Use of cyst fluid CEA, CA19-9, and amylase for evaluation of pancreatic lesions

Objectives

The study goals were development of reference intervals and an interpretive algorithm for pancreatic cyst fluid tumor markers.

Design and methods

442 pancreatic cyst fluids were tested for CEA, CA19-9, and amylase.

Results

CEA > 30 ng/mL discriminates mucinous from non-mucinous cysts. After CEA analysis, amylase and CA19-9 segregate non-mucinous and mucinous subtypes, respectively.

Conclusions

Pancreatic cyst fluid tumor markers supplement other diagnostic measures. This study provides estimated reference intervals and an algorithm for interpretation.     

预防内镜逆行胰胆管造影术后胰腺炎的探讨

目的 评价西咪替丁对经内镜逆行胰胆管造影（ＥＲＣＰ）术后高淀粉酶血症及急性胰腺炎的预防作用。方法 将４１４患者随机分为Ａ、Ｂ、Ｃ三组,Ａ组（１５８例）分别于术前一日、 当日及术后一日给予西咪替丁（８００ｍｇ／ｄ,静脉滴注）,Ｂ组（１４７例０分别于术前３０ｍｉｎ及术后４ｈ内给予生长抑素类似物奥曲肽０．１ｍｇ皮下注射,Ｃ组（１０９例）给予安慰剂,术前、术后３ｈ及２４ｈ检测血清淀粉酶（正常参考值１０～１     

Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions

Background and study aimspancreatic cysts are commonly found lesions and proper diagnosis is very important for planning further management. The study aims to evaluate the role of cyst fluid amylase and tumour markers as cancer antigen (CA 19-9) and carcinoembryonic antigen (CEA) in addition to mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.Patients and methodsThis prospective study was conducted on 184 patients diagnosed to have pancreatic cystic lesions from January 2013 to January 2018. Fluid analysis for CA 19-9, CEA, amylase, mucin stain and cytopathology were done. We compared these data with the final diagnosis based on histopathology after surgical resection, positive cytopathology and long period of follow up of the patients for at least 18 months.ResultsThe highest AUC was that of cystic CEA with cut-off value of 160 ng/ml; it had a sensitivity of 60.4% and a specificity of 85%. The best cut-off value for cystic CA 19-9 was 1318 U/ml with a sensitivity of 64.1% and a specificity of 68.1%. The cut-off value of cyst amylase level was 5500 U/L, with 84.2% sensitivity and 37.1% specificity. The sensitivity of mucin stain in detecting mucinous cystic neoplasm was 85.45%, specificity was 86.05% with accuracy 85.87%.ConclusionCyst fluid analysis by investigating amylase, mucin, CA 19-9, CEA and EUS examination improves the diagnosis of different pancreatic cysts.     

正常胰胆管汇合患者胆汁淀粉酶升高与胆道疾病关系的研究

目的探讨正常胰胆管汇合（NPBJ）者胆汁淀粉酶升高与胆道疾病的关系。方法连续202例患者（胆管胆汁组）在内镜治疗胆道疾病时抽取胆管胆汁检测淀粉酶,其中68例同时检测胆汁脂肪酶,149例做胆汁细菌培养,27例测Oddi括约肌压力（SOM）,38例测胆管压力。另外73例（胆囊胆汁组）经皮经肝胆囊镜治疗胆囊结石,取胆囊中胆汁检测淀粉酶,31例进行胆囊黏膜活检。两组病例均除外先天性胰胆管汇合异常、胆肠吻合术和既往内镜乳头切开治疗者。结果胆管胆汁组95例（47．0％）淀粉酶升高,其中肿瘤（56．9％,29／51）与非肿瘤疾病（43．7％,66／151）差异无统计学意义（P〈0．05）,但肝门部胆管癌大多数（7／9）淀粉酶值升高;胆汁脂肪酶水平与淀粉酶有明显的相关性（r=0．561）;淀粉酶水平与Oddi括约肌和胆管压力无明显关联;胆汁细菌培养阳性率在淀粉酶值正常和升高者之问无明显差异。胆囊胆汁组34．3％淀粉酶升高,其中87．5％见胆囊上皮细胞异型增生,与淀粉酶正常者差异有统计学意义（P〈0．01）。结论NPBJ胆道疾病患者胰液向胆管逆流发生频度较高,淀粉酶升高者中肿瘤和非肿瘤疾病无显著差异,但淀粉酶升高者胆囊上皮细胞异型增生和肝门部胆管癌发生频度高。     

