD40L (sCD40L) in pancreatitis severity. METHODS: Between February 2000 and February 2003, 279 consecutive patients with acute pancreatitis were prospectively enrolled in our study. In this report, 40 patients with mild and 40 patients with severe pancreatitis were randomly studied. sCD40L concentrations were measured 48 hours after admission. RESULTS: sCD40L levels were significantly higher 48 hours after admission in severe pancreatitis than in mild pancreatitis. Using a cutoff of 1000 pg/L, the sensitivity and specificity of sCD40L to detect a severe course of the disease were 78% and 62% respectively compared to 72% and 81% for CRP. Logistic regression analysis found that CRP was the only statistically significant marker able to detect a severe course of the disease. CONCLUSION: These findings indicate that CRP remains a valuable marker to determine the severity and prognosis of acute pancreatitis whereas sCD40L levels should be assessed in further studies.     

Sequential Changes in Pancreatic Markers in Acute Pancreatitis

Background: Trypsinogen activation within acinar cells plays a crucial role in the pathogenesis of acute pancreatitis (AP). Our aim was to characterize temporal changes of trypsinogen-1, trypsinogen-2, complexes of trypsin-1- &#33 1 -antitrypsin (T1-AAT) and trypsin-2- &#33 1 -antitrypsin (T2-AAT), trypsinogen activation peptide (TAP) and pancreatic secretory trypsin inhibitor (PSTI) in patients with AP. Methods: The study comprised 64 consecutive patients with AP (19 with severe disease) and 32 controls. The concentrations of trypsinogen-1 and -2, PSTI, T1-AAT and T2-AAT were determined by time-resolved immunofluorometric assays (IFMA), and TAP was measured using a competitive enzyme immunoassay from serum and urine. Results: The concentrations of trypsinogen-1 and -2 in serum reflected similar patterns, but excretion of trypsinogen-1 into urine was markedly lower than that of trypsinogen-2, the concentration of which correlated strongly with disease severity. The concentrations of T1-AAT were no higher in severe AP than in mild AP, while T2-AAT concentrations were significantly higher in severe than in mild disease. PSTI increased over the course of several days, showing strong correlation with disease severity. The concentrations of plasma and urinary TAP decreased rapidly to undetectable levels. During the early phase of AP, TAP correlated with the disease severity in plasma and urine but there was no difference between controls and patients with mild AP. Conclusion: More pronounced changes in trypsinogen-2 and its complex with AAT than in those of trypsinogen-1 were demonstrated, suggesting that trypsinogen-2 might play a more important role in the pathogenesis of AP than earlier believed. Urinary PSTI showed features warranting further investigations as a marker of disease severity.     

急性胰腺炎患者血淀粉酶变化和CT诊断的比较

目的探讨血淀粉酶的变化规律及其机制。方法本研究对确诊的172例急性胰腺炎(AP)患者随机分为3组,分别在发病≤12 h、12～24 h、48～72 h行CT和血淀粉酶检查。分析不同时间段CT和血淀粉酶检出率。结果 87.5%患者血淀粉酶在6～12 h升高;100%患者血淀粉酶在12 h以上升高。91.3%的患者在12～24 h之间CT检查发现胰腺炎症变化,但与发病大于48 h相比,无显著差异。12 h之内,血淀粉酶升高的阳性率高于CT诊断的阳性率(χ2=22.04,P<0.01)。48～72 h D级、E级检出率明显高于12 h之内和12～24 h之间的检出率。血淀粉酶随着轻症急性胰腺炎分级水平有上升趋势;随着重症急性胰腺炎分级水平有下降趋势。结论血淀粉酶升高的水平与胰腺炎的病情程度无明显相关性,推测其机制可能与胰腺微循环受损程度有关。     

Neopterin in Acute Pancreatitis

Background: Activation of the cellular immune system may play a role in the pathogenesis of acute pancreatitis (AP); it has recently been proposed that excessive leukocyte stimulation may lead to the most severe forms of AP. The aim of this study was to investigate serum neopterin, a useful in vivo marker of macrophage activation, in mild and severe AP and its relationship with other markers of leukocyte activation, such as interleukin-6 (IL-6) and tumor necrosis factor (TNF). Methods: Serum levels of neopterin (mmol/ml), IL-6 (pg/ml), and TNF (pg/ml) were measured on the 1st and 7th day of hospitalization in 17 patients with severe AP and 24 with mild AP. Severe AP was defined in accordance with the Atlanta criteria: all patients have necrosis at contrast-enhanced computerized tomography scan. Results: Day 1: Neopterin and IL-6 levels were significantly higher in the severe than in the mild AP and normal controls; mild AP values were also significantly higher than in normal controls. The best neopterin cutoff level we obtained (30 mmol/ml) reached a specificity of 76% and a sensitivity of 46% in distinguishing severe from mild AP. Day 7: Neopterin was significantly higher in severe AP than in mild AP and in normal controls; no difference was seen between mild AP values and normal controls; neopterin serum levels were significantly higher on day 7 than on day 1 in severe AP but not in mild AP; in both groups of patients IL-6 was significantly higher on day 1 than on day 7. Using a neopterin cutoff level of 40 mmol/ml, we found a specificity and sensitivity value of 92% in differentiating severe from mild AP. With regard to TNF values, no difference was seen on days 1 and 7 in the two groups of patients in comparison with normal controls. Neopterin serum values did not correlate with IL-6 and TNF on either day. Conclusions: These results confirm the activation of the cellular immune system in AP. Initially enhanced NEOP and IL-6 serum levels reflect the severity of the disease; neopterin may be considered a reliable prognostic indicator also at a distance from AP onset because its levels increase during the 1st week of AP in patients with severe forms only.     

CT严重指数、超声造影联合血清降钙素原评估AP疗效

背景超声具有无创简便等优点,在急性胰腺炎病诊治中发挥着重要作用,而超声造影能通过分析胰腺微循环血流灌注,评估其缺血坏死状态,为临床诊治提供血流动力学信息.目的探讨超声造影联合血清降钙素原(procalcitonin,PCT)在评估急性胰腺炎(acute pancreatitis,AP)病情和疗效中的应用价值,及其与CT严重指数(CT severity indices,CTSI)的相关性.方法选取在我院接受治疗的AP患者作为研究对象,共63例,其中轻症AP患者38例(轻症AP组),重症AP患者25例(重症AP组).所有患者治疗前后测定血清PCT水平,行胰腺超声造影及腹部多层螺旋CT检查,记录超声造影严重指数(ultrasound severity indices,USSI)及CTSI,分析超声造影联合PCT评估疗效的可行性.结果超声造影诊断轻症AP患者37例,重症AP患者26例,敏感度=92.00%(23/25),特异度=92.11%(35/38);准确率=92.06%(58/63);重症AP组的血清PCT水平、USSI及CTSI明显高于轻症AP组,差异均有统计学意义(P<0.05);不同治疗结局组间的血清PCT水平、USSI及CTSI比较,差异均有统计学意义(P<0.05);治疗后患者血清PCT水平、USSI分别与CTSI呈正相关(r=0.803,0.951,均P<0.05);治疗后患者血清PCT水平、USSI分别与临床疗效呈负相关(r=-0.721,-0.836,均P<0.05).结论超声造影能有效显示胰腺组织缺血坏死状态,准确反映AP病情,联合血清PCT水平可为临床全面准确评估AP病情及预后提供有价值的参考.