Pancreatic involvement in chronic viral hepatitis

AIM:To elucidate the frequency and characteristics of pancreatic disorders in the course of chronic viral hepatitis. METHODS:We prospectively assessed the serum pancreatic enzyme levels and imaging findings in patients with chronic viral hepatitis and healthy control subjects. RESULTS: Serum amylase (t-Amy), salivary amylase (s-Amy), pancreatic amylase (p-Amy) and serum lipase levels were higher in hepatitis patients in comparison to control subjects. However, in asymptomatic viral carriers, only the serum t-Amy levels were higher than those of the controls. The levels of each enzyme rose with the progression of liver disease in patients with hepatitis B or C; whereas the levels of each enzyme within the same clinical stage of the disease did not differ between patients diagnosed with either hepatitis B or hepatitis C virus. Imaging findings demonstrated chronic pancreatitis in only 1 out of 202 patients (0.5%). CONCLUSION: Our data suggest that serum levels of pancreatic enzymes increase with the progression of liver disease in patients diagnosed with viral hepatitis. Pancreatic disease, asymptomatic in most cases, may represent an extrahepatic manifestation of chronic viral hepatitis.     

肥胖抑制素对大鼠胰腺腺泡和胰腺小叶淀粉酶分泌的影响

目的 研究不同剂量肥胖抑制素(Obestatin)对大鼠离体胰腺腺泡及胰腺小叶淀粉酶分泌的影响.方法 体外分离大鼠胰腺腺泡,与不同浓度Obestatin(0、0.1、1、10、30 nmol/L)共培养1 h;另一组加Obestatin 30 min后加入100 pmol/L的胆囊收缩素(CCK-8)继续培养30 min.分离含有胰腺内神经末端、胰岛细胞及外分泌细胞的胰腺小叶,与不同浓度Obestatin共培养30 min;另一组加Obestatin同时加75 mmol/L KC1共培养30 min.测定培养液及细胞或胰腺小叶组织内淀粉酶含量,计算淀粉酶分泌率.结果 0、0.1、1、10、30 nmol/L Obestatin不影响胰腺腺泡细胞淀粉酶分泌率[(3.48±1.44)％、(3.70±1.39)％、(3.36±1.24)％、(3.86±1.41)％、(4.54±2.01)％].CCK-8能显著刺激腺泡细胞的淀粉酶分泌率[(13.84±2.63)％比(3.48±1.44)％,P＜0.05],但0.1、1、10 nmol/L Obestatin 对CCK-8诱导的胰腺腺泡淀粉酶分泌无显著性影响[(14.55±1.70)％、(13.79±1.81)％、(14.39±1.12)％].Obestatin(0.1、1、10、30 nmol/L)不影响胰腺小叶淀粉酶分泌率.KCl可显著刺激胰腺小叶淀粉酶分泌率[为对照组的(1.84±0.29)倍,P＜0.05],但Obestatin对KC1诱导的胰腺小叶淀粉酶分泌无显著影响[为对照组的(2.01±0.30)、(1.89 ±0.41)、(1.74±0.14)、(1.88±0.33)倍].结论 Obestatin对体外培养的大鼠胰腺腺泡细胞及胰腺小叶淀粉酶分泌率无显著影响,也不能阻断或协同CCK-8和KCl对胰腺淀粉酶分泌的促进作用.     

Pancreatic enzymes and abdominal adipose tissue distribution in new-onset prediabetes/diabetes after acute pancreatitis

BACKGROUNDNew-onset prediabetes/diabetes after acute pancreatitis (NODAP) is the most common sequela of pancreatitis, and it differs from type 2 prediabetes/diabetes mellitus (T2DM).AIMTo study the associations between circulating levels of pancreatic amylase, pancreatic lipase, chymotrypsin and fat phenotypes in NODAP, T2DM, and health. METHODSIndividuals with NODAP (n = 30), T2DM (n = 30), and sex-matched healthy individuals (n = 30) were included. Five fat phenotypes (intra-pancreatic fat, liver fat, skeletal muscle fat, visceral fat, and subcutaneous fat) were determined using the same magnetic resonance imaging protocol and scanner magnet strength for all participants. One-way analysis of covariance, linear regression analysis, and relative importance analysis were conducted.RESULTSIntra-pancreatic fat deposition (IPFD) was higher in NODAP (9.4% ± 1.8%) and T2DM (9.8% ± 1.1%) compared with healthy controls (7.8% ± 1.9%) after adjusting for covariates (P = 0.003). Similar findings were observed in regards to visceral fat volume (P = 0.005), but not subcutaneous fat volume, liver fat, or skeletal muscle fat. Both IPFD (β = -2.201, P = 0.023) and visceral fat volume (β = -0.004, P = 0.028) were significantly associated with circulating levels of pancreatic amylase in NODAP, but not in T2DM or healthy individuals. Of the five fat phenotypes, IPFD explained the highest amount of variance in pancreatic amylase concentration (R² = 15.3% out of 41.2%). None of the phenotypes contributed meaningfully to the variance in pancreatic lipase or chymotrypsin.CONCLUSIONBoth NODAP and T2DM are characterized by increased IPFD and visceral fat volume. However, only NODAP is characterized by significant inverse associations between the two fat phenotypes and pancreatic amylase.     

尿胰蛋白酶原—2测定在急性胰腺炎诊断中的意义

目的：探讨尿胰蛋白酶原－2的测定在急性胰腺炎诊断中的临床意义。方法：收集69例急腹症病人血清和尿液标本，按最终诊断分为急性胰腺炎组（34例）和非急性胰腺炎组（35例），分别测定尿胰蛋白酶原－2，血清脂肪酶和血、尿淀粉酶，并将其结果进行比较。结果：尿胰蛋白酶原－2试纸条检测对急性胰腺炎诊断的敏感性，特异性，准确度分别为85％，83％，84％；血清脂肪酶为82％，60％，71％；血淀粉酶为88％，54％，71％；尿淀粉酶为79％，54％，67％。结论：尿胰蛋白酶原－2检测是诊断急性胰腺炎的一个非常有用的筛选指标，尤其是特异性较高。阴性结果可以在很大程度上排除急性胰腺炎。     

Estimating the way of deposition of saliva stains using quantitative analysis of forensic salivary biomarkers

Analyzing the way of deposition of saliva stains contributes to appropriate interpretation of saliva as evidence in court, particularly in sexual assault cases. In this proof-of-concept study, we aimed to confirm the difference between drooling-derived (non-contact) saliva and licking-derived (contact) saliva and clarify whether objectively distinguishing between the two saliva is possible. To allow discrimination between these two samples, an indicator was devised where the relative Streptococcus salivarius DNA quantity was calculated by dividing the S. salivarius DNA copies by the amount of stained saliva from the same saliva sample using quantitative polymerase chain reaction and salivary α-amylase activity assays. The study findings reveal that the value of the proposed indicator of licking-derived saliva was 100-fold significantly greater than that of drooling-derived saliva (P < 0.05, Welch’s t-test). However, theoretical and technical challenges preclude the application of this indicator as a practical method. We believe that this saliva-specific bacterial DNA-based approach could allow estimation of the saliva stain deposition method